Pathway of Competency Requirements in Otolaryngology - Head and Neck Surgery (2017)

PATHWAY OF COMPETENCY REQUIREMENTS IN OTOLARYNGOLOGY - HEAD AND NECK SURGERY (2017)

2017 VERSION 1.0

Effective for residents who enter training on or after July 1st 2017

MEDICAL EXPERT MILESTONES: RESIDENCY

Transition to discipline Foundations of discipline Core of discipline Transition to practice

1. Practice medicine within their defined scope of practice and expertise

Comment [FV2]: TTP 1 ab, TTP 2 Demonstrate compassion and Demonstrate a 1.1. Demonstrate a a commitment to high-quality commitment to high- commitment to high- care and for patients quality care of their quality care of their Comment [FV1]: F 9 patients patients

Explain how the Intrinsic Demonstrate the application Integrate the CanMEDS Intrinsic 1.2. Integrate the CanMEDS Roles need to be integrated of the CanMEDS Intrinsic Roles into their practice of Intrinsic Roles into their in practice of Otolaryngology Roles when managing Otolaryngology – Head and Neck practice of – Head and Neck Surgery to patients under supervision Surgery Otolaryngology – Head deliver optimal patient care and Neck Surgery Comment [FV3]: C 11 a Comment [FV40]: TTP 2 , TTP 3 , TTP 6

1.3. Demonstrate the Apply the competencies of Consolidate the competencies of Comment [FV4]: F 1 a, F 2 a, F 3 a, F 4 a, competencies of Surgical Surgical Foundations Surgical Foundations F 6 , F 7ab, F 8 , F 10 a, F 11, F 12

Foundations Comment [FV28]: C 4 C 8 a , C 15 a, C 16 a, C 20 a, C 21 , C 22 a, C 25 a, C 26 Demonstrate an a , C 27 a 1.4. Apply knowledge of the Apply knowledge of clinical Apply a broad base and depth of awareness of the context clinical and biomedical and biomedical sciences as Comment [FV5]: F 4 a, F 6 , F 7 a knowledge in the basic and clinical of practice, including what sciences relevant to relevant to Otolaryngology – sciences relevant to is required to practice Comment [FV6]: F 1 a, F 2a , F 4a, F 6, F Otolaryngology – Head Head and Neck Surgery safely and effectively in a 7 F 10 a, F 12 and Neck Surgery Otolaryngology – Head and Neck • Embryology community practice, and Comment [FV7]: F 4 a, F 6, F 7 Surgery • Anatomy exercise the ability to Comment [FV8]: F 11 • Histology adapt to that context

• Neuroanatomy Comment [FV9]: F 6 , F 7 , F 8, F 11 F • Physiology 12 • Pathophysiology Comment [FV10]: F 1 a, F 6 , F 7 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved. This document may be reproduced for educational purposes only provided that the following phrase is included in all related materials: Copyright © 2017 The Royal College of Physicians and Surgeons of Canada. Referenced and produced with permission. Please forward a copy of the final product to the Office of Specialty Education, attn: Associate Director, Specialties. Written permission from the Royal College is required for all other uses. For further information regarding intellectual property, please contact: [email protected]. For questions regarding the use of this document, please contact: [email protected].

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• Pathology Laryngology Comment [FV11]: F 7 • Microbiology Comment [FV12]: F 1a, F 2a, F 4 a , F 6 • • Biochemistry Anatomy and physiology of , F7 • Genetics upper aerodigestive system • Comment [FV13]: F 7 Immunology related to swallowing, • Pharmacology including phases of normal Comment [FV29]: C 8 a

Comment [FV14]: swallowing F 7 Apply knowledge of Comment [FV15]: F 6 , F 7 Head and Neck Surgery tumorigenesis of benign Comment [FV16]: F 6 F 7 neoplasms and cancers of the head and neck • principles of diagnosis, Comment [FV17]: C 19 a treatment, and adjuvant Comment [FV18]: C 18 a Apply knowledge of the therapy for salivary gland physics of sound, voice, and neoplasia Comment [FV30]: C 22 a speech production • endocrinologic and metabolic Comment [FV31]: C 20 a, C 21 Apply knowledge of pathophysiology neurophysiology and neuropsychology of hearing • pharmacology pertaining to Comment [FV32]: C 20 a management of head and neck perception Comment [FV19]: F 7 a neoplasia and Apply knowledge of edocrinologic/metabolic cutaneous anatomy, disorders aesthetic subunits, relaxed skin tension lines and non- distortable landmarks of the Facial Plastic and Reconstructive face Comment [FV20]: Surgery F 9 Apply knowledge of common fracture patterns of the facial • principles of restoration and Comment [FV33]: C 16 a, C 22 a, C 25 a, skeleton and their enhancement of form and C 26 a, C 27 a mechanisms of injury function including but not Comment [FV21]: F 10 a , C 26 a limited to: Apply knowledge of medication dosing in o principles of cervicofacial Comment [FV34]: C 25 a, C 26 a, C 27 a pediatric patients aesthetic surgery Comment [FV22]: F 5 a, F 6 Apply knowledge in clinical o biomechanical Comment [FV23]: F 7 a and biomedical sciences as characteristics of skin and Comment [FV35]: C 25 a, C 26 a, C 27 a, they apply to the diagnostic bone in the facial region as they relate to techniques C 22 a techniques/procedures used in facial plastic and relevant to Otolaryngology – reconstructive surgery Head and Neck Surgery: including tissue expansion, and plating maxillofacial • conducting hearing

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

assessments using tuning fractures forks Comment [FV24]: F 7 o principles and techniques of • conventional audiometry facial reconstruction, Comment [FV36]: C 25 a, C 26 a, C 27 a, (including but not limited including local and regional Comment [FV25]: F 7 to tympanometry and flaps and grafts stapedial reflex testing) principles and techniques of and otoacoustic emission o Comment [FV37]: C 26 a, C 27 a C 22 a facial reanimation testing principles of trauma Comment [FV38]: • audiological assessments o C 26 a, C 27 a management as it pertains in different age groups Comment [FV26]: F 7 to the maxillofacial region

o maxillofacial structural, Comment [FV39]: C28 a Apply the principles of cosmetic and functional Comment [FV27]: F 1 a , C 17 a, C 20 a, diagnostic imaging principles including but not C 22 a, C 26 a , C 30 limited to facial buttresses, occlusion, and orbital function

Comment [FV41]: F 2 a , F 3 , F 6, F 3 a , Apply clinical and biomedical Apply a broad base and depth of F 4 a, F 5 a , F 6 , F 7 a sciences to manage patient knowledge in clinical and presentations in biomedical sciences to the medical Comment [FV48]: C 1 , C 3 , C 5 a , C 7 a Otolaryngology – Head and and surgical management of the ,C 9 a, C 11 a, C 12 a , C 13 a , C 14 ad, Neck Surgery: breadth of patient presentations in C 15 a, C 17 a , C 18 a, C 19 ad, C 20 ac , C 24 a , C 25 a, C 26 a, C 27 a, C 28, Otolaryngology – Head and Neck • epistaxis C 29 a, C 30 , C 10 , C 22 a Surgery: Comment [FV42]: • nasal fracture F 3 a

• peritonsillar abscess General Otolaryngology Comment [FV43]: F 2a • neck mass/swelling • head and neck manifestations Comment [FV49]: C 7 a of systemic disease • airway management Comment [FV44]: F 4 a • blunt and penetrating neck • infections and trauma Comment [FV45]: F 5 a inflammatory conditions and other pharyngeal • laryngeal trauma and adenotonsillar • acute and chronic infections of disorders in both children the head and neck and adults • superficial and deep neck • otitis externa space infections

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• acute otitis media • airway obstruction and acute airway emergencies Comment [FV50]: C 5 a, C 11 a hearing loss • sleep disordered breathing, Comment [FV46]: F 7 a • dizziness including obstructive sleep Comment [FV51]: C 9 a • acute and chronic apnea and snoring, in both sinusitis children and adults

• nasal obstruction • non-neoplastic disorders of the Comment [FV52]: C 7 a salivary glands • hoarseness and Comment [FV47]: F 6 • dysphagia epistaxis Comment [FV53]: C 13 a • neck mass or swelling • nasal obstruction and rhinorrhea • post-operative head and neck wounds • middle ear disorders in both Comment [FV54]: C 12 a children and adults • facial lacerations • facial fractures • disorders of the external ear Comment [FV55]: C 12 a • acute and chronic • complications of treatment Comment [FV56]: wounds and management , including C 1 , C 9 a, C 14 ad, C 17 a , C 10 iatrogenic injury

Demonstrate an awareness Understands steps of Pediatric Otolaryngology Comment [VF57]: O-score: of the spectrum of diseases procedure, potential risks, F 1b , F 2 b, F 3 b, F 4 b , F 5 b • infectious and inflammatory and means to F 7b, F 10 b, F 13 b, C 5 b, C 6, C 7 b, C and conditions affecting airway conditions avoid/overcome them 8 bc, C 9 b, C 11 b, C 12 b, C 13b, C 14 children that require prompt bc, C 15 b, C 16 b , C 17 b , C 18 bc, C • neoplastic and vascular attention, including but not 19 bc, C 20 b, C 22 b, C 23, C 24 b, C 25 anomalies b, C 26 b, C 27 b, C 29 bc limited to airway compromise, post-operative • congenital and inherited complications, and the toxic conditions patient • pediatric airway obstruction, both acute and non-acute, and the determination of the urgency of intervention

• speech, hearing, voice, and Comment [FV58]: C 12 a swallowing disorders

• allergic, inflammatory and neoplastic disorders of the nasal cavity and septum

• acute and chronic

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

inflammatory and infectious disorders of the paranasal sinuses

• complications of infections of the paranasal sinuses

• orbital issues including trauma, infection, and inflammatory disorders such as exophthalmos of Graves disease

• anterior skull base including cerebrospinal fluid leaks, meningoencephalocles, iatrogenic and external trauma

Otology

Comment [FV59]: C 29 a • acute and chronic infections or inflammatory diseases of the external and middle ear and their associated complications

• tinnitus (pulsatile and Comment [FV60]: C 28 nonpulsatile) • Eustachian (auditory) tube Comment [FV61]: C 29 a disorders • non-infectious/inflammatory Comment [FV62]: C 29 a conditions affecting the ear (i.e. otosclerosis)

• congenital and genetic causes Comment [FV63]: C 30 of hearing and vestibular disorders

• congenital disorders of the ear Comment [FV64]: C 29 a • neoplastic conditions of the outer and middle ear and mastoid

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

and barotrauma

• conditions affecting the ear Comment [FV66]: C 29 a

Neurotology Comment [FV67]: C 29 a • profound hearing loss, including the ethical and surgical issues surrounding provision of cochlear implantation and Deaf culture

• neoplasms of the lateral skull base

• trauma to skull base, including Comment [FV68]: C 29 a, C 10 but not limited to traumatic facial nerve paralysis and cerebrospinal fluid leakage

• balance disorders, both central Comment [FV69]: C 30 and peripheral

• systemic conditions affecting Comment [FV70]: C 30 the ear

• ototoxicity

• age-related audiovestibular Comment [FV71]: C 30 disorders

• congenital and genetic disorders of the inner ear

• disorders of the facial nerve , Comment [FV72]: C 10 including congenital disorders, Bell’s (idiopathic/viral) palsy, Ramsey Hunt (Herpes zoster oticus), facial schwannoma/neuroma, and complications of systemic disorders • complications of middle Comment [FV73]: C 10 ear/mastoid disease, including infectious diseases Page 6 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• other causes of facial paralysis: oncological Comment [FV74]: C 10 disorders; upper versus lower motor neuron disorders; intratemporal versus extratemporal causes

Rhinology Comment [FV75]: C 15 a • infectious and inflammatory (allergic and nonallergic) conditions (CJ)

• bacteriology and bacterial Comment [FV76]: C 14 a resistance as related to sinusitis

• pathophysiology of chronic Comment [FV77]: C 14 a sinusitis with and without polyposis Comment [FV78]: C 14 a • principles of therapeutic agents for allergic disorders of the nose and Chronic Rhinosinusitis with nose polyps (CRSwNP) and Chronic Rhinosinusitis without nasal polyps (CRSsNP), including topical and systemic therapies

• benign and malignant tumours (CS)

• diseases of the anterior skull base (CS)

• trauma to the nose (CJ)

• trauma to the paranasal sinuses (CS)

Laryngology

• Dysphonia including that resulting from:

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

o infectious and inflammatory conditions

o trauma o benign and malignant tumours

o neurologic voice disorders o the professional voice Comment [FV79]: C 18 a

Head and Neck Surgery

• benign neoplasms and their management

• malignant neoplasms of the Comment [FV80]: C 19 a mucosa, soft tissue, and specialized tissue, including mucosa, mesenchyma, and neuroendocrine tissues

• medical and surgical Comment [FV81]: C 20 a conditions of the thyroid

• medical and surgical conditions of the parathyroid

• medical and surgical Comment [FV82]: C 22 a conditions of the salivary glands

• chronic pain, malnutrition, Comment [FV83]: C 19 d wound care, and other issues in the palliative management of patients with head and neck neoplasia • impact, adverse effects and Comment [FV84]: C 19 d complications of neoplasia and antineoplastic treatments on normal anatomic structures and physiology of the head and neck • psychological impact of head Comment [FV85]: C 19 d and neck neoplasia and Page 8 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

treatment for both patients and their families • psychology of addictions, Comment [FV86]: C 19 d including but not limited to smoking cessation strategies and management of alcohol withdrawal • rehabilitation principles Comment [FV87]: C 19 d pertinent to patients treated for head and neck cancer, (especially principles for rehabilitation of speech and swallowing)

Facial Plastic and Reconstructive Surgery Comment [FV88]: C 24 a • congenital anomalies of the cervicofacial region

• effects of aging in the Comment [FV89]: C 27 a cervicofacial region including skin, soft tissue, and bone

• wound healing abnormalities, Comment [FV90]: C 25 a, C 27 a including the keloid scar

• post-traumatic conditions Comment [FV91]: C 26 a, C 27 a

• aesthetic anomalies of the Comment [FV92]: C 24 a, C 27 a cervicofacial region

• benign and malignant lesions Comment [FV93]: C 25 a of the skin

Apply a broad base and depth of Comment [FV94]: C 8 a, C 11 a , C 12 a, knowledge in clinical and C 14 a , C 18 a, C 28, C 29 a, C 30 , C biomedical sciences as they apply 10 to the diagnostic techniques/procedures relevant to Otolaryngology – Head and Neck

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Surgery:

• principles of diagnostic imaging

o recognition of normal structures and orientation within the temporal bone and skull base, facial skeleton, paranasal sinuses, soft tissue of the oral cavity, pharynx, larynx and neck

o application of diagnostic imaging within facial plastic and reconstructive surgery, including interpretation of maxillofacial trauma imaging

o interpretation of diagnostic imaging of the head and neck including the temporal bone and skull base, facial skeleton, paranasal sinuses, soft tissue of the oral cavity, pharynx, larynx and neck

o identification of appropriate Comment [FV95]: C 29 imaging and/or investigations for ear disorders including but not limited to osteomyelitis of skull base; suspected complication of chronic otitis media

• principles of diagnostic Comment [FV96]: C 8 a, C 11 a, C 14 a, endoscopy as relevant to adult C 18a, and/or pediatric patients

• objective vocal testing, and Comment [FV97]: C 18 a electrophysiological techniques

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• aerodynamic testing, Comment [FV99]: C 18 a

• hearing assessments, Comment [FV100]: C 12 a, C 28 , C 29 a, including but not limited to

o otoacoustic emissions (OAEs) Comment [FV101]: C 12 a, C 28 , C 29 a,

o electrocochleography, Comment [FV102]: C 28 , C 29 a o auditory brainstem response (ABR) Comment [FV103]: C 12 a, C 28, C 29 a,

o cortical auditory evoked responses Comment [FV104]: C 28 , C 29 a

o impedance/ tympanometry Comment [FV105]: C 28 , C 29 a

• vestibular assessment, Comment [FV106]: C 30 including but not limited to principles of performance, and interpretation of electro/videonystagmography, computerized dynamic posturography, Gans sensory organization protocol, rotational chair assessment, head impulse testing, and vestibular evoked myogenic potentials

• electrophysiological Comment [FV107]: C 10 assessments, including but not limited to intraoperative monitoring of cranial nerves and electroneurography

• techniques for testing children with special needs • assessment methods used Comment [FV108]: C 18 a specifically in children to evaluate speech, hearing, voice and/or swallowing disorders (including nasometry, and sound field audiograms)

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Apply a broad base and depth of Comment [FV109]: C 15 a , C 17 a, C 18 knowledge in clinical and a, C 19 a, C 24 a, C 25 a , C 27 a, C biomedical sciences as they apply 28, C 29 a , C 30 , C 10 to the therapeutic techniques/procedures relevant to Otolaryngology – Head and Neck Surgery:

Otology • principles of use of surgical Comment [FV110]: C 28, C 29 a and non-surgical assistive devices, including but not limited to hearing aids, bone conduction hearing devices, cochlear implants, and middle ear implants • Tinnitus maskers and Comment [FV111]: C 28 environmental masking • Cognitive behavioural therapy, Comment [FV112]: C 28 tinnitus retraining therapy • Use of ear wick and Comment [FV113]: C 29 a microdebridement • Other therapeutic options Comment [FV114]: C 28 including possible interventional radiology

Neurotology Comment [FV115]: C 29 a • principles of laser therapy for surgical procedures in the ear

• principles underlying the effect Comment [FV116]: C 29 a, C 30 of topical and systemic medications, including their therapeutic and ototoxic implications including but not limited to intratympanic

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

injections

• use of antiviral therapy and corticosteroids Comment [FV117]: C 10

Rhinology Comment [FV118]: C 15 a • principles of image guidance systems and their application to surgery (CJ)

Laryngology Comment [FV119]: C 17 a, C 18 a • principles of therapeutic procedures related to both endoscopic and open approaches

• principles and techniques of laryngeal augmentation and laryngeal framework surgery

• principles of laser therapy of Comment [FV120]: C 17 a, C 18 a the larynx

Head and Neck Surgery Comment [FV121]: C 19 a • principles of different oncologic treatment modalities (including surgery, radiation therapy, chemotherapy, and immunotherapy)

• surgical approaches to the skull base and orbit • principles of management of cerebral spinal fluid and brain for surgeries involving the skull base

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

cryotherapy, robotic surgery and/or electro surgery

• reconstructive surgical options Comment [FV123]: C 24 a and their advantages, disadvantages, and complications

• principles of skin grafts, Comment [FV124]: C 24 a pedicle flaps, and free flaps

• principles governing use of Comment [FV125]: C 25 a local and systemic chemo- and immunotherapeutic agents • principles of oncologic Comment [FV126]: C 25 a, C 27 a management of cutaneous malignancies of the face, head, and neck

Facial Plastic and Reconstructive Surgery Comment [FV127]: C 25 a • principles of therapeutic radiation

• principles and techniques of Comment [FV128]: C 25 a frozen section diagnosis and Mohs micrographic surgery

• intra-operative design and inset of regional or free flaps

Comment [FV130]: C 5 a, C 13 a, C 20 a, Perform focused clinical Perform clinical assessments that C 21, C 22 a 1.5. Perform appropriately assessments with address the breadth and depth of timed clinical recommendations that are issues in each case assessments with well-documented Assess and document the extent Comment [FV131]: recommendations that C 14 d Recognize urgent issues that of the disease including rating are presented in an Comment [FV129]: F 1 a, F 2 a, F 3 a, F may need the involvement of scores where appropriate 5 a, F 7, F 10 a, F 11 organized manner more senior colleagues and Page 14 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

engage them immediately

Comment [FV132]: C 2 On the basis of patient- Maintain a duty of care and patient Carry out professional 1.6. Carry out professional centered priorities, seek safety while balancing multiple duties in the face of Comment [FV134]: TTP 1 ab, TTP 3, TTP duties in the face of assistance to prioritize responsibilities multiple, competing 4 multiple, competing multiple competing tasks that demands Prioritize patients on the basis of demands need to be addressed Comment [FV133]: C 2 , C 11 a clinical presentations

Comment [FV136]: C 5 a, C 20 a, C 22 a Identify clinical situations in Develop a plan that considers Adapt care as the complexity, Recognize and respond to 1.7. Recognize and respond which complexity, the current complexity, uncertainty, and ambiguity of the the complexity, Comment [FV138]: TTP 1 ab , TTP 2 , to the complexity, uncertainty, and ambiguity uncertainty, and ambiguity in patient’s clinical situation evolves uncertainty, and TTP 3 uncertainty, and may play a role in decision- a clinical situation ambiguity inherent in Seek assistance in situations that ambiguity inherent in making medical practice Comment [FV137]: C 5 a, C 21 medical practice Recognize and respond to the are complex or new complexity and uncertainty with managing an anticipated difficult airway by seeking proper assistance Comment [FV135]: F 13 a

2. Perform a patient-centered clinical assessment and establish a management plan

Comment [FV139]: TTD 1 Identify the concerns and Identify and recognize life Consider clinical urgency, Prioritize which issues 2.1. Prioritize issues to be goals of the patient and threatening or emergent feasibility, availability of need to be addressed Comment [FV140]: F 1 a, F 11 , F 2 a, F addressed in a patient family during the encounter issues: resources, and comorbidities in during future visits or with 3 a F 4 a encounter determining priorities to be other health care • upper airway Comment [FV149]: C 2 , C 8 a, C 11 a, C addressed during the current practitioners obstruction/comprom 13 a , C 14 a , C 15 a encounter or during future visits ise, Comment [FV150]: TTP 1 ab, TTP 3 or with other health care • hemorrhage practitioners Comment [FV141]: F 1 a, F 2a • infection • severe systemic Comment [FV142]: F 1 a effects of sepsis Comment [FV143]: F1 a • dehydration Comment [FV144]: F 2 a • issues of patients with head trauma Comment [FV145]: F 2 a

Iteratively establish Comment [FV146]: F 11 priorities, considering the perspective of the patient and family (including values and preferences) as the patient’s situation evolves Recognize patients at risk of Page 15 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

aspiration of gastric contents into the airway Comment [FV147]: F 13

Identify concerns for flap Comment [FV148]: F 8 viability and seek assistance of members of the microsurgical team

Comment [FV151]: TTD 1 Elicit a basic head and neck Elicit a complete history for Elicit a history, perform a physical Focus the clinical 2.2. Elicit a history, perform a history injury or trauma to the head exam, select appropriate encounter, and perform it Comment [FV153]: F 10 a, F 11 , C 26 a physical exam and select and neck investigations, and interpret their in a time-effective manner Synthesize patient Comment [FV166]: C 1 , C 7 C 9 a, C 12 appropriate results for the purpose of without excluding key information including • cause, mechanism a, C 14 ad, C 17 a, C 20 a, C 21 , C 25 investigations, and diagnosis and management, elements symptoms, differential and time of injury a, C 27 a , C 22 a interpret their results for disease prevention, and health diagnosis, and treatment • level of Comment [FV171]: TTP 3 the purpose of diagnosis promotion and management, plan clearly and concisely consciousness, Comment [FV152]: TTD1 disease prevention, and • headache, Perform a focused history and health promotion • neck pain, physical exam to cllassify phase of Comment [FV167]: C 8 a • nausea/vomiting, dysphagia: oral; oro-pharyngeal; • change of vision, esophageal • epistaxis, Identify risk factors for recurrent • CSF leak, disease • rhinorrhea, otorrhea, Comment [FV168]: C 14 d • hearing loss, Identify risk factors pertaining to • vertigo, individual cases of head and neck • focal motor deficits, neoplasia Comment [FV169]: C 19 a paresthesia, • cranial nerve function Identify patients experiencing or Comment [FV170]: C 8 a at risk for aspiration Comment [FV154]: Elicit a focused history and C 26 a perform a physical exam to identify patients with potential for a difficult airway Comment [FV155]: F 12 , F 13 a

Elicit a history of risk factors Comment [FV156]: F 8 for anastomotic failure in head and neck reconstruction:

• presence of underlying comorbidity

• presence of anticoagulant therapy

Perform a primary and Comment [FV157]: F 11 secondary assessment as per

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

ATLS guidelines Perform a physical exam with attention to risk of cervical spine injury Comment [FV158]: F 10 a, F 11 Perform a detailed secondary history and neurological Comment [FV159]: F 11 assessment after the initial stabilization

Identify and differentiate Comment [FV160]: F 1 a, F 2 a, F 3 a, F normal and abnormal 4 a, F 5 a, F 6 , F 7 a findings in history and physical exam Apply the Glasgow coma scale in a patient with altered level of consciousness Comment [FV161]: F 11

Identify post-operative Comment [FV162]: F 8 factors that could compromise free flap survival including but not limited to deep neck infection, neck hematoma, salivary fistula, compressive dressing Describe the size, components, and specific characteristics of a wound including special functional and aesthetic considerations Comment [FV163]: F 9 Recognize signs of a compromised flap Comment [FV164]: F 8 Identify predictors of a difficult airway on physical examination such as a large overbite, large tongue, narrow mouth opening, short Comment [FV165]: F 13 a chin and/or Mallampati score Comment [FV172]: TTD 1

Comment [FV174]: F 3 a, F 4 a F 6, F 7 a, F 11 Perform a head and neck Perform and interpret Perform and interpret findings of physical exam findings of office-based office and /or clinic based exams: Comment [FV179]: C 14 d, C 17 a, C 18 a, C 29 a, C 30 Page 17 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• utilization of microscope exams: • neuro-vestibular history and Comment [FV180]: C 30 for otoscopy physical examination • otomicroscopy • pneumatic otoscopy • neuro-otological examination Comment [FV181]: C 29 a • tuning fork tests (Weber • basic puretone and Rhinne) audiogram/ • stroboscopy Comment [FV175]: F 7a • tympanogram utilization of headlight for • voice and airway analysis Comment [FV182]: C 17 a, C 18 a anterior rhinoscopy and • flexible and/or rigid • endoscopic culture examination of oral endoscopy Comment [FV176]: F 4a, C 14 d

cavity • flexible and/or rigid • palpation of neck, nasopharyngolaryn- Perform an appropriate workup for including thyroid goscopy with or without childhood sensory neural hearing • examination of cranial topical anaesthesia loss, including but not limited to Comment [FV177]: F 3 a, F 6 genetic testing, imaging, and nerves • Dix-Hall-Pike test • use of rigid and flexible cytomegalovirus testing • vestibular exam, endoscope for including head thrust, examination of upper gait tests, cranial nerve, aerodigestive tract cerebellar and Comment [FV173]: TTD 1 oculomotor exam Comment [FV178]: F 7a Comment [FV183]: F 1 a, F 2 a , F 3a, F Develop a specific differential Develop a differential diagnoses, 4 a, F 5 a, F 6 , F 7a diagnosis relevant to the evaluation plan and treatment patient’s presentation, for plan based on findings of Comment [FV184]: C 7 a, C 11 a , C common Otolaryngology – appropriate investigations 14a Head and Neck Surgery presentations

Comment [FV185]: F 2 a, F 3 a, F 4 a, F Select and interpret Select and interpret appropriate 6 , F 7 a, F 10 a appropriate investigations investigations for any for common Otolaryngology – Otolaryngology – Head and Neck Comment [FV192]: C 1 , C 7 a, C 8 a, C Head and Neck Surgery Surgery presentation based on 12 a , C 14 ad, C 15 a C 16 a, C 17, C presentations, based on a a differential diagnosis 20 a, C 21 C 25 a , C 26 a, C 10 , C 22 a differential diagnosis • laboratory testing Comment [FV193]: C12 a • laboratory testing, • vestibular and audiological • vestibular and testing Comment [FV186]: F 2, F 3 , F 6 audiological testing • manometry and/or PH Comment [FV194]: C 14 d • diagnostic imaging of monitoring Comment [FV187]: F 10 the head and neck • flexible • diagnostic imaging nasopharyngolaryngoscop Comment [FV195]: C 8 a • biopsy, (tissue y Comment [FV188]: F 2a and/or fine-needle • fiberoptic endoscopic examination of Comment [FV189]: F 4 Page 18 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

aspiration) swallowing(FEES) Comment [FV196]: C 8a • diagnostic imaging Select, prioritize and thyroid ultrasound Comment [FV197]: C 20 a interpret appropriate o additional imaging, following o barium swallow Comment [FV190]: F 11 initial CT stabilization/management of o Comment [FV198]: C 26 a life-threatening or acute o MRI Comment [FV199]: C 10 conditions • biopsy (tissue and/or fine Comment [FV200]: C 8 a Select and interpret needle aspiration) Comment [FV201]: C 1, C 14 d, C 20 a, C laboratory and imaging • diagnostic endoscopy 22 a investigations • aerodynamic testing Comment [FV191]: F 1 a

Comment [FV202]: C 17 a

Integrate key maxillofacial Comment [FV203]: C 26 a structural cosmetic and functional principles into the diagnosis and management of facial fractures, and their complications such as temporomandibular (TMJ) disorders, and cerebrospinal fluid (CSF) leak

Select and interpret vestibular Comment [VF204]: C 28 , C 29 and/or audiological investigations

Comment [FV205]: F 5 a, F 6 , C 10 Work with patients and their Establish goals of care, which may Administer goals of care, 2.3. Establish goals of care in families to understand include achieving cure, improving which may include Comment [FV206]: C 8 a, C 16 a, C 19 d, collaboration with relevant options for care function, slowing disease achieving cure, improving C 20 c , C 25 a , C 22 a patients and their progression, treating symptoms, function, slowing disease Comment [FV209]: TTP 3 families, which may and palliation, in collaboration progression, treating include slowing disease with patients and their families symptoms, and palliation progression, treating in collaboration with Address the impact of the medical symptoms, achieving patients and their families Comment [FV207]: C 9 a, C 18 a, C 20 condition on the patient’s ability to a, C 21 , C 24 a , C 28, C 29 a, C 22 a cure, improving function, in time effective manner and palliation pursue life goals and purposes

Share concerns (in a constructive Comment [FV208]: C 18 a, C 24 a, C 27 and respectful manner) with a, C 28, C 29 a patients and their families about their goals of care when they are not felt to be achievable

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Comment [FV210]: TTD 1 Propose initial management Develop, implement and Develop, implement, and Establish patient-centred 2.4. Establish a patient- of common problems in document initial management document management plans that management plans for all Comment [FV211]: F 2 a, F 3 a, F 4 a, F centred management Otolaryngology – Head and plans for common problems consider all of the patient’s health patients in a practice 5 a, F 6 plan that includes Neck Surgery in Otolaryngology – Head and problems and context in nonsurgical/medical Comment [FV217]: C 1 , C 9 a, C 14 ad, Neck Surgery collaboration with patients and management, pre- C 16 a , C 19 d, C 20 c, C 21 , C 24 a, C their families and, when 25 a , C 26 a, C 10, C 22 a operative, peri- • indication for appropriate, the interprofessional operative, and post- admission Comment [FV221]: TTP 1 a, TTP 3 team operative care • fluid management Comment [FV212]: F 2 a • analgesia • appropriate Recognize and establish a antimicrobial Comment [FV218]: C 5 a, C 11 a, C 13 a management plan for life selection threatening or emergent issues: • surgical procedural options • upper airway obstruction Comment [FV219]: C 5a, C 11 a • timing/urgency of operative • hemorrhage Comment [FV220]: C 13 a intervention • deep space neck infection Comment [FV213]: F 2 a

Recognize and suggest an • extension of infection from the initial management plan for paranasal sinuses emergent issues Comment [FV214]: F 2 a, F 3 a, F 10 a , F 11, F 4 a , F 5 a, F 13 a • Airway management including but not Comment [FV215]: F 13 a limited to anticipated difficult airway • CSF leak Comment [FV216]: F 11

Comment [FV222]: F 2 a, F 3 a, F 5 a , F Ensure that the patient and Ensure that the patient and family 6 , F 7 a , C 16 a , family are informed about are informed about the risks and the risks and benefits of each benefits of each treatment option Comment [FV223]: C 29 a treatment option in the in the context of best evidence context of best evidence and and guidelines, including guidelines procedures for which the patient is referred to other surgeons • bone anchored hearing aids • stapedotomy • cochlear implants

Comment [FV224]: F 3 a Discuss with the patient and Develop, in collaboration with a family the degree of patient and his or her family, a uncertainty inherent in all plan to deal with clinical

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

clinical situations uncertainty

Demonstrate knowledge of Comment [FV225]: F 8 Provide timely and adequate intraoperative optimization responses to complications and Comment [FV229]: C 1 , C 14 d, C 19 d, and patient care undesired side effects of C 20 c, C 28 treatment Demonstrate knowledge of Comment [FV226]: F 11 immediate management Establish patient-centred Comment [VF230]: C 28, C 29 modalities of the elevated management plans ICP patient Describe the options for wound closure by sequentially applying the concept of the “reconstructive ladder”

Select the most appropriate wound closure option for the wound and patient Comment [FV227]: F 9

Apply techniques for post- Comment [FV228]: F 8 operative monitoring of free flap including but not limited to refill, Doppler implantable or not, color, prick test, oedema, firmness

3. Plan and perform procedures and therapies for the purpose of assessment and/or management

Comment [FV231]: F 5 a, F 6 , F 7a Describe the indications, Describe the indications, Determine the most appropriate 3.1. Determine the most contraindications, risks, contraindications, risks, and procedures or therapies for the Comment [FV237]: C 16 a appropriate procedures and/or alternatives for a alternatives for a given purpose of assessment and/or or therapies Comment [FV240]: TTP 1 a, TTP 3 given procedure or therapy procedure or therapy management Comment [FV238]: C 7 a, C 12 a, C 13 Describe indications for use Integrate all sources of a, C 16 a , C 17 a, C 18 a, C 20 a, C 21, of adjuncts to bag mask information to develop a C 24 a, C 25 a , C 26 a , C 27 a, C 22 a ventilation procedural or therapeutic plan that is safe, patient- Comment [FV232]: F 12 Describe indications and centred, and considers the contra-indications for risks and benefits of all tracheal intubation and for approaches use of supraglottic airway Comment [FV239]: C 9 a , C 15 a, C 20 Integrate planned a, C 21, C 25 a, C 26 a, C 27 a, C 22 a Page 21 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

devices procedures or therapies Comment [FV233]: F 12 into global assessment and Understand the indications management plans and risks of rapid sequence induction and intubation and their steps of execution Comment [FV234]: F 13 a

Describe to patients common Comment [FV235]: F 6 , F 7a procedures or therapies for common conditions in their discipline

Gather/assess required Comment [VF236]: O-score: information to reach F 1b , F 2 b, F 3 b, F 4 b , F 5 b diagnosis and determine F 7b, F 10 b, F 13 b, C 5 b, C 6, C 7 b, C correct procedure required 8 bc, C 9 b, C 11 b, C 12 b, C 13b, C 14 bc, C 15 b, C 16 b , C 17 b , C 18 bc, C 19 bc, C 20 b, C 22 b, C 23, C 24 b, C 25 b, C 26 b, C 27 b, C 29 bc

Obtain informed consent for Obtain informed consent for 3.2. Obtain and document Comment [FV243]: C 12 a , C 14 a, C 17 commonly performed medical complex medical and Obtain and document informed a , C 18 a C 20 a, C 21, C 24 a, C 25 a, informed consent, and surgical procedures and surgical procedures and consent, explaining the risks and C 26 a, C 27 a, C 22 a explaining the risks and therapies, under supervision therapies benefits of, and the rationale for benefits of, and the Comment [FV245]: TTP 2 the proposed options rationale for, a proposed Document the consent Use shared decision-making Comment [FV241]: F 6 , F 7 a, F 9 procedure or therapy discussion accurately in the consent process, Comment [FV244]: C 9 a C 12 a , C 15 a, taking risk and uncertainty C 16 a , C 20 a, C 21, C 22 a into consideration Comment [FV242]: F 6 , F 7 a

3.3. Prioritize a procedure or Consider urgency and Triage a procedure or Comment [FV246]: F 1 a, F 2 a, Recognize and discuss the Prioritize a procedure or therapy, therapy, taking into potential for deterioration in therapy, taking into importance of the triaging taking into account clinical Comment [FV247]: C 12 a, C 15 a, C 20 account clinical urgency advocating for the timely account clinical urgency, and timing of a procedure or urgency, potential for a, C 21, C 26 a, C 22 a and available resources execution of a procedure or potential for deterioration, therapy deterioration, and available therapy and available resources Comment [FV249]: TTP 2 resources

Advocate for a patient’s Comment [FV248]: C 11 a procedure or therapy on the basis of urgency and available resources Comment [FV250]: F 12 Prepare the equipment 3.4. Perform diagnostic and Demonstrate effective Independently perform the core required to be immediately Comment [FV254]: TTP 2 therapeutic procedures procedure preparation, diagnostic and therapeutic available for basic airway relevant to including the use of a pre- procedures in a skillful and safe management Otolaryngology – Head procedure time-out or safety manner, adapting to and Neck Surgery in a checklist as appropriate Demonstrate preparation for unanticipated findings or Comment [vf*251]: F 1 Page 22 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

skilful and safe manner, emergent airway changing clinical circumstances

adapting to management, including but

unanticipated findings or not limited to rigid changing clinical bronchoscopy set up and circumstances tracheostomy set up

Apply a stepwise approach to Comment [FV252]: F 12 sedation/intubation in an uncomplicated patient

Describe the use of Comment [FV253]: F 11 , F 12 specialized surgical tools and instruments

• nerve stimulators • image guided systems • Endoscopies for anterior skull base

Set up and position the Set up and position the Competently perform core Comment [FV255]: F 12 patient for a procedure patient for intubation Otolaryngology – Head and Comment [FV266]: C 19 a, C 30 Neck Surgery procedures

Perform basic Otolaryngology Administer local anesthesia in a timely manner: Comment [FV256]: F 9 – Head and Neck Surgery procedures in a skilful, fluid, Perform common General Otolaryngology and safe manner with Otolaryngology – Head and • biopsies, including fine minimal assistance: Neck Surgery procedures in needle aspirate (FNAB), a skillful, fluid, and safe punch, incisional, manner with minimal • maintenance of sterile excisional, and/or open assistance: Comment [FV257]: F 6 , F 9 , F 10 b, F technique • biopsy of the temporal 12 , • fine needle aspiration • comprehensive artery biopsy examination including • upper aerodigestive indirect and flex • Bag mask ventilation Comment [FV267]: C 15, C 17, C 19 a flexible endoscopies laryngoscopy • Basic airway maneuvers with or without foreign • basic suturing and knot to relieve airway body extraction and/or tying applying an obstruction, including biopsy understanding of the chin lift/head tilt, jaw • diagnostic endoscopy equipment/materials thrust and application of CPAP • flexible or rigid

laryngoscopy with or • oropharyngeal airway without foreign body insertion to assist extraction and/or

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

ventilation biopsy and/or dilatation

• nasopharyngeal airway • flexible or rigid insertion to assist esophagoscopy with or ventilation without foreign body extraction and/or • Direct laryngoscopy for biopsy and/or dilatation endotracheal tube insertion and • flexible or rigid confirmation of bronchoscopy with or placement using chest without foreign body rise, breath sounds and extraction and/or capnography biopsy and/or dilatation

• Insertion of supraglottic • flexible and/or rigid airway and confirmation nasopharyngolaryngosc of placement opy with or without foreign body extraction • Extubation of an and/or biopsy endotracheal tube • emergency surgical • Removal of supraglottic airway including airway cricothyroidotomy and Comment [FV258]: F 12 • laryngeal mask airway awake tracheostomy insertion and placement including but not confirmation limited to emergent and complex • Videolaryngoscopy • fistula repair (tracheo- (Glidescope) for Comment [FV259]: F 13 endotracheal intubation cutaneous) and confirmation of • incision and drainage of placement using chest deep neck space rise, breath sounds and infections capnography • penetrating and blunt • elective tracheostomy neck trauma and tracheostomy care management • hematoma (neck evacuation) • tracheotomy (open and percutaneous) • benign neck surgery not otherwise included • cricothyroidotomy • surgery for sleep • drainage of abscess disordered breathing Comment [FV260]: F 2 including peritonsillar (palate surgery) and superficial neck • Zenker’s

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

abscesses diverticulotomy • diagnostic • cricopharyngeal tympanocentesis and myotomy myringotomies and/or • esophageal dilation tube insertion • saliva management • epistaxis management, procedures for including nasal packing problems including and cautery xerostomia and • rigid sino-nasal hypersalivation • endoscopy salivary gland duct Comment [FV261]: F 6 dilation with or without • cauterization of anterior stone removal septum

• endoscopically-directed Pediatric Otolaryngology culture • biopsy of head and • nasal septal hematoma neck neoplasms evacuation • otoplasty • nasal cavity foreign body Comment [FV262]: F 6 removal • myringoplasty • closed reduction of nasal • tympanoplasty fracture • myringotomy with • tonsillectomy, ventilation tube adenoidectomy, and insertion in complex patients, including but adenotonsillectomy Comment [FV263]: not limited to those F 5 • microscopic ear with a cleft palate, examination with or Trisomy 21, Apert’s without debridement Syndrome, or other and/or foreign body head and neck related removal syndrome • myringotomy, with or • pre-auricular sinus without ventilation tube excision insertion • branchial cleft • cerumen removal sinus/cyst excision Comment [FV264]: F 7 • cleaning of mastoid • thyroglossal duct cyst cavity excision • skin biopsy (including • infant tracheostomy shave, punch, incisional, • surgical management of Page 25 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

and excisional) floor of mouth lesions including ranula and • raising of skin flaps sublingual gland • wound closure excision Comment [FV265]: F 9 • Primary wound • incision and drainage of closure including neck abscesses appropriate selection • excision of neck nodes of suture material, or other masses method of suture placement and • management of vascular anomalies, technique both surgical excision • Split/full thickness and sclerotherapy skin grafting • otomicroscopy and ear debridement (in clinic, • Simple advancement, awake) rotation or transposition flap

Otology:

• myringoplasty

• meatoplasty • tympanotomy • tympanoplasty • canaloplasty • ossiculoplasty • tympanomastoidectomy (Pediatric and adult), including both canal wall up (combined approach) and canal wall down approaches • mastoidectomy including both canal wall up (combined approach) and canal

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

wall down approaches

Neurotology

• intratympanic therapeutic injections

• particle repositioning Comment [FV268]: C 30 maneuvers, including Epley maneuver and log roll maneuver

Rhinology: Independently perform the following procedures in a skilful • surgical management of and safe manner, adapting to epistaxis unanticipated findings or • biopsy of intranasal changing clinical circumstances: masses Rhinology: • debridement of the nasal cavities • revision endoscopic sinus • limited endoscopic surgery sinus surgery (nasal • revision septoplasty polypectomy, uncinectomy, maxillary antrostomy, and anterior ethmoidectomy)(JC) • Endoscopic sinus surgery (ESS) complete sphenoethmoidectomy SC)

• open sinus procedures, Comment [FV269]: C 15 including Caldwell-Luc and trephine • septoplasty (JC) • turbinoplasty(JC) • debridement of ESS cavity

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Laryngology:

• diagnostic

laryngoscopy, and esophagoscopy with or without foreign body extraction and/or biopsy and/or dilatation

• microlaryngoscopy with or without removal of laryngeal/tracheal lesions

• vocal fold injections

• laser/ debridement Comment [FV270]: C 17 procedures on the larynx

Head and Neck Surgery • simple submandibular gland excision (JC) • excision of neck mass (JC) • hemithyroidectomy (SC) • superficial parotidectomy (SC) • parathyroidectomy (SC) • thyroidectomy (SC) • neck dissection (SC) • simple trans oral mucosal resections (SC) • open neck biopsies (JC)

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Facial Plastic and Reconstructive Surgery

• regional anaesthesia of the head, face, and neck) (JC) • Basic alignment and fixation of fractured or osteotomized bone with due consideration of functional, cosmetic and structural issues • intraoperative decision making and technical assistance during management of non- nasal facial fracture

• cartilage graft (JC) • composite graft (auricular) (JC) • bone graft (calvarial) (JC) • local/locoregional flaps (JC) • rhinoplasty (SC) • facial trauma and reconstructive surgery (JC) • scar revision (JC) • management of pigmented/vascular lesions of the skin(JC) • regional flaps • cosmetic cervicofacial surgery (SC)

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• complex trauma repair • resection of lesions with negative margins and reconstruction with appropriate reconstructive techniques

Provide assistance with Demonstrate an Demonstrate an neurosurgical procedures in understanding of, and understanding of the the operating room: perform all or parts of the following advanced Comment [FV271]: F 11 • Burr hole drilling with following Otolaryngology – procedures: assistance Head and Neck Surgery • Craniotomy procedures under Laryngology • Wound closure supervision: laryngeal fracture repair • Apply proper dressing Pediatric Otolaryngology laryngeal framework surgery

• choanal atresia repair • cleft lip and palate repair • laryngeal cleft repair- open and endoscopic • laryngotracheal reconstruction • cricothyroid resection • slide tracheoplasty • piriform aperture stenosis repair • microtia repair • aural atresia repair

Head and Neck • laryngectomy (SC) • oromandibular resection

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• maxillectomy

Otology • procedures for bone anchored hearing aids • stapedotomy • cerebrospinal fluid (CSF) leak repair • excision of exostoses

Neurotology • surgical excision of tumours of the middle ear/mastoid (including paraganglioma) • cochlear implant surgery • facial nerve decompression • labyrinthectomy • approaches to skull base, including translabyrinthine, middle fossa and suboccipital approaches • semicircular canal repair or plugging • petrous apicectomy

Laryngology

• thyroplasty type 1

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

procedures (SC)

Perform Otolaryngology – Head and Neck Surgery procedures as part of a simulated learning activity:

Rhinology:

• frontal sinus trephine • drainage of intraorbital subperiostial abscess • lateral canthotomy • orbital decompression for intraorbital hemorrhage • repair of iatrogenic cerebral spinal fluid leakage

Apply dressings for post- Comment [FV272]: F 9 procedure care

Establish and implement a Comment [FV273]: F 1 a, F 6 , F 7 a plan for post-procedure care of the listed procedures

Document procedures accurately

Seek advice or supervision as Comment [FV274]: F 1 a, needed when unanticipated findings or changing clinical circumstances are encountered Page 32 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Comment [VF275]: O-score: Patient correctly prepared F 1b , F 2 b, F 3 b, F 4 b , F 5 b and positioned, understands F 7b, F 10 b, F 13 b, C 5 b, C 6, C 7 b, C approach and required 8 bc, C 9 b, C 11 b, C 12 b, C 13b, C 14 instruments, prepared to deal bc, C 15 b, C 16 b , C 17 b , C 18 bc, C with probable complications 19 bc, C 20 b, C 22 b, C 23, C 24 b, C 25 b, C 26 b, C 27 b, C 29 bc Efficiently performs steps, Comment [VF276]: O-score: avoiding pitfalls and F 1b , F 2 b, F 3 b, F 4 b , F 5 b respecting soft tissues F 7b, F 10 b, F 13 b, C 5 b, C 6, C 7 b, C 8 bc, C 9 b, C 11 b, C 12 b, C 13b, C 14 3D spatial orientation and bc, C 15 b, C 16 b , C 17 b , C 18 bc, C able to position 19 bc, C 20 b, C 22 b, C 23, C 24 b, C 25 b, C 26 b, C 27 b, C 29 bc instruments/hardware where intended Comment [VF277]: O-score: F 1b , F 2 b, F 3 b, F 4 b , F 5 b Appropriate complete post F 7b, F 10 b, F 13 b, C 5 b, C 6 , C 7 b, C 8 bc, C 9 b, C 11 b, C 12 b, C 13b, C 14 procedure plan bc, C 15 b, C 16 b , C 17 b , C 18 bc, C 19 bc, C 20 b, C 22 b, C 23, C 24 b, C 25 Obvious planned course of b, C 26 b, C 27 b, C 29 bc procedure with economy of Comment [VF278]: movement and flow O-score: F 1b , F 2 b, F 3 b, F 4 b , F 5 b F 7b, F 10 b, F 13 b, C 5 b, C 6, C 7 b, C 4. Establish plans for ongoing care and, when appropriate, timely consultation 8 bc, C 9 b, C 11 b, C 12 b, C 13b, C 14 ... Comment [VF279]: O-score: 4.1. Implement a patient- Ensure follow-up on results Coordinate investigation, Implement a patient- F 1b , F 2 b, F 3 b, F 4 b , F 5 b ... centred care plan that of investigation and response treatment, and follow-up plans centred care plan that Comment [FV280]: F 1 a, F 3 a, F 4 a, F supports ongoing care, to treatment when multiple physicians and supports ongoing care, 6 , F 7 a healthcare professionals are follow-up on follow-up on Comment [FV283]: C 1 , C 9 a , C 13 a , C Recognize need for involved investigations, response investigations, response 21 , C 26 a , C 22 a to treatment, and further consultation of other to treatment, and further consultation healthcare professionals Establish plans for ongoing care, consultation Comment [FV288]: TTP 1 a, TTP 2 , TTP taking into consideration the 3 Implement appropriate patient’s clinical state, Comment [FV281]: F 1 a, F 3 a, F 4 a , F wound care and follow-up at Establish a system that circumstances, preferences, and 7a, F 8 , F 10 a the end of each procedure ensures appropriate actions, as well as available failsafe follow-up of Comment [FV284]: C 1 , C 7 a , C 9 a, C resources, best practices, and investigation results 12 a, C 14 ad, C 17 a, C 18 a C 19 d , C research evidence 20 c, C 26 a, C 22 a

Comment [FV289]: TTP 3 Accurately identify situations that necessitate consultation of other Comment [FV282]: F 9 health professionals to assist in Comment [KJ285]: C 1 , C 13 a, C 14 d, the management of disorders C 17 a, C 19 d, C 20 c, C 21 , C 24 a, C encountered in Otolaryngology – 10 , C 22 a Page 33 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

head and Neck Surgery

Provide long-term management of Comment [FV286]: C 14 d a patient after medical and/or surgical treatment

Address end-of-life issues in Comment [FV287]: C 19 d patients with head and neck cancer

5. Actively contribute, as an individual and as a member of a team providing care, to the continuous improvement of health care quality and patient safety

Recognize the occurrence of 5.1. Recognize and respond to harm from health care a patient safety incident

delivery, including Differentiate outcomes of patient safety incidents medical conditions and diseases from complications related to the inherent risks of treatments and from patient safety incidents

Demonstrate knowledge of Apply the stages for disclosure of Apply the stages for the Canadian disclosure adverse events: disclosure of adverse guidelines (understanding events, including post • attend to clinical care harm, potential-for-harm, no analysis disclosure, and potential-for-harm, close • plan the initial disclosure acknowledge the role of calls, the stages of disclosure meeting with patient and apology of adverse events and family

reporting them) • plan the post-analysis disclosure

Report patient safety incidents to appropriate institutional representatives

Prioritize the initial medical Recognize near-misses in real response to adverse events time and respond to correct them, to mitigate further injury preventing them from reaching the patient Incorporate, as appropriate, Comment [FV290]: C 10 Page 34 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

into a differential diagnoses,

harm from health care delivery

Identify potential improvement Comment [FV291]: C 3 opportunities arising from harmful patient safety incidents and near misses

Participate in an analysis of Comment [FV292]: C 3 patient safety incidents

5.2. Adopt strategies that Describe common types of Use cognitive aids such as Apply the principles of Comment [FV295]: TTP 2 Engage patients and their families promote patient safety cognitive and affective bias procedural checklists, situational awareness to in the continuous improvement of and address human and surgical timeouts, debriefing, clinical practice patient safety system factors Describe the principles of structured communication

situational awareness and tools, or care paths to their implications for enhance patient safety Comment [FV293]: F 12 Otolaryngology – Head and Neck Surgery practice Describe strategies to Comment [FV294]: C 3 mitigate the negative effects

of human and system factors on clinical practice

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

COMMUNICATOR MILESTONES: RESIDENCY

Transition to discipline Foundations of discipline Core of discipline Transition to practice

1. Establish professional therapeutic relationships with patients and their families

1.1. Communicate using a Communicate using a patient-centred approach patient-centered approach that encourages patient that facilitates patient trust trust and autonomy and and autonomy and is is characterized by characterized by empathy, empathy, respect, and respect, and compassion compassion

1.2. Optimize the physical Mitigate physical barriers to Optimize the physical Comment [FV296]: F 1 a, F 3 a, F 8, F 9, environment for patient communication to optimize environment for patient F 12 comfort, dignity, privacy, patient comfort, privacy, comfort, dignity, privacy, engagement, and safety engagement, and safety engagement, and safety

1.3. Recognize when the Recognize when the values, Comment [FV297]: C 24 a, C 27 a values, biases, or biases, or perspectives of perspectives of patients, patients, physicians, or other physicians, or other health care professionals health care professionals may have an impact on the may have an impact on quality of care, and modify the quality of care, and the approach to patient care modify the approach to according to the context of the patient accordingly Otolaryngology – Head and Neck Surgery

1.4. Respond to patients’ Identify, verify and validate Respond to patients’ non- Comment [FV298]: C 19 a non-verbal behaviours to non-verbal cues on the part verbal communication and enhance communication of patients and their families use appropriate non-verbal behaviours to enhance Use appropriate non-verbal communication with patients communication to demonstrate attentiveness, interest, and responsiveness Page 36 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

to the patient and family

1.5. Manage disagreements Recognize when personal Recognize when strong Comment [FV299]: C 11 a, C 13 a, C 18 and emotionally charged feelings in an encounter are emotions (such as anger, a , C 19 a, C 28 conversations, including valuable clues to the fear, anxiety, or sadness) are but not limited to patient’s emotional state impacting an interaction and discussions surrounding respond appropriately end-of-life issues Establish boundaries as needed in emotional situations

Manage emotionally charged Comment [FV300]: C 19 a conversations

1.6. Adapt to the unique Assess patients’ decision- Tailor approaches to Adapt to the unique needs Comment [FV301]: F 1 a, F 7a needs and preferences of making capacity decision-making to patient and preferences of each Comment [FV302]: C 5 a , C 12 a each patient and to his capacity, values, and patient and to his or her or her clinical condition preferences clinical condition and Comment [FV304]: TTP 3 and circumstances circumstances Recognize the communication Comment [FV303]: C 29 a requirements relevant to patients who are deaf, hard of hearing or who have speech and/or voice disorders

2. Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients and their families

Conduct a patient-centred Comment [FV305]: F 1 a, F 3 a, F 4 a, F 6 2.1. Use patient-centred interview, gathering all Use patient-centred , F 7, F 10 a, C 8 a interviewing skills to relevant biomedical and interviewing skills to Comment [FV309]: C 7 a, C 9 a , C 12 a, effectively identify and psychosocial information for effectively gather relevant C 14 a, C 16 a, C 20 a, C 21, C 25 a gather relevant any clinical presentation biomedical and psychosocial biomedical and information psychosocial information Comment [FV306]: F 4 a, F 5 a, F 6 , F 7 Demonstrate knowledge of Integrate, summarize, and techniques for eliciting health Comment [FV310]: C 1 , C 14 a, C 16 a , present the biopsychosocial information from children and C 20 a, C 21 , C 25 a, C 26 a information obtained from a their families patient-centred interview

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Integrate and synthesize Actively listen and respond to Comment [FV307]: F 5 a information about the patient cues Comment [FV311]: C 16 a ,C 17 a, C 19 patient’s beliefs, values, d, C 20 ac, C 21 , C 25 a, preferences, context and expectations with biomedical and psychosocial information

Recognize the psychological, occupational, and social consequences of disorders of the head and neck, including end-of-life discussions or chronic debilitating issues

Recognize the psychological, Comment [FV308]: F 7 a occupational, and social consequences of sensory or communication disorders

2.2. Provide a clear structure Conduct a focused and Manage the flow of Provide a clear structure for Comment [FV312]: F 1 a, F 2 a, F 3 a, F 4 for and manage the flow efficient patient interview, challenging patient and manage the flow of an a , F 6 of an entire patient managing the flow of the encounters, including those entire patient encounter Comment [FV313]: C 18 a, C 19 a, C 27 a encounter encounter while being with angry, distressed, or attentive to the patient’s excessively talkative cues and responses individuals

2.3. Seek and synthesize Seek and synthesize relevant Comment [FV314]: F 1 a, F 6 relevant information information from other from other sources, sources, including the including the patient’s patient’s family, with the family, with the patient’s patient’s consent consent

3. Share health care information and plans with patients and their families

3.1. Share information and Communicate the diagnosis, Use strategies to verify and Provide information on Communicate clearly with Comment [FV316]: F 1 a explanations that are prognosis and plan of care in validate the understanding of diagnosis and prognosis in a patients and others in the Comment [FV317]: C 12 a, C 13 a , C 15 clear, accurate, and a clear, compassionate, the patient and family with clear, compassionate, setting of ethical dilemmas a , C 17 a, C 19 ad, C 20 ac , C 21, C 25 timely, while checking respectful, and accurate regard to the diagnosis, respectful, and objective a for patient and family Page 38 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

understanding manner to the patient and prognosis, and management manner family plan Convey information related Comment [FV318]: C 1 , C 7 a, C 9 a, C

to the patient’s health status, 13 a, C 14 a ,C 17 a , C 19 d, C 20 ac, Recognize when to seek help care, and needs in a timely, C 24 a, C 25 a, C 26 a in providing clear honest, and transparent explanations to the patient manner and family Comment [FV315]: TTD 1

3.2. Disclose harmful patient Describe the steps in Disclose patient safety Communicate the reasons for Plan and document follow-up Comment [FV319]: C 1 incidents, to patients and providing disclosure after a incidents to the patient and unanticipated clinical to a harmful patient safety their families accurately patient safety incident family accurately and outcomes to patients and incident and appropriately appropriately disclose patient safety incidents

Apologize appropriately for a harmful patient safety incident

4. Engage patients and their families in developing plans that reflect the patient’s health care needs and goals

4.1. Facilitate discussions Conduct an interview, Explore the perspectives of Facilitate discussions with the Comment [FV320]: TTD 1 with patients and their demonstrating cultural the patient and others when patient and family in a way Comment [FV321]: C 12 a , C 20 a, C 21 , families in a way that is awareness developing care plans that is respectful, non- C 25 a respectful, non- judgmental, and culturally judgmental, and Communicate with cultural safe culturally safe awareness and sensitivity

4.2. Assist patients and their Assist patients and their families to identify, families to identify, access, access, and make use of and make use of information information and and communication communication technologies to support their technologies to support care and manage their health their care and manage their health

Comment [FV322]: F 1 a, F 2 a, F 6 4.3. Use communication skills Demonstrate steps to Answer questions from the Use communication skills and Comment [FV323]: C 1 , C 9 a C 12 a , and strategies that help obtaining informed consent patient and family about next strategies that help the C 16 a, C 19 d, C 20 ac, C 21 , C 25 a Page 39 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

patients and their steps patient and family make families make informed informed decisions regarding decisions regarding their their health health Use translation service as needed

5. Document and share written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy

5.1. Document clinical Organize information in Use the vocabulary and Adapt record keeping to Document clinical encounters Comment [FV324]: TTD 1 encounters in an appropriate sections within appropriate abbreviations specific guidelines of in an accurate, complete, Comment [FV329]: C 19 a accurate, legible, an electronic or written specific to Otolaryngology – Otolaryngology – Head and timely and accessible complete, timely, and medical record Head and Neck Surgery Neck Surgery and the manner, and in compliance Comment [FV330]: TTP 1 a , TTP 2 , accessible manner, in and workplace clinical context with legal and privacy TTP 3 compliance with Maintain accurate and up-to- requirements regulatory and legal date problem lists and Document information about Document procedures in the Comment [FV325]: F 1 a, F 3 a, F 6 requirements medication lists patients and their medical OR report in a fashion that is conditions in a manner that commensurate with level of enhances intra-and participation interprofessional care Identify and correct vague or Document clinical encounters ambiguous documentation Comment [FV326]: F 1 a, F 2 a, F 3 a , F to adequately convey clinical 4 a, F 6, F 11 reasoning and the rationale for decisions

Document the Comment [FV327]: F 12 , F 13 airway/intubation information accurately and comprehensively within an electronic or written medical record

Document soft tissue defects and closure providing a good description, including but not limited to diagnosis, progression of healing or deterioration and management plan, including follow up Comment [FV328]: F 9

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

5.2. Communicate effectively Demonstrate reflective Adapt use of the health Demonstrate an using a written health listening, open-ended record to the patient’s health understanding of the role of record, electronic inquiry, empathy, and literacy and the clinical social media in a medical medical record, or other effective eye contact while context practice digital technology using a written or electronic medical record Communicate effectively Comment [FV331]: C 1 , C 14 ad, C 20 a, using a written health record, C 21, C 25 a, C 26 a electronic medical record, or other digital technology

5.3. Document and share Assess patients’ needs and Adapt written and electronic Share information with Comment [FV332]: TTP 1 b written and electronic preferences with respect to communication to the patients and others in a information about the methods of information specificity of the discipline manner that respects patient medical encounter to sharing and to the expectations of privacy and confidentiality optimize clinical patients and enhances understanding decision-making, patient safety, confidentiality, and privacy

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

COLLABORATOR MILESTONES: RESIDENCY

Transition to discipline Foundations of discipline Core of discipline Transition to practice

1. Work effectively with physicians and other colleagues in the health care professions

1.1. Establish and maintain Compare and contrast Anticipate, identify, and Establish and maintain Comment [FV335]: C 3 , C 8 a positive relationships enablers of and barriers to respond to patient safety healthy relationships with Comment [FV336]: TTP 3 with physicians and collaboration in health care issues related to the function physician and other other colleagues in the of a team colleagues in the health care health care professions Respect established rules of professions to support to support relationship- their team relationship-centered centered collaborative collaborative care care Receive and appropriately Comment [FV333]: F 1 b, F 6 respond to input from other health care professionals

Differentiate between task and relationship issues among health care professionals

Establish and maintain positive relationships with physicians and other colleagues Comment [FV334]: F 8 , F 11 , F 12

Comment [FV337]: F 1 a Discuss the role and Describe the roles and scopes Recognize, value, and utilize Negotiate overlapping and 1.2. Negotiate overlapping responsibilities of a specialist of practice of other health the expertise of shared care responsibilities Comment [FV340]: C 2 , C 4 , C 13 a, C and shared in Otolaryngology – Head and care providers related to interprofessional team with physicians and other 19 ad, C 20 c, C 24 a, C 28 , C 30, responsibilities with Neck Surgery Otolaryngology – Head and members colleagues in the health care physicians and other Comment [FV342]: TTP 2 Neck Surgery professions in episodic and colleagues in the health Liaise with intersecting health ongoing care Comment [FV341]: care professions in Contribute individual C 4, C 10 , C 13 a C professions 15 a , C 19 ad, C 20 c, C 21 ,C 24 a, episodic and ongoing expertise to interprofessional • audiologists, Identify indications that care Comment [FV343]: TTP 3 teams • speech language necessitate consultation with pathologists, other health care Comment [FV338]: F 10 a Consult as needed with other • vestibular therapists, professionals health care professionals, • respiratory • difficult airways including but not limited to therapists, • complex hearing,

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

other physicians or surgeons • radiation oncologists, balance Comment [FV339]: F 11 , F 12 C 2 , C 8 • paediatricians, • speech, and a, C 12 a, C 13 a, , C 15 b, C 16 b, C 17 • radiologists, and swallowing disorders ab , C 18 bc, C 19 ad, C 20 ac, C 21 , C anesthesiologists 24 a , C 25 a , C 26 a , C 27 • dieticians, Work effectively with clinic Comment [FV344]: TTP 3 • physiotherapists, staff and other health • social workers, professionals • ophthalmologists • psychotherapists • psychiatrists • sleep disorder specialists • family physicians

1.3. Engage in respectful Discuss with the patient and Identify referral and Provide timely and necessary Engage in respectful shared Comment [FV345]: F 1 a, F 3 a shared decision-making, family any plan for involving consultation as opportunities information to colleagues to decision-making with Comment [FV349]: C 5 a, C 19 d, C 20c, other health care to improve quality of care enable effective relationship- physicians and other such as a tumour board, C 30 with physicians and professionals, including other and patient safety by sharing centered care colleagues in the health care other colleagues in the physicians, in the patient expertise professions Comment [FV350]: TTP 1 b health care professions care Integrate the patient’s Lead interprofessional team Comment [FV346]: F 3 a, F 6 perspective and context into meetings, including but not Comment [FV351]: TTP 4 the collaborative care plan limited to tumour boards

Communicate effectively with Use referral and consultation Comment [FV352]: TTP 1 b, TTP 3 physicians and other as opportunities to improve colleagues in the health care quality of care and patient professions safety by sharing expertise Comment [FV347]: F 13 a, C 7 b, C 13 a, C 17b, C 19 ad, C 20 c, C 21 , C 24 a Professional and effective Comment [VF348]: O-score: communication/utilization of F 1b , F 2 b, F 3 b, F 4 b , F 5 b staff F 7b, F 10 b, F 13 b, C 5 b, C 6, C 7 b, C 8 bc, C 9 b, C 11 b, C 12 b, C 13b, C 14 bc, C 15 b, C 16 b , C 17 b , C 18 bc, C 2. Work with physicians other colleagues in the health care professions to promote understanding, manage differences, and resolve 19 bc, C 20 b, C 22 b, C 23, C 24 b, C 25 conflicts b, C 26 b, C 27 b, C 29 bc 2.1. Show respect toward collaborators Convey information Actively listen to and engage Delegate tasks and Comment [FV354]: F 1 a, F 13 a thoughtfully in interactions with responsibilities in an Comment [FV356]: C 2 collaborators appropriate and respectful Show respect towards manner Comment [FV353]: TTD1, F 13 a , TTP 2 collaborators Respond to requests and Comment [FV355]: F 12 Page 43 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

feedback in a respectful and Maintain positive Comment [FV357]: C 13 a, C 24 a timely manner relationships in all professional contexts

2.2. Implement strategies to Identify communication Gather the information and Implement strategies to promote understanding, barriers between health care resources needed to manage promote understanding, manage differences, and professionals differences and resolve manage differences, and resolve conflict in a conflict among collaborators resolve conflicts in a manner manner that supports a Communicate clearly and that supports a collaborative Comment [FV358]: F 1 a collaborative culture directly to promote Analyze problems with team culture understanding, manage dynamics differences, and resolve conflicts Gain consensus among colleagues in resolving Listen to understand and find conflicts Comment [FV359]: F 1 a common ground with collaborators

3. Hand over the care of a patient to another health care professional to facilitate continuity of safe patient care 3.1. Determine when care should be transferred to Identify patients requiring Decide when care should be Comment [FV360]: F 1 a, F 3 a another physician or handover to other physicians transferred to another Comment [FV361]: TTP 1 ab health care professional or health care professionals physician or health care professional

Comment [FV362]: F 3 a Communicate with the Organize the handover of 3.2. Demonstrate safe Describe specific information Demonstrate safe handover receiving physicians or health care to the most appropriate Comment [FV366]: C 1 handover of care, both required for safe and of care, both verbal and care professionals during physician or health care verbal and written, effective handover during written, during patient Comment [FV367]: TTP 1 b transitions in care, clarifying professional during a patient transitions in care transitions to a different issues after transfer as transition to a colleague, health care professional, needed Analyze gaps in different health care setting, or stage of care communication between Comment [FV363]: F 5 a professional, setting, or Communicate with the health care professionals stage of care patient’s primary health care during transitions in care professional about the

patient’s care Recognize and act on patient Comment [FV364]: F 9 Summarize the patient’s safety issues in the transfer issues in the transfer of care summary, including plans to deal with ongoing issues

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Demonstrate safe handover care, both written and verbal during patient transitions Comment [FV365]: F 10 a, F 11 , F 12

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

LEADER MILESTONES: RESIDENCY

Transition to discipline Foundations of discipline Core of discipline Transition to practice

1. Contribute to the improvement of health care delivery in teams, organizations, and systems

1.1. Apply the science of Describe quality Compare and contrast the Analyze and provide Apply the science of quality Comment [FV368]: C 3 quality improvement to improvement traditional methods of feedback on processes seen assurance and Comment [FV370]: TTP 5 contribute to improving methodologies research design with those in one’s own practice, improvement (practice systems of patient care of improvement science team, organization, or based learning and system system based learning and Seek data to inform improvement) to contribute practice and engage in an Participate in a patient to improving systems of Comment [FV369]: C 3 iterative process of safety and/or quality patient care improvement improvement initiative Incorporate evidence based Comment [FV371]: TTP 5 Demonstrate effective skills medicine for quality in quality assurance assurance and improvement in Otolaryngology – Head and Neck Surgery practice

Perform audits/self-audits of Comment [FV372]: TTP 5 clinical practice and their implication for quality and improvement

1.2. Contribute to a culture Review and understand the Demonstrate knowledge of Actively encourage all Contribute to a culture that Comment [FV373]: F 12 that promotes patient guidelines regarding and adherence to the involved in health care, promotes patient safety Comment [FV374]: TTP 2, TTP 5 safety patient safety provided by standard safety procedures regardless of their role, to the institution in place at the resident’s report and respond to centre unsafe situations

Engage patients and their families in the continuous improvement of patient safety

Model a just culture to promote openness and increased reporting

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

1.3. Analyze patient safety Describe the available Actively participate in audit Chair audit rounds, identify Comment [FV375]: TTP 4 incidents and near supports for patients and rounds, identifying safety safety issues that need to misses to enhance health care professionals issues that need to be be addressed, and systems of care when patient safety addressed, and generating generate solutions incidents occur solutions Analyze harmful patient Comment [FV376]: TTP 4 safety incidents and near misses to enhance systems of care

1.4. Use health informatics to Describe the data available Map the flow of information Use health informatics to Comment [FV377]: C 3 improve the quality of from health information in the care of patients in improve the quality of Comment [FV378]: TTP 4 patient care and systems in their discipline Otolaryngology – Head and patient care and optimize optimize patient safety to optimize patient care Neck Surgery and suggest patient safety changes for quality improvement and patient safety

Use data on measures of clinical performance during team discussions and to support team decision- making

2. Engage in the stewardship of health care resources

2.1. Allocate health care Describe the costs of Describe models for Use clinical judgment to Allocate health care Comment [FV380]: C 2 resources for optimal common diagnostic and resource stewardship in minimize wasteful practices resources for optimal Comment [FV381]: TTP 1 a, TTP 3 patient care therapeutic interventions health care used at the patient care relevant to Otolaryngology institution level Develop practice-based and – Head and Neck Surgery system-based rules for Consider costs when resource allocation Comment [FV379]: F 7 a choosing care options

2.2. Apply evidence and Apply evidence and Determine cost Apply evidence and Comment [FV382]: F 5 a, F 7 a guidelines with respect to discrepancies between best management processes to management processes Comment [FV384]: TTP 2 to achieve cost- utilization relevant to practice and their current achieve cost-appropriate appropriate care common clinical scenarios practice care

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Apply American Society of Optimize practice patterns Anesthesiology (ASA) for cost-effectiveness and Guidelines for Management cost control of the Difficult Airway Comment [FV383]: F 13 a

3. Demonstrate leadership in professional practice

3.1. Demonstrate leadership Analyze their own leadership Contribute to a health care Demonstrate leadership skills Comment [FV385]: C 3 skills to enhance health styles, including strengths, change initiative to enhance health care Comment [FV387]: TTP 2, TTP 4 care weaknesses, and biases Assume the role of chief Comment [FV386]: C 2 , C 13 a resident and lead junior residents in a hospital patient care team

3.2. Facilitate change in Analyze patient feedback to Develop a strategy for Facilitate change in health Comment [FV388]: C 3 help improve patient implementing change in care to enhance services health care to enhance Comment [FV390]: TTP 4 services and outcomes experiences and clinical health care with patients, and outcomes outcomes physicians, and other health care professionals Describe key health policy and organizational issues in Analyze ongoing changes Comment [FV389]: C 3 their discipline occurring in health care delivery

4. Manage career planning, finances, and health human resources in a practice

4.1. Set priorities and Align priorities with Build relationships with Set priorities and manage manage time to expectations for mentors time to integrate practice integrate practice and professional practice and personal life personal life Organize work using strategies that address Manage time effectively in Comment [FV391]: TTP 3 strengths and identify the ambulatory clinic areas to improve in personal effectiveness Review and act on test Comment [FV392]: TTP 3 results in a timely manner

4.2. Manage a career and a Review opportunities for Examine personal interests Reconcile expectations for Manage a career and a practice practice preparation, and seek career mentorship practice with job practice including choices available and counselling opportunities and for further training workforce needs Plan practice finances, Page 48 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

considering short- and Maintain a portfolio and Adjust educational long-term goals reflect professional experiences to gain development competencies necessary for future independent practice

Describe remuneration models as they pertain to the discipline

4.3. Implement processes to Describe how practice Improve personal practice Implement processes to Comment [FV393]: TTP 5, TTP 6 ensure personal practice standardization can by evaluating a problem, ensure personal practice improvement improve quality of health setting priorities, executing improvement care a plan, and analyzing the results

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

HEALTH ADVOCATE MILESTONES: RESIDENCY

Transition to discipline Foundations of discipline Core of discipline Transition to practice

1. Respond to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment

1.1. Work with patients to Analyze a given patient’s Demonstrate an approach Facilitate access to the Work with patients to Comment [FV394]: C 29 a address determinants of needs for health services or to working with a patient to local and national services address the determinants health that affect them, resources related to the advocate for beneficial and resources that are of health that affect them scope of Otolaryngology – services or resources available for patients, and their access to needed and their access to Head and Neck Surgery including but not limited to health services or needed health services those who are deaf and resources and resources hard of hearing Work with individual Comment [FV395]: C 19 d patients to improve their timely access to diagnostic and therapeutic care

1.2. Work with patients and Identify resources or Select patient education Apply the principles of Work with the patient and Comment [FV396]: F 5 a , F 6 agencies that address the resources related to behaviour change during family to increase their families to increase Comment [FV397]: C 8 a opportunities to adopt health needs of patients Otolaryngology – Head and conversations with patients opportunities to adopt healthy behaviours Neck Surgery about adopting healthy healthy behaviours behaviours Educate the patient and family about information and communication technologies to improve health

1.3. Incorporate disease Work with the patient and Evaluate with the patient the Incorporate disease Comment [FV398]: F 1 a, F 3 a, F 4 a, F 6 prevention, health family to identify potential benefits and harms prevention, health , F 7a, F 10 a promotion, and health opportunities for disease of health screening promotion, and health Comment [FV399]: C 25 a surveillance into prevention, health surveillance activities into interactions with promotion, and health Promote hearing protection interactions with individual Comment [FV406]: TTP 3 individual patients protection and conservation at home patients Comment [FV400]: C 28 and at work

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

through smoking cessation, responsible alcohol use, UVA/UVB protection, and/or promotion of HPV vaccination for girls and boys Comment [FV401]: C 18 a, C 24 a, C 25 a

Work with families to Comment [FV402]: C 8 a implement foreign body aspiration prevention

Minimize otitis media by Comment [FV403]: C 12 a encouraging healthy environment including strategies such as smoking cessation (second hand smoke) and encouraging breastfeeding for newborns

Promote screening for and management of early childhood hearing and communication disorders

Promote choking Comment [FV404]: C 8 a prevention in children

Recognize importance and Comment [FV405]: C 29 a understand principles of newborn/universal hearing screening

2. Respond to the needs of the communities or populations they serve by advocating with them for system-level change in a socially accountable manner

2.1. Work with a community Identify communities or Analyze current policy or Work with a community or or population to identify populations they serve who policy developments that population to identify the the determinants of are experiencing health affect the communities or determinants of health that health that affect them inequities populations they serve affect them

2.2. Improve clinical practice Identify patients or Report epidemics or Improve clinical practice by Comment [FV407]: TTP 4 by applying a process of populations that are not clusters of unusual cases applying a process of continuous quality being served optimally in seen in practice, balancing continuous quality Page 51 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

improvement to disease their clinical practice patient confidentiality with improvement to disease prevention, health the duty to protect the prevention, health promotion, and health public’s health promotion, and health surveillance activities surveillance activities Participate in local and national health promotion and disease prevention programs relevant to their practice

2.3. Contribute to a process to improve health in the Partner with others to Appraise available Contribute to a process to Comment [FV408]: TTP 4 community or population identify the health needs of resources to support the improve health in the they serve a community or population health needs of communities or populations they serve communities or populations they serve they serve Demonstrate an awareness Distinguish between of the Otolaryngology – potentially competing Head and Neck Surgery health interests of the Surgeon’s privileged individuals, communities, perspective on health and and populations they serve access to patients accounts, and acknowledge Promote policies that the ways in which this encourage early authority and knowledge identification of patients can be leveraged to presenting with disorders of influence healthcare the head and neck through systems by: screening programs for • hearing impairment and actively educating other malignancy of the head and health care professionals and the public regarding neck common head and neck

problems that benefit

from early intervention

• educating and advocating for recommended management strategies (i.e. guidelines) to prevent antimicrobial resistance by encouraging rational antibiotic use

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

• encouraging broad adherence to existing vaccination protocols and evolving ones

• encouraging health care systems to allocate appropriate resources to serve current and emerging need of community

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

SCHOLAR MILESTONES: RESIDENCY

Transition to discipline Foundations of discipline Core of discipline Transition to practice

1. Engage in the continuous enhancement of their professional activities through ongoing learning

1.1. Develop, implement, Describe physicians’ Create a learning plan in Review and update earlier Develop, implement, Comment [FV410]: TTP 6 monitor, and revise a obligations for lifelong collaboration with a learning plan(s) with input monitor, and revise a personal learning plan to learning and ongoing designated supervisor, from others, identifying personal learning plan to enhance professional enhancement of competence identifying learning needs learning needs related to all enhance professional practice practice related to Otolaryngology – CanMEDS Roles to generate Head and Neck Surgery and immediate and longer-term career goals career goals

Use technology to develop, record, monitor, revise, and report on learning in medicine

Demonstrate a structured approach to monitoring progress of learning in the clinical setting Comment [FV409]: F 13 a

1.2. Identify opportunities for Identify, record, prioritize Seek and interpret multiple Identify opportunities for Comment [FV413]: TTP 5 and answer learning needs sources of performance data learning and improvement by learning and Comment [FV414]: TTP 5 , TTP 6 improvement by that arise in daily work, and feedback, with guidance, regularly reflecting on and regularly reflecting on scanning the literature or to continually improve assessing their performance and assessing their attending formal or informal performance using various internal and performance, using education sessions external data sources various internal and external data sources Identify opportunities for learning needs that arise in daily work and seek for feedback from staff or senior residents Comment [FV411]: F 11

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

performance and preparation Comment [FV412]: F 13 a

Maintain a surgical procedure log

1.3. Engage in collaborative Identify the learning needs of Participate in collaborative Lead collaborative learning Comment [FV415]: TTP 4 learning to continuously a health care team learning projects projects improve personal practice and contribute Engage in collaborative Comment [FV416]: TTP 6 to collective learning to continuously improvements in practice improve personal practice and contribute to collective improvements in practice

2. Teach students, residents, the public, and other health care professionals

2.1. Recognize the influence Define the “hidden Identify behaviours Use strategies for deliberate, Recognize the influence of Comment [FV417]: C 2 of role-modeling and the curriculum” associated with positive and positive role-modelling role-modelling and the impact of the formal, negative role-modelling impact of the formal, informal, and hidden informal, and hidden curriculum on learners Describe the link between curriculum on learners role-modelling and the hidden curriculum Be a positive role-model to junior residents

2.2. Promote a safe learning Explain how power Identify and respond to Ensure a safe learning Comment [FV418]: C 2 environment differentials between threats to the safe learning environment for all members learners and teachers can environment as they occur of the team affect the learning environment Provide a safe environment Comment [FV419]: C 2 for junior learners

2.3. Ensure patient safety is Identify and respond to Supervise learners to ensure Ensure patient safety is Comment [FV420]: C 2 unsafe clinical situations they work within limitations, maintained when learners maintained when Comment [FV422]: TTP 2 learners are involved involving learners seeking guidance and are involved supervision when needed

Balance clinical supervision Comment [FV421]: C 2 and graduated responsibility,

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

ensuring the safety of patients and learners

2.4. Plan and deliver a Demonstrate basic skills in Describe how to formally Plan and deliver a learning learning activity teaching others, including plan a medical education activity peers session based on the learning needs of others

Describe sources of information used to assess learning needs

Define specific learning objectives for a teaching activity

Describe clinical teaching Comment [FV423]: C 2 strategies relevant to their discipline

2.5. Provide feedback to Provide written or verbal Role-model regular self- Comment [FV424]: TTP 2 enhance learning feedback to other learners, assessment and feedback- performance faculty and other members seeking behaviour of the team Provide effective feedback to enhance learning and performance of others

2.6. Assess and evaluate Appropriately assess junior Assess and evaluate Comment [FV425]: C 2 learners, teachers, and learners in various learning learners, teachers, and programs in an situations programs in an educationally educationally appropriate appropriate manner manner

3. Integrate best available evidence into practice

3.1. Recognize practice Recognize uncertainty and Generate focused questions Comment [FV428]: C 4 , TTP 6 , uncertainty and knowledge gaps in clinical to address practice knowledge gaps in and other professional uncertainty and knowledge clinical and other encounters relevant to gaps Page 56 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

professional encounters Otolaryngology – Head and and generate focused Neck Surgery Comment [FV426]: F 13 a questions that can address them Recognize uncertainty and knowledge gaps in clinical encounters and generate questions relevant to neurosurgery safe practice while on rotation Comment [FV427]: F 11

3.2. Identify, select, and Conduct a basic literature Identify, select, and navigate Comment [FV429]: C 4 search pre-appraised resources navigate pre-appraised Comment [FV430]: C 4 resources Contrast the various study designs used in medicine and the quality of various pre- appraised resources

3.3. Critically evaluate the Interpret study findings Evaluate the applicability Critically evaluate the Comment [FV431]: C 3 integrity, reliability, and including a critique of their (external validity or integrity, reliability, and applicability of health- relevance to Otolaryngology generalizability) of evidence applicability of health-related related research and – Head and Neck Surgery from a resource research and literature literature practice Describe the study results in Determine the validity and both quantitative and risk of bias in a source of qualitative terms evidence

3.4. Integrate evidence into Identify the commonly used Discuss the barriers to and Identify new evidence Integrate best evidence and Comment [FV432]: TTP 1 a, TTP 3 decision-making in their medical literature databases facilitators of applying appropriate to their scope of clinical expertise into practice and know how to access evidence into practice professional practice through decision-making in their them quality-appraised evidence- practice Describe how various sources alerting services of information, including studies, expert opinion, and Demonstrate awareness and practice audits, contribute to knowledge of clinical practice the evidence base of medical guidelines for practice Otolaryngology-Head and Neck Surgery

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

4. Contribute to the creation and dissemination of knowledge and practices applicable to health

4.1. Demonstrate an Describe the role of research Apply the principles of Demonstrate an Comment [FV433]: C 4 understanding of the and scholarly inquiry in research and scholarly understanding of the scientific principles of addressing questions in inquiry to contribute to a scientific principles of research and scholarly Otolaryngology – Head and scholarly investigation or the research and scholarly inquiry and the role of Neck Surgery dissemination of research inquiry and the role of research evidence in findings in Otolaryngology – research evidence in health health care Head and Neck Surgery care

4.2. Identify ethical principles Discuss and provide Identify ethical principles for Comment [FV434]: C 4 for research and examples of the ethical research and incorporate incorporate them into principles applicable to them into obtaining informed obtaining informed research and scholarly consent, considering harm consent, considering inquiry relevant to and benefit, and considering potential harms and Otolaryngology – Head and vulnerable populations benefits, and considering Neck Surgery vulnerable populations

Comment [FV435]: C 4 Actively participate as a Compare and contrast the 4.3. Contribute to the work of research team member, roles and responsibilities of a research program balancing the roles and members of a research team, responsibilities of a and describe how they differ researcher with the clinical from clinical and other roles and responsibilities of a practice roles and physician responsibilities Execute at least three of the Comment [FV436]: C 4 following elements of a research project: development of the hypothesis, including a comprehensive literature review; development of the protocol for the scholarly project; preparation of a grant application; development of the research ethics proposal; interpretation and synthesis of the results

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

4.4. Pose questions amenable Discuss and critique the Describe and compare the Pose medically and Comment [FV437]: C 4 to scholarly investigation possible methods of common methodologies used scientifically relevant and and select appropriate addressing a given scholarly for scholarly inquiry in appropriately-constructed methods to address question Otolaryngology – Head and questions amenable to them Neck Surgery scholarly investigation

Identify the pertinent Select appropriate methods Comment [FV438]: C 4 population, intervention, of addressing a given control group and outcomes scholarly question for a specific clinical question

4.5. Summarize and Summarize and Summarize and Comment [FV439]: C 4 communicate to communicate to peers the communicate to professional professional and lay findings of applicable and lay audiences, including audiences, including research and scholarship patients and their families, patients and their the findings of applicable families, the findings of research and scholarly relevant research and inquiry scholarly inquiry Prepare a manuscript Comment [FV440]: C 4 suitable for publication in a peer-reviewed journal

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

PROFESSIONAL MILESTONES: RESIDENCY

Transition to discipline Foundations of discipline Core of discipline Transition to practice

1. Demonstrate a commitment to patients by applying best practices and adhering to high ethical standards

1.1. Exhibit appropriate Consistently prioritize the Independently manage Manage complex issues while Comment [FV441]: TTD 1 needs of patients and others specialty-specific issues preserving confidentiality professional behaviours Comment [FV444]: C 5 a and relationships in all to ensure a patient’s surrounding confidentiality, aspects of practice, legitimate needs are met intervening when Intervene when behaviours Comment [FV445]: C 2 demonstrating honesty, confidentiality is breached toward colleagues and integrity, humility, Demonstrate punctuality learners undermine a Comment [FV442]: TTD 1 commitment, respectful environment compassion, respect, Complete assigned Comment [FV443]: TTD 1 responsibilities Exhibit appropriate altruism, respect for Comment [FV446]: C 20 diversity, and professional behaviours and maintenance of relationships in all aspects of Comment [FV447]: C 1 , C 14 d, C 20 a, confidentiality practice, reflecting honesty, C 21, C 25 a, C 26 a , TTP 1 ab, TTP 2 , TTP 3 integrity, humility, commitment, compassion, respect, altruism, respect for diversity, and maintenance of confidentiality

1.2. Demonstrate a Set clinical skills goals for the Develop a strategy for Demonstrate a commitment Demonstrate excellence in Comment [FV448]: C 1 , C 2 , C 4 , C 12 commitment to first year of residency acquiring and mastering to excellence in all aspects of all aspects of practice and a, C 14 ad, C 20 a, C 21, C 25 a , C 26 a excellence in all aspects clinical skills during residency practice mentor junior colleagues Comment [FV450]: TTP 2 , TTP 4 of practice and to active participation in Analyze how the system of Comment [FV449]: C 16 a collaborative care care supports or jeopardizes excellence

1.3. Recognize and respond Identify common ethical Manage ethical issues Recognize and respond to Comment [FV451]: F 11 to ethical issues problems encountered in encountered in the clinical ethical issues encountered in encountered in practice surgical practice including and academic setting, independent practice including but not limited issues unique to including but not limited to to deaf community, end Otolaryngology – Head and the deaf community, end of of life issues, children Neck Surgery life issues, treatment of and families, children and families, driver Page 60 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

driving/vertigo and OSA licensing with regards to patients with vertigo or obstructive sleep apnea

1.4. Recognize and manage Identify potential conflicts of Proactively resolve real, Recognize and manage conflicts of interest interest in a surgical practice potential, or perceived conflicts of interest in conflicts of interest independent practice transparently and in accordance with ethical, legal, and moral obligations

1.5. Exhibit professional Describe the risks of Demonstrate appropriate use Intervene when aware of Mentor junior colleagues behaviours in the use of technology-enabled of technology-enabled breaches of professionalism regarding professional technology-enabled communication in practice communications involving technology-enabled behaviours in the use of communication communication technology-enabled communication

2. Demonstrate a commitment to society by recognizing and responding to societal expectations in health care

2.1. Demonstrate Describe the ways that Manage tensions between Demonstrate a commitment Demonstrate accountability Comment [FV452]: C 2 physicians are accountable to societal and physician’s to the promotion of the to patients, society, and the accountability to Comment [FV453]: TTP 4 , TTP 6 patients, society and the expectations public good in health care, profession by recognizing patients, society, and the profession including stewardship of and responding to societal profession by responding Describe the tension between resources expectations of the to societal expectations the physician’s role as profession in healthcare advocate for individual Demonstrate a commitment patients and the need to to maintaining and manage scarce resources enhancing competence

2.2. Demonstrate a Demonstrate a commitment Demonstrate a commitment Comment [FV454]: TTP 3 , TTP 5 commitment to patient to patient safety and quality to patient safety and quality safety and quality improvement through improvement initiatives improvement adherence to institutional within their own practice policies and procedures environment

Monitor institutional and clinical environments and respond to issues that can harm patients or the delivery of health care Page 61 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

3. Demonstrate a commitment to the profession by adhering to standards and participating in physician-led regulation

3.1. Fulfil and adhere to the Describe the roles of the Demonstrate knowledge of Describe how to respond to a Fulfil and adhere to the Comment [FV455]: TTP 1 ab, TTP 3 professional and ethical Royal College, provincial the key professional colleague complaint or legal professional and ethical licensing authority, hospital standards of practice as action codes, standards of practice, codes, standards of board and university from a mandated by the Royal and laws governing practice practice, and laws resident’s perspective College, provincial licensing Demonstrate accountability governing practice authority, hospital board and to patients, the profession, university and society with regard to the impact of decisions that Fulfill and adhere to the are made professional and ethical codes, standards of practice, Describe the relevant codes, and laws governing practice policies, standards, and laws governing physicians and the Demonstrate knowledge of profession including the policies, procedures and standard-setting and guidelines for residency code disciplinary and credentialing of conduct of your institution procedures

3.2. Recognize and respond Describe common lapses on Identify specific Recognize and respond to Recognize and respond to to unprofessional and professional and ethical unprofessional or unethical real or simulated unprofessional and unethical practice among health care behaviours that have been unprofessional and unethical behaviours in physicians and unethical behaviours in workers witnessed behaviours in physicians and other colleagues in the physicians and other other colleagues in the health care professions colleagues in the health Respond to peer-group health care professions care profession lapses in professional conduct Describe and identify regulatory codes and procedures relevant to involving a regulatory body in a case of serious unprofessional behaviour or practice

3.3. Participate in peer Provide examples of peer Participate in the review of Participate in peer Comment [FV456]: C 3 assessment and review and standard-setting practice, standard-setting assessment and standard- standard-setting processes and quality improvement setting activities Page 62 of 64 © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved.

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

Participate in the assessment Comment [FV457]: C 2 of junior learners

Prepare a morbidity and mortality report or chart review

4. Demonstrate a commitment to physician health and well-being to foster optimal patient care

4.1. Exhibit self-awareness Demonstrate knowledge of Develop a personal plan for Exhibit strategies for Exhibit self-awareness and Comment [FV459]: C 2 the factors in residency that managing stress and managing stress and effectively manage influences and manage influences Comment [FV460]: TTP 1 a, TTP 3 , TTP 6 on personal wellbeing may affect personal well- maintaining physical and maintaining physical and on personal well-being and and professional being and professional mental well-being mental well-being during professional performance Comment [FV458]: F 11 performance performance residency Manage the impact of Develop a personal plan for Comment [FV461]: TTP 6 Demonstrate knowledge of physical and environmental Integrate skills that support managing stress and the resident safety policy of factors on performance adaption and recovery in maintaining physical and your program challenging situations mental well-being during independent practice

Demonstrate an ability to Comment [FV462]: TTP 1 ab, TTP 3 regulate attention, emotions, thoughts, and behaviours while maintaining capacity to perform professional tasks

4.2. Manage personal and Recognize evolving Describe the influence of Manage competing personal Develop a strategy to Comment [FV463]: TTP 5 , TTP 6 professional demands for professional identity personal and environmental and professional priorities manage personal and a sustainable practice transitions and manage factors on the development during residency professional demands for a throughout the physician inherent stresses of a career plan sustainable independent life cycle practice

4.3. Promote a culture that Be aware of the risk factors Describe and recognize signs Support others in their Promote a culture that Comment [FV464]: C 2 recognizes, supports, for physician distress of physician or other health professional transitions recognizes, supports, and and responds effectively care worker distress responds effectively to to colleagues in need colleagues in need Demonstrate knowledge of the resources available to Provide mentorship to physicians in distress colleagues

PROGRESSION OF COMPETENCY REQUIREMENTS IN THE SPECIALTY OF OTOLARYNGOLOGY – HEAD AND NECK SURGERY (2017)

the impact of patient safety incidents