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Department of Otolaryngology – Head & Neck Surgery Residency Training DEPARTMENT OF OTOLARYNGOLOGY – HEAD & NECK SURGERY RESIDENCY TRAINING MANUAL 2012-2013 Last revised on: 2013-03-18 TABLE OF CONTENTS Page Goal of the program …………………………..….. 4 Objectives of training & specialty training requirements …………………………..….. 6 Educational program …………………………….. 9 Residency Program Committee (terms of reference) ……………………………. 15 Objectives: ¾ Jewish General Hospital rotational objectives …………………… 19 ¾ Montreal Children’s Hospital rotational objectives …………………… 23 ¾ Montreal General Hospital rotational objectives …………………… 29 ¾ Royal Victoria Hospital rotational objectives …………………… 38 Rotations: ¾ Rotation to the Quebec North …………………… 42 ¾ Community-based rotation (Lakeshore General) …………………… 45 ¾ PGY1 Surgical Foundation (CORE) Surgery Rotation …………………… 50 - Independent Rotation Specific Objectives for Surgical Foundation General surgery ………………………………………………………… 55 Pediatric General Surgery………………………………………………… 61 Critical Care………………………………………………………………. 68 Anesthesia………………………………………………………………… 72 Emergency………………………………………………………………… 78 Neurosurgery………………………………………………………………. 82 Plastic and Reconstructive Surgery………………………………………….. 86 Oral and Maxillofacial (OMF) Surgery and Trauma ………………………. 91 Oncology (Surgical/Radiation)……………………………………………… 94 - Airway Basics Course …………………… 99 ¾ PGY2 First year of residency training in otolaryngology …………………… 103 ¾ PGY3 Second year of residency training in otolaryngology. ……………… 143 - Resident Enrichment year………………………………………………… 153 ¾ PGY4 Third year of residency training in otolaryngology ………………….. 156 ¾ PGY5 fourth year of residency training in otolaryngology………………… 176 ¾ Approved research laboratories ……………………… 189 ¾ Educational Courses (facial plastics, etc.) … ………………... 193 ¾ Double-program/Master’s program in otolaryngology ………………….. 210 ¾ Fellowship program description (Members) …………………… 214 ¾ Head & Neck Fellowship program ………………..… 217 ¾ Rhinology Fellowship program ………………….. 222 ¾ Laryngology Fellowship Program …………………. 226 ¾ Pediatric Fellowship Program ………………….. 230 Lectures /Grand rounds ………………………………………………………….………… 231 Journal Clubs /MCH teaching sessions ……………………………………………………………. 242 MCH Resident Teachings ………………………………………………………………………… 243 McNally Memorial Lectureship …………………………………………………………… 244 2 Raymer Lectureship ……………….… 247 Melvin D. Schloss Pediatric Lectureship ………………… 249 Herbert Stanley Birkett Memorial Lectureship ………………… 251 Annual Resident Research Day/James D. Baxter Lectureship ………………… 257 Royal College of Physicians & Surgeons of Canada Training Requirements ……………. 260 Evaluation & Promotion in Postgraduate Training Program ........……………. 261 Policies on resident safety ……………….. 275 Departmental staff ………………… 280 3 DEPARTMENT OF OTOLARYNGOLOGY – HEAD & NECK SURGERY GOAL OF THE PROGRAM 18/03/2013 The goal of the program to produce a specialist in otolaryngology who has achieved competencies in all of the 7 CanMEDS roles including that of: medical expert, communicator, collaborator, manager, health advocate, scholar and professional. Graduating residents will be competent to function as a consultant otolaryngologist - head and neck surgeon. GRADUATE OF RESIDENCY TRAINING PROGRAM A graduate of this training program will meet the requirements necessary to obtain registration forms from: 1. the Professional Corporation of Physicians of Quebec 2. the Royal College of Physicians and Surgeons of Canada 3. As of 2004, the American Board of Otolaryngology no longer recognizes Canadian training programs and has revoked eligibility of Canadian residents to write the American Board of Otolaryngology exams. There are active efforts to resolve the difficulty at this time, which applies to all residents from Canadian training programs in otolaryngology. To this end, all Canadian training programs have been modified to parallel the American training programs. At this time, the program consists of one year of surgical foundation (CORE) surgery program followed by four years of otolaryngology training. A precedent for reversing such decisions has already been set in other specialties. 4 The graduate in otolaryngology is expected to have acquired all 7 CanMEDS key competencies. More specifically, graduates are expected to: 1. Possess a sound knowledge of the general principles of medicine and surgery. As of July 1993, it is mandatory for residents to pass the Principles of General Surgery exam as required by the Royal College of Physicians and Surgeons of Canada. 2. Acquire sufficient knowledge of basic and clinically applied science in addition to the necessary clinical skills for the practice of otolaryngology, which includes the areas of otology, neurotology, pediatrics, general otolaryngology, rhinology, head and neck surgery, facial plastic and reconstructive surgery, Residents will also embrace components of neurology, neurosurgery, plastic surgery, dermatology, respirology, pathology and oral and maxillo-facial surgery. 3. Demonstrate the knowledge, skills and attitudes relating to gender, culture, and ethnicity pertinent to otolaryngology head and neck surgery. They will demonstrate an ability to incorporate gender, sexual orientation, age, culture and ethnic perspectives in data presentation analysis and in research methodology. 4. Develop an orderly and logical approach to patient management, elicit an accurate history, a focused physical examination selecting appropriate investigations including diagnostic imaging, laboratory testing, biopsies and vestibular and audiology testing 5. Demonstrate satisfactory interpersonal relationships with colleagues, nurses, ancillary medical personnel, patients and their families. 6. To seek appropriate consultation from other professionals recognizing the limits of their expertise. 7. Possess high standards of professional ethics, responsibility to both patients and the community, and to his/her own continuing self-education 8. Gain an appreciation of the role of basic and clinical research in the further development of the speciality to enhance areas of professional competence. 9. To use preventive and therapeutic interventions effectively by implementing a management plan in collaboration with a patient and the family by advocating specific preventative otolaryngology - head and neck surgery criteria. (ex: smoking cessation, responsible alcohol use, sun exposure protection, prevention of noise-induced hearing loss, etc.) 5 OBJECTIVES OF TRAINING AND SPECIALTY TRAINING REQUIREMENTS IN OTOLARYNGOLOGY – HEAD & NECK SURGERY 18/03/2013 As of July 1, 1993, as a Quebec university program, candidates can enter directly upon graduating from fourth year medicine into speciality training "streams" of residency such as otolaryngology. As of July 1, 1990, candidates will enter general surgery (PGY1- otolaryngology) and then commence their formal otolaryngology training for four years (PGY2- 5). 1. General objectives: The otolaryngologist must possess a sound knowledge of the general principles of medicine and surgery as they apply to the practice of otolaryngology. This will require adequate training and experience in eight domains: - Head and neck surgery - Facial plastic and reconstructive surgery - Pediatric otolaryngology - Rhinology - Laryngology - Otology - Neurotology - General otolaryngology A sound knowledge of the basic sciences is necessary for the understanding and practice of otolaryngology. Training is geared toward promoting an understanding of the above domains with respect to embryology, genetics, applied anatomy, physiology, pathophysiology, histology, pathology, immunology, microbiology and biochemistry. For both pediatric and adult population the specific areas for these domains are: Head and neck: parathyroid and thyroid glands, salivary glands, nose and paranasal sinuses, oral cavities, pharynx (nasopharynx, oropharynx, hypopharynx), larynx, trachea, esophagus, neck, skin and skull base 6 Ear: ear (external, middle, inner), temporal bone and related structures including the peripheral auditory system, central auditory system, vestibular system and the component of anatomical and neurological structures, special senses of hearing and balance Nose: nose and paranasal sinuses, special senses of olfaction and skull base Larynx: trachea and upper airway, swallowing, airway protection and respiration as it pertain to the larynx and upper airway. This includes the principles and techniques of objective vocal testing, aerodynamic testing, electrophysiologic techniques and principles of laser therapy pertinent to the larynx. Face: face and its structural components including facial nerve In addition, the otolaryngologist must have a special knowledge of the basic principles and clinical techniques of: • Audiology: Knowledge of physics of sound and neurophysiology of hearing, principles of conventional audiometry, immittance testing including tympanometry, otoacoustic emissions (OAEs), electrocochleography, auditory brain stem response (ABR) and cortical auditory evoke responses for evaluation of adult and pediatric patients with hearing disorders. • Speech: Knowledge of physics of voice and speech production, and the physiology of voice. This includes principles of technique used in evaluation in treatment of speech and hearing disorders. These techniques should be based on the age of the patient. • Vestibular function: Knowledge of the principles of vestibular assessment including performance and interpretation of electronystagmography (ENG), computerized dynamic posturography, rotational chair assessment, and vestibular-evoked
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