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OTL Rotation Objectives

A. GENERAL COMPETENCIES

( )denotes optional competencies

At the completion of the Pediatric Otolaryngology rotation, the student will be able to:

1) MEDICAL EXPERT

•    Develop an introductory knowledge in general pediatric otolaryngology including the subspecialties of head & neck surgery, rhinology, laryngology, plastic and reconstruction, and otology.
•    Demonstrate the ability to take a directed history, and to perform a complete exam required in otolaryngology, and to develop a differential diagnosis.
•    Differentiate between emergency, severe and minor otolaryngology conditions, and to decide which condition warrant appropriate and timely referral to an otolaryngologist
•    Demonstrate the ability to evaluate and manage common ear, nose and throat problems presenting to the primary care physician
•    (Demonstrate skills in basic surgical techniques such as knot-typing, suturing and limited dissection.)

2) COMMUNICATOR/DOCTOR-PATIENT RELATIONSHIP

•    Communicate effectively and empathetically with patients and their families.
•    Demonstrate thorough and clear documentation and charting, with concise recording of pertinent positive and negative findings.
•    Demonstrate the ability to present a patient case in a clear, concise and complete manner.

3) COLLABORATOR

•    Establish and maintain effective working relationships with colleagues and other healthcare professionals commonly treating otolaryngology patients (nursing, audiology, speech language pathology).
•    (Demonstrate knowledge of community resources available to the otolaryngologist.)

4) MANAGER

•    Demonstrate appropriate and cost-effective use of investigations and treatments.
•    Learn to set priorities and manage time efficiently
•    (Develop organizational skills and efficiency in managing patients and maintaining patient flow.)
•    (Develop an understanding of the factors contributing to resource issues in the otolaryngology clinic.)

5) HEALTH ADVOCATE/COMMUNITY RESOURCES

•    Demonstrate an awareness of the underlying psychosocial and socioeconomic problems that contribute to otolaryngologic problems.
•    Identify opportunities for primary and secondary prevention strategies

6) SCHOLAR

•    Access and critically appraise the literature relevant to otolaryngology.
•    (Understand the many unique learning and teaching opportunities available in otolaryngology.)

7) PROFESSIONAL

•    Recognize and accept his or her limitations and know when to ask for help.
•    Be reliable and responsible in fulfilling obligations.
•    Recognize situations where common medical errors may occur in the otolaryngology clinic.

B. EDUCATIONAL CORE OBJECTIVES

() denotes optional objectives

1) SKILLS

By the end of the Otolaryngology rotation, the student should be able to demonstrate basic proficiency in the following skills.

a) Clinical Examination Skills:

•    Complete Head and Neck examination
•    Cranial nerve examination
•    Otoscopy including pneumatic otoscopy (recognize and describe abnormal findings on ear examination)
•    Under direct staff supervision, student may acquire skills such as:
      - Direct laryngoscopy
      - (Use a microscope to examine the ear)
      - (Removal of ear wax)

b) Operative Skills:

•    Closure of skin wounds
•    For the following procedures, student will contribute to the preoperative preparation of patients, observe the surgery and participate in their care postoperatively.
      - Adenotonsillectomy
      - Myringotomy and Tube Insertion
      - Rigid Bronchoscopy

2) PROBLEM BASED

By the end of the Otolaryngology rotation, the student should be able to demonstrate an approach (including differential diagnosis, assessment and management) to patients presenting with the following common conditions.

a) Ear Infections

•    Understand the pathology, presentation and management of acute otitis media (AOM),  serous otitis media, and otitis externa
•    Understand the common associated risk factors
•    Describe the common complications associated with AOM
•    Discuss the indications for myringotomy and tube insertion

b) Hearing Loss

•    Understand the basic principles of anatomy, physiology and pathology of the ear as related to hearing impairment.
•    Understand the etiology, presentation, differential diagnosis and management of the common causes of conductive and sensorineuralhearing loss
•    Be familiar with the interpretation of basic audiograms (hearing test) and impedance testing
•    Understand the need for early diagnosis and management of hearing loss in infants and of sudden sensorineural hearing
•    Be familiar with the Universal Infant Hearing Program
•    Be familiar with the devices available for rehabilitation (hearing aids/assistive devices)

c) Adenotonsillar Hypertrophy/ Sore Throat

•    Recognize symptoms of obstructive sleep apnea in children, and how they differ from adults.
•    Describe the potential long-term complications of untreated OSA
•    Understand the management of adenotonsillar hypertrophy
•    Know the indications for tonsillectomy and adenoidectomy
•    Conduct a physical examination to differentiate causes of throat pain
•    Order appropriate investigations for evaluation of a sore throat, and know when treatment is indicated.
•    Recognize potential complications of tonsillitis and deep space neck infections

d) Airway Obstruction/ Aspiration / Hoarseness

•    Be able to define stridor and understand how the quality of stridor can help localize the area of obstruction
•    Be able to identify signs and symptoms of impending airway obstruction
•    Be able to assess a patient with stridor (history and physical examination)
•    Know the differential diagnosis and basic management of common causes of stridor and / or respiratory distress in children (including laryngomalacia, subglottic stenosis, foreign body aspiration, epiglottis and croup)
•    Be familiar with appropriate airway management in acute airway obstruction (including positioning, artificial airways and tracheotomy
•    Describe the mechanisms in place that maintains and protects the lower respiratory tract
•    Describe the presentation, differential and management of pediatric aspiration
•    Formulate a differential diagnosis for dysphonia (hoarseness)

e) Nose and Paranasal Sinuses

•    Describe the functions of the nose (airway, mucociliary system, warming and humidification), and understand the anatomy
•    Demonstrate knowledge of the differential diagnosis of nasal obstruction (with and without rhinitis)
•    Recognize, investigate, and treat acute sinusitis
•    Be aware of the indications for referral in chronic sinusitis
•    Formulate an approach to a patient with acute epistaxis

f) Upper Digestive Tract

•    Outline the three phases of swallowing and demonstrate knowledge of the differential diagnosis of dysphagia
•    Demonstrate a knowledge of the anatomy and physiology of the 3 major salivary glands
•    Discuss the differential and management of salivary gland swelling
•    Understand the basic presentation and treatment of acute sialadenitisand drooling

g) Pediatric Neck Masses

•    Demonstrate knowledge of the differential diagnosis of congenital neck lesions (midline and lateral) and knowledge of the pertinent embryology.
•    
Discuss the investigations and management of pediatric neck masses.

C.  LEARNING RESOURCES

1) Recommended Reading

•    Books available in the B240 Conference room:
      - Primary Care Otolaryngology.  Stafferl JG et al eds.
      - EMILY method for examining the tympanic membrane in a child. Schloss MD and Katz MS eds.
•    Textbook: Head and Neck Surgery – Otolaryngology. Bailey BJ and Johnson JT eds.

2) Online resources

•    Baylor College of Medicine: http://www.bcm.edu/oto/gr-archive
•    Otolaryngology Houston: http://www.ghorayeb.com/pictures.html
•    Martindale's The "Virtual" Medical Centre: http://www.martindalecenter.com/MedicalAudio_2_C.html
•    Canadian Society of Otolaryngology – Head and Neck Surgery (link for “Undergraduate Education):www.entcanada.org
•    University of Western Ontario: http://www.uwoent.ca/files/Clerkship_Lecture.pdf