• Adult hospital rotations of total of 9 months rotation (JGH, MGH, RVH)
• Duration: During the Second Half of PGY4 (Jan 1- June 30), two rotations of 3 months
In addition to one rotation of 3 months during the enrichment year as PGY4
• The PGY4 residents will be expected to use their knowledge of the basic sciences to gradually expand their clinical repertoire and clinical problem solving skills.
• Their technical training is designed to meet the requirements as outlined in the rotational objectives of the McGill Department of Otolaryngology – Head & Neck Surgery Residency Handbook
• All of the general otolaryngology clinics, sub-specialty clinics and surgeries are supervised by attending staff.
• All pre and post operative care management are fortified
• Regular informal quizzing as well as structured written and oral examinations serves as part of the evaluation process, using the One45 framework.
• All residents must undergo a STASER or STACER evaluation by attending staff person every six months. They are also evaluated by 360 degree inter-professional evaluation (feedback from allied health care personnel, nurses, secretaries)
Medical Expert
1. Operative objectives
a) In addition to acquiring greater proficiency in the procedures encountered during the first year, development will be acquired in the following skills:
• Septal surgery (septoplasty, nasal polypectomy)
• Sinus surgery
• Cervical node biopsy
• Assistance at major head and neck surgery
• Microlaryngeal surgery
b) Some experience of the following procedures with adequate supervision should be obtained near the end of the second year:
• Rhinologic surgery
o rhinoplasty
o ethmoidectomy, functional endoscopic sinus surgery
• Otologic surgery
o myringoplasty
o tympanoplasty
o mastoidectomy
• Neurotologic surgery
o intratympanic injections
• Head and neck surgery
o salivary gland surgery e.g. submandibular gland excision
o Neck dissection different types
• Facial plastics and Reconstructive surgery
o Flaps local and locoregional
o split and full thickness skin graft
• Laryngnologic procedures
o vocal fold injection
o laser laryngeal procedures
o medialization
• General Otolaryngology
o rigid upper endoscopy with foreign body extraction
o management of obstructive sleep apnea and surgical options
o management of head and neck manifestations of systemic disease
o cricothyroidotomy
o tracheostomy
c) Exposure to the following procedures:
• Otology
o Stapedectomy
o facial nerve surgery
o labyrinthine surgery
o neurotologic procedures
• Head and Neck
o Parotidectomy
o composite resection maxillectomy
o thyroid and parathyroid surgery
o Zenker’s diverticulum surgery
o laryngectomy
• Facial Plastic and reconstructive
o Otoplasty
o face lift
o blepharoplasty
2. Didactic objectives
Active resident participation in academic half and full day seminars, lectures, hospital rounds and journal clubs will increase. Where possible, the residents will be increasing involvement in teaching junior medical staff to include medical students, clinical clerks and junior residents. The resident will be introduced to the methods of clinical research and ethics in clinical trials.
3. Temporal bone dissection
The resident will complete his program of temporal bone dissection in preparation for the development of his clinical otological skills. A temporal bone course is given in the fall of every year.
PGY4 at the JGH- The Expert Role specific objectives
PGY4 at the MGH - The Expert Role specific objectives
PGY4 at the RVH - The Expert Role specific objectives
Communicator Role
As a communicator the otolaryngology resident should effectively facilitates the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. The resident is thought and evaluated on these issues:
• Demonstrate effective establishment of therapeutic relationships with patients and their families
• Recognize unique issues related to head and neck patients, particularly relevant to patients with cancer of the head and neck including end-of-life discussions
• Recognize unique biopsychosocial issues related to deafness and the deaf community and recognize their unique communication requirements
• Demonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
• Obtain and synthesize relevant history from patients, their families, and communities
• Prepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
• Present histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
• Respect diversity and difference, including gender, religion and cultural beliefs on decision-making
• Discuss common procedures with patients and their families in a clear and understandable form including risks/benefits, informed consent, and post-operative care
• Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
• Participate, and present effectively in organized rounds and seminars
The communicator role is evaluated especially on:
• Demonstrate effective establishment of therapeutic relationships with patients and their families
• Present histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
• Obtain and synthesize relevant history from patients, their families, and communities
• Prepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
• Discuss more complex procedures (e.g. tympanoplasty, thyroidectomy) with patients and their families in a clear and understandable form including risks/benefits, informed consent, and post-operative care
• Prepare, participate, and present effectively in organized rounds and seminars
• Demonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
• Recognize unique issues related to head and neck patients particularly relevant to patients with cancer of the head and neck including end-of-life discussions
• Respect diversity and difference, including gender, religion and cultural beliefs on decision-making
• challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
Collaborator Role
As collaborators the otolaryngology residents effectively work within a health care team to achieve optimal patient care. The resident is thought and evaluated on these issues:
• Demonstrate an understanding of the team structure of an in-patient service ('the resident team') and fulfill his/her role in this structure
• Demonstrate recognition and respect for the opinions & roles of other team members
• Identify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
• Demonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
• Recognize the expertise and role of allied health professionals such as speech language pathologists, audiologists, technicians, nurses, and clerical staff
• Recognize the advantages for optimal patient care provided by an multidisciplinary Head and Neck oncology team
The collaborator role is evaluated especially on:
• Identify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
• Demonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
• Recognize the expertise and role of allied health professionals
• Recognize the advantages for optimal patient care provided by a multidisciplinary head and neck oncology program
Manager Role
As managers the otolaryngology residents are integral participants in health care organizations, making decisions about allocating resources, and contributing to the effectiveness of the health care system. The resident is thought and evaluated on these issues:
• Utilize resources effectively to balance patient care duties, learning needs, educational / teaching responsibilities & outside activities and personal life
• Allocate finite health care resources in a wise, equitable, and ethical fashion
• Utilize information technology to optimize patient care and life-long learning including facile use of hospital IT resources (e.g. filmless radiology, electronic charting)
• Actively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
• Accurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
• Use patient information tools effectively
• Demonstrate an appreciation of the importance of quality assurance/improvement, such as patient safety initiatives
• Take care of charts and use head and neck patient database
• Demonstrate ability to lead a health care team
• Serve in administrative and leadership roles, such as participate effectively in committees and meetings
The manger role is evaluated especially on:
• Demonstrate ability to lead a health care team
• Utilize resources effectively to balance patient care duties, learning needs, Educational/teaching responsibilities and outside activities
• Allocate finite health care resources in a wise, equitable, and ethical fashion
• Utilize information technology to optimize patient care and life-long learning including facile use of hospital IT resources (e.g. filmless radiology, electronic charting)
• Demonstrate an appreciation of the importance of quality assurance/improvement
• Actively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
• Accurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
• Serve in administrative and leadership roles, such as participate effectively in committees and meetings
Health Advocate Role
As Health Advocate the otolaryngology residents responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations. The resident is thought and evaluated on these issues:
• Recognize and respond to opportunities for advocacy within Otolaryngology, both for your patients as well as for the community in which we practice and populations at large
• Encourage behaviors that promote hearing protection and conservation at work and at home
• Facilitate patients' access to local and national resources available for the hearing impaired
• Encourage behaviors that reduce/eliminate risk factors for the development of head & neck cancer (e.g., tobacco, alcohol, UVA/UVB sun exposure)
The health advocate role is evaluated especially on:
• Recognize and respond to opportunities for advocacy within Otolaryngology, both for your patients as well as for the community in which we practice
• Demonstrate familiarity with important determinants of health relevant to Otology such as environmental noise exposure
• Encourage behaviors that promote hearing protection and conservation at work and at home
• Facilitate patients' access to local and national resources available for the hearing impaired
• Encourage behaviors that reduce/eliminate risk factors for the development of head and neck cancer (e.g.: tobacco, alcohol, UVA/UVB sun exposure)
Scholar Role
As Scholars the otolaryngology residents demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge. The resident is thought and evaluated on these issues:
• Actively participate in the teaching of medical students (didactic, in clinics, and on Wards / in OR
• Facilitate learning in patients and other health professionals
• Actively participate in preparation and presentation of weekly hospital and grand rounds
• Demonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
• Develop, implement, and monitor a personal educational strategy and seek guidance for this educational strategy as appropriate
• Contribute to the development of new knowledge through participation in clinical or basic research studies
• Demonstrate commitment to evidence based standards for care of common problems in Otolaryngology
• Demonstrate the evolving commitment to, and the ability to practice, life-long learning
The scholar role is evaluated especially on:
• Actively participate in the teaching of medical students (didactic, in clinics, and on wards/in OR)
• Facilitate learning in patients and other health professionals
• Actively participate in preparation and presentation of weekly hospital and Grand Rounds
• Demonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
• Practice the skill of self-assessment
• Develop, implement, and monitor a personal Educational strategy and seek guidance for this Educational strategy as appropriate
• Demonstrate the evolving commitment to, and the ability to practice, life-long learning
• Contribute to the development of new knowledge through participation in clinical or basic research studies
• Demonstrate commitment to evidence based standards for care of common problems in Otolaryngology
• Actively participate in weekly academic rounds series including advance preparation for the topic(s)
Professional Role
• As professionals the otolaryngology residents are committed to the health and well-being of individual s and society through ethical practice, profession-led regulation, and high personal standards of behavior. The resident is thought and evaluated on these issues:
• Deliver highest quality care with integrity, honesty, and compassion
• Exhibit appropriate professional and interpersonal behaviors
• Practice medicine and Otolaryngology in an ethically responsible manner
• Recognize limitations and seek assistance as necessary
• Seek out and reflect on constructive criticism of performance
• Endeavour to develop an appropriate balance between personal and professional life to promote personal physical and mental health/well-being as an essential to effective, life-long practice
• Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation, e.g. recognize and respond to others unprofessional behavior in practice, understand the legal and ethical codes of practice
The Professional role is evaluated especially on:
• Deliver highest quality care with integrity, honesty, and compassion
• Exhibit appropriate professional and interpersonal behaviors
• Practice medicine and Otolaryngology in an ethically responsible manner
• Recognize limitations and seek assistance as necessary
• Seek out and reflect on constructive criticism of performance
• Endeavor to develop an appropriate balance between personal and professional life to promote personal physical and mental health/well-being as an essential to effective, life-long practice
• Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation (e.g.: recognize and respond to other unprofessional behavior in practice, understand the legal and ethical codes of practice