Western University
Department of Otolaryngology - Head and Neck Surgery

North (NRG) – Junior Level (PGY-2)

The overall objective of this rotation will be to provide an introduction to Neurotology and Rhinology and to acquire basic clinical skills related to these subspecialties. There will also be the expectation to demonstrate the ability to provide consultative services, office and emergency therapeutics, ward care, as well as perform basic operative procedures. There will also be experience in General Otolaryngology.

Medical Expert

General Skills:

1. Take a relevant, appropriately-detailed history from a patient presenting for otolaryngology assessment
2. Perform a detailed, thorough head and neck examination
3. Perform effective indirect laryngoscopy
4. Perform effective flexible nasopharyngoscopy with accurate interpretation of findings
5. Perform effective anterior and posterior nasal packing for epistaxis
6. Incise and drain a peritonsillar abscess including recognition of the signs and symptoms associated with a peritonsillar abscess
7. Incise and drain a wound abscess including indications for the procedure
8. Manage a tracheostomy/change a tracheostomy tube
9. Promptly and effectively assess patients with airway emergencies including airway obstruction
10. Perform open and bedside tracheotomies (translaryngeal, Percutaneous)
11. Interpret X-ray and cross-sectional imaging of the head and neck

Neurotology

1. Take a relevant, appropriately-detailed history from a patient presenting for vestibular/dizzy assessment
2. Perform a detailed, thorough examination of the vestibular system
3. Effectively manage pain associated with surgery (e.g. mastoidectomy, skull base surgery)
4. Perform myringotomy in the OR with direct consultant supervision
5. Participate in the post-operative ward and office management of patients who have undergone otologic surgery and lateral skull base surgery
6. Interpret X-ray and cross-sectional imaging of temporal bones and soft tissues of the head and neck
7. Be able to perform and interpret conventional audiometry and tympanometry in adults
8. Understand the principles and application of auditory brainstem response (ABR) and Otoacoustic Emissions (OAEs)
9. Understand the principles and application of videonystagmography including interpretation of findings
10. Accurately diagnose benign postional vertigo and demonstrate a rational approach to its treatment
11. Understand the principles of the particle repositioning manoeuvre

Rhinology

1. Perform a relevant history on patients presenting with sinonasal complaints
2. Perform diagnostic nasal endoscopy (rigid and flexible) including preparation of the nose and accurate interpretation of findings
3. Perform biopsy of sinonasal lesions
4. Provide post-operative care for patients post sinus surgery including appropriate medical therapy and endoscopic debridement
5. Develop an appreciation of the indications for endoscopic sinus surgery
6. Effectively prepare patients for endonasal surgery such as septoplasty and endoscopic sinus surgery
7. Gain experience with basic endoscopic sinus surgery such as handling of endoscopes and instruments, local anaesthetic infiltration, polypectomy
8. Understand the principles and application of rhinomanometry as well as interpretation of results
9. Acquire familiarity with indications for surgery and approaches for management of nasal obstruction including nasal septoplasty
10. Perform inferior turbinate reduction with direct consultant supervision

Communicator

1. Demonstrate effective establishment of therapeutic relationships with patients and their families
2. Present histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
3. Obtain and synthesize relevant history from patients, their families, and communities
4. Prepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
5. Discuss common (e.g. myringotomy) procedures with patients and their families in a clear and understandable form including risks/benefits, informed consent, and post-operative care
6. Prepare, participate, and present effectively in organized rounds and seminars

Collaborator

1. Identify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
2. Demonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
3. Recognize the expertise and role of allied health professionals

Manager

1. Utilize resources effectively to balance patient care duties, learning needs, educational/teaching responsibilities and outside activities
2. Allocate finite health care resources in a wise, equitable, and ethical fashion
3. Utilise information technology to optimize patient care and life-long learning including facile use of hospital IT resources (e.g. filmless radiology, electronic charting)
4. Demonstrate an appreciation of the importance of quality assurance/improvement
5. Actively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
6. Accurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions

Health Advocate

1. Recognize and respond to opportunities for advocacy within Otolaryngology, both for your patients as well as for the community in which we practice
2. Demonstrate familiarity with important determinants of health relevant to Neurotology and Rhinology such as environmental noise exposure and environmental air quality

Scholar

1. Actively participate in the teaching of medical students (didactic, in clinics, and on wards/in OR)
2. Facilitate learning in patients and other health professionals
3. Actively participate in preparation and presentation of weekly Grand Rounds
4. Demonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
5. Practice the skill of self-assessment
6. Develop, implement, and monitor a personal educational strategy and seek guidance for this educational strategy as appropriate
7. Demonstrate the evolving commitment to, and the ability to practice, life-long learning
8. Contribute to the development of new knowledge through participation in clinical or basic research studies
9. Demonstrate commitment to evidence based standards for care of common problems in Otolaryngology
10. Actively participate in weekly academic half-day seminar series including advance preparation for the topic(s)

Professional

1. Deliver highest quality care with integrity, honesty, and compassion
2. Exhibit appropriate professional and interpersonal behaviours
3. Practice medicine and Otolaryngology in an ethically responsible manner
4. Recognize limitations and seek assistance as necessary
5. Seek out and reflect on constructive criticism of performance
6. 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