Otolaryngology-Head and Neck Surgery Service

UNC Otolaryngology-Head & Neck Surgery Service

Medical Student Information Handout

Welcome to the OTO-HNS service!

We look forward to an educational and productive experience for each of you in caring for patients with diseases of the head and neck. While on our service, you will have the opportunity to learn about a wide range of problems while participating as a member of the team in the clinic, on the wards, and in the operating room. The fourth year residents will be your primary resource persons for questions regarding the schedule, end of rotation test, oral presentation expectations, call, and any problems that may occur during the course of the rotation.

Medical Student Clerkship Director:

Dr. Adam Zanation

Contact:

The Department of Otolaryngology – Head & Neck Surgery and the Department of Surgery in The School of Medicine are both committed to fostering a respectful educational environment. If a student has concerns, the student is encouraged to meet with the Ombudsman for Students. This is a confidential meeting where a student may discuss a concern and learn about resources and procedures available to them.

Education:

A. The primary goal of your rotation on the OTO-HNS service is for you to learn about the diagnosis and treatment of patients with diseases of the head and neck. Our attendings and residents have a commitment to excellence in education and consider teaching students a top priority. But, it is YOUR interest that will facilitate worthwhile and effective teaching and learning.

B. One of the most effective teaching methods in medicine is asking questions, whether this is on morning rounds, in the operating room, in conference, or in clinic. We use this method liberally, so please read and be prepared.

C. Additionally, we may ask students to look up articles or general information from textbooks to present succinctly on morning rounds.

D. At the end of the rotation each student is expected to give a concise 5 min oral presentation with a one-page handout to the team at morning rounds on a topic of their own choosing. Discuss this topic with one of the residents prior to preparation

E. Your mandatory conferences take precedence over work on our service. Please excuse yourself to attend these at the appropriate time, however, there may be a rare occasion when you are an essential member of the operating team and are asked to stay for completion of a procedure.

F. You are encouraged to seek out information from sources such as the textbooks in our library, and journal articles regarding more in-depth information on patients you see in the operating room and clinic. Here is a list of some online resources available to you:

· American Academy of Otolaryngology – Head & Neck Surgery Foundation (AAO-HNSF)

http://www.entlink.net/

§ Click on Clinical Otolaryngology OnLine (COOL) to learn about many high-yield areas of interenst to Otolaryngologists in training.

§ Click on Core Education Curriculum as well. This is a curriculum designed especially for medical students.

· Online Journals:

1. Head & Neck journal

http://www.interscience.wiley.com/

2. Archives of Otolaryngology – Head & Neck Surgery

http://archotol.ama-assn.org/

3. Archives of Facial Plastic Surgery

http://archfaci.ama-assn.org/

· National Comprehensive Cancer Network

http://www.nccn.org

Here you will find evidence-based guidelines for the management of cancers in all sites, including head and neck, thyroid. There are also algorithms for management of cancer pain, nausea, and anemia. You can order a free CD-ROM online at this site. A must see site for all oncology-related education.

· Atlas of Head and Neck Pathology

Department of Otolaryngology – Head & Neck Surgery

Ohio State University Medical Center, William H. Saunders, MD

http://medicine.osu.edu/oto/atlas.html

· Iowa Protocols

http://wiki.uiowa.edu/display/protocols/Home

Excellent source of information in our field.

· Otolarynoglogy Pictures

http://www.ghorayeb.com/Pictures.html

Great site to surf and see some great high-yield pictures.

· Otolaryngology/ Head & Neck Surgery

University of North Carolina

http://www.unc-ent.org/

Great links for learning more about the field of OHNS.

Schedule:

A. A general schedule grid (Section I) is provided and breaks down the service for two, three, or four medical students. This should provide each student with roughly equal exposure to our staff in clinic and the operating room. If an attending is on vacation or absent for any reason ask the fourth year resident what activity would be most educational for that day.

B. The administrative chief resident may request your presence/help in the operating room or elsewhere if the need or a particularly educational experience arises regardless of the schedule.

Call Responsibilities:

A. Call Requirements:

· For 3rd year medical students - Take call at least 1 night/week and 1 day/night combination your first weekend on service (either Saturday or Sunday)

· For non-AI 4th year medical students - Take call at least 1 night/week and 1 full weekend per 4-week rotation

· For AI 4th year medical students – We want you to average q 3 call while on service. This means taking call 1 night/week and 2 full weekends per 4-week rotation.

B. When taking call, you will be expected to round with the call team in the evening and then stick around for any active consults, etc. that are occurring at that time. If nothing is in the works, the call team is allowed to leave the hospital. The junior resident on call will contact you for admissions, emergent operations, and ER cases that have educational merit. Call is HOME CALL.

C. The student on call should contact the junior resident on call late in the day to find out when afternoon rounds will take place. On the weekends, contact the junior resident the night before to find out the time for morning rounds. Pre-rounding is not expected on the weekends.

Rounds:

A. Rounds begin promptly at:

7AM on Mondays and Thursdays

6:30 AM on Tuesdays, Wednesday and Fridays

* Pre-round on all of your patients and BE THERE ON TIME.

B. You will present your patients on cue from the administrative chief resident. Presentations will follow the SOAP format and should cover pertinent positives and negative only. There is no time for superfluous information on morning rounds. Take this opportunity to refine your presentation skills into providing concise story while also providing accurate, yet necessary, information to the team. Sample presentations are provided in Section II.

C. Ideally, all patients on the service should be covered by the students. We would expect that 3rd year medical students to cover 3-4 patients at a time, while 4th year medical students to cover 4-6 patients at a time.

· For 4th year medical students on their Critical Care rotation, you are expected to cover ALL ICU patients on our service, regardless of whether you were part of their operation or not.

· If you are a part of a patient’s operation, you are expected to follow that patient for the entire length of their hospital stay.

o At the end of the operation ask the resident what the pertinent exam findings will be to present on rounds the next morning.

o If you are a 3rd year medical student and the patient will be staying in the ICU for a period of time post-operatively, make sure to ask the resident that you are working with if they would like you to see and follow the patient.

o We expect “systems-based” presentations for all of the ICU patient. See example in (Section II)

D. Pre-round on patients and have your proposed plan outlined in your mind or on paper so that you can provide the group with a streamlined presentation.

E. Be sure to check lab work and look at radiographic studies for your patients. Don’t rely solely on RTAZ for X-ray interpretation; this is the time to start reading films, not your first night on call as an intern.

F. Feel free to ask questions of the residents at anytime, especially on morning rounds. If you have a question chances are your fellow students are wondering as well.

G. Attending rounds are held every Tuesday at 7AM. Be prepared to present any of your patients to the attending with a brief disease history, operative indication, operation, and post-operative course. See example in (Section II)

Conferences:

A. You are expected to attend all mandatory medical student conferences. Attend our conferences when there is not a schedule conflict.

B. Conferences generally will be held in the 7th floor conference room.

Monday

7AM morning rounds 6th floor Neuroscience

5PM resident conference 7th floor Neuroscience

Tuesday

6:30AM morning rounds 6th floor Neuroscience

7AM attending rounds, location usually in top floor of Starbucks

Wednesday

6:30AM morning rounds 6th floor Neuroscience

7:00AM Journal Review Session, POB conference room

7:30AM Grand Rounds, POB conference room

5PM resident conference 7th floor Neuroscience

Thursday

7AM morning rounds 6th floor Neuroscience

5PM resident conference 7th floor Neuroscience

Friday

6:30AM morning rounds

7:00AM Multidisciplinary Head and Neck Tumor Conference, Cancer Hospital

Clinic:

A. The clinic is set up in 3 “pods” each of which has 5-7 patient rooms. On any given day 2-3 clinics will be simultaneously occurring each with 2-3 nurses.

B. Ask the attending at the beginning of clinic how they would like you to interact with patients in terms of seeing them together, versus seeing them first and presenting them to the attending.

C. Please treat the nurses and ancillary staff with an appropriate degree of respect and courtesy. They will do the same.

D. Teaching heads are available for flexible fiberoptic laryngoscopes; ask the attending if you may use them for endoscopies. Several rooms have microscopes, video towers available as well. We also have a video stroboscopy machine that will be utilized. Don’t be afraid to use the otoscopes to look in patients ears. Ask one of the residents to show you how to perform an indirect mirror laryngoscopy.

E. If you don’t know where something is, ask any of the residents.

MS revised, 6/21/10

Section I

Weekly Assignments:

Student A – week 1