Residency Level:PGY 4

Surgical Rotation:Head and Neck Surgery

Length of Rotation:Two Months

Goals and Objectives

Patient care:

  • Master the evaluation and preparation of the pre-operative head and neck surgery patient
  • Preoperative evaluation and post operative management of complex head and neck surgical patients
  • Master the management skills required to independently evaluate the head and neck surgical patient, develop your own plan for the patient and communication of the plan to the appropriate level of supervision
  • Take ownership in care of the patient
  • Post-operative care of the head and neck surgical patient
  • Mechanisms and criteria for minimally invasive head and neck surgical surgery
  • Mechanisms and criteria for rotational and free flaps
  • Fluid and electrolyte management including indications for parenteral and enteral nutrition
  • Understanding and utilization of diagnostic techniques including routine films, contrast studies, ultrasound, CT scan, MRI and endoscopic procedures
  • Clear and timely documentation of daily progress notes
  • Develop a strong work ethic
  • Develop appropriate safe hand offs
  • Develop the ability to care for head and neck surgical emergencies in the role as the senior surgical resident on call, particularly airway issues

Technical skill:

  • Master more advanced surgical techniques and dissections
  • Diagnostic Evaluation of the nasopharyngeal tract, including physical examination, radiologic evaluation, and laryngoscopic/ bronchoscopic/ endoscopic examination
  • With appropriate supervision, perform biopsies of lesions of face, nose, oral cavity
  • With appropriate supervision, perform tracheostomy
  • With appropriate supervision, perform procedures such as thyroidectomy, parathyroidectomy, radical neck dissection and major head and neck tumor surgery

Medical knowledge:

  • Master the anatomy and physiology of the ear, nose, throat, thyroid and parathyroid.
  • Master the pathology of head and neck neoplasms.
  • Master airway management, indications for elective and emergency tracheostomy
  • Indications and utilization of endoscopic techniques
  • Causes and management of epistaxis.
  • Evaluation and management of facial trauma
  • Demonstrate evidence of continued increase in head and neck surgery core knowledge from basic surgical texts, additional readings and the SCORE curriculum as noted below
  • Study and prepare for the ABSITE

Practice-based learning and improvement:

  • Participate actively in M and M conferences, daily chief conferences and journal clubs
  • Learn to critically read the literature
  • Master the IT resources available to you to develop a commitment to lifelong learning and education

Interpersonal and communication skills:

  • Develop the appropriate skills to provide efficient, concise, patient presentations
  • Master text paging, emailing, etc.
  • Develop strong doctor patient relationships using counseling and education of patients and their families
  • Learn to master EPIC to provide proper documentation in the electronic medical record
  • Learn to properly consult other specialty services in a professional manner

Professionalism:

  • Respect every patient regardless of social or other circumstances
  • Log cases appropriately
  • Log your duty hours using My Evaluations appropriately and in a timely fashion
  • Complete all required clinical and residency documents in a timely fashion
  • Demonstrate sensitivity to age, gender and culture of patients and other members of the health care delivery team
  • Learn to be punctual
  • Always exemplify professional attire, appropriate grooming and hygiene
  • Demonstrate honesty, integrity and leadership skills

Systems-based practice:

  • Demonstrate the effective communication with referring physicians throughout the Swedish health care system
  • Keep patients’ safety foremost while discharging patients in a timely fashion
  • Demonstrate time management and organizational skills while adhering to work hour regulations
  • Gain an understanding of the importance of discharge planning and the writing of timely discharge orders to the overall throughput of patients in our system

SCORE CURRICULUM CATEGORY 27: HEAD AND NECK
Diseases/Conditions
BROAD
• Cervical lymphadenopathy
• Upper airway obstruction
FOCUSED
• Epistaxis
• Mucosal cancers of the oral cavity
• Mucosal cancers of the pharynx
• Mucosal cancers of the larynx
• Parotid gland tumors
• Submandibular gland tumors / Operations/Procedures
ESSENTIAL − COMMON
• Tracheostomy
ESSENTIAL − UNCOMMON
• Cricothyroidotomy
COMPLEX
• Resection of lip/tongue lesions
• Parotidectomy
• Modified radical neck dissection
SCORE CURRICULUM CATEGORY 14: ENDOCRINE
Diseases/Conditions
BROAD
• Thyroid nodule(s)
• Papillary carcinoma
• Follicular carcinoma
• Primary hyperparathyroidism
• Hypothyroidism (postoperative)
• Hypercalcemia
• Hypocalcemia
• Addisonian crisis
• Hyperthyroidism
FOCUSED
• Thyroiditis
• Medullary carcinoma
• Hurthle cell tumors
• Anaplastic carcinoma
• Secondary hyperparathyroidism
• Tertiary hyperparathyroidism
• Recurrent or persistent hyperparathyroidism
• Parathyroid carcinoma
• Multiple endocrine neoplasia type I
• Multiple endocrine neoplasia type IIA
• Multiple endocrine neoplasia type IIB / Operations/Procedures
ESSENTIAL − COMMON
• Partial or total thyroidectomy
• Parathyroidectomy