Policy on Resident Educational Progression

The educational goals of the Duke University OHNS Residency Program are listed below for each year of training.

PGY Level Specific

First Year (PGY1)

OBJECTIVE: The first year OHNS Resident functions as an integral part of the General Surgery surgical team principally caring for patients in the ward setting, leading ward rounds with tempo and precision. The resident should demonstrate substantial achievement of the following attributes and goals before advancing to the second year of training:

Operating Room Certification:

Sterile technique
Draping
One and two-handed knots with silk
Common instrument terminology
Timely operative notes
Reliable in clerical responsibilities (daily notes, discharge summaries, post-op checks).

Floor Rounding:

Reliable
Responds in a timely fashion for floor rounds
Has most recent data available
Recognizes and follows role as part of the Care Team
Integrates medical students into the Team

Didactic Preparation:

Reads basic surgical text(s) cover to cover
Acquires adequate knowledge of clinical and basic science principles as it applies to disease processes and patient care

Skills:

Performs appropriate focused history and physical examination with identification of pertinent physical findings
Presents rounds in a focused coherent manner
Tracks clinical data and studies with data immediately available for role
Prepares for each operation through readings, practice of skills (i.e., knot tying, etc.) and preparation of the integrated approach of patient care through the use of the
ACGME General Competencies.

Second Year (PGY2)

OBJECTIVE: The second year OHNS Resident incorporates the scope of patient management skills learned in the PGY1 year to develop the skills and competence to assess and care for the OHNS patient, particularly regarding the timeliness (elective, emergent, urgent) of otolaryngologic management. The resident should demonstrate substantial achievement of the following attributes and goals before advancing to the third year of training:

Operating/Outpatient Surgical Techniques:

Performs setup of instrumentation and patient preparation for OHNS surgical procedures
Demonstrate appropriate use of surgical instrumentation in performance of simple general otolaryngologic procedures, and avoidance of complications
Become proficient in dictation of operative notes
Independent in clerical responsibilities (including supervision of RGY1 in daily notes, discharge summaries, post op checks)
Didactic/Clinical/Educational:
Assistant supervise first year residents with the basic procedures on the floor
Actively participates in appropriate outpatient clinics
Teach PGY1 and medical students at the VA and DUMC
Learns to investigate, prepare, and deliver two grand rounds lectures to the division
Read and completes assignments in didactic education course
Becomes competent in the comprehensive head and neck history taking, physical examination and ordering of appropriate diagnostic testing for the clinical problem
Presents in an organized, brief fashion, and begins to develop treatment plans
Tracks clinical data with immediate availability
Reads in preparation for each operation including summary of pertinent anatomy, indications, contraindications, and complications
Engages more senior house staff and attending physicians in preoperative discussion. Becomes familiar with monitoring and management of medically and surgically complex OHNS patients
Learn the principles and methods of scientific investigation, and apply these principles in the development of a scientific study and grant proposal
Begins to understand basic statistical methods, reads pertinent specialty journals with a critical eye

Third Year (PGY3)

OBJECTIVE: The PGY3 is an effective leader with an emphasis placed on the diagnosis and refinement of a treatment plan in more complex cases. He/she serves as the primary contact for surgical consultation in the hospital. He/she concentrates on technical learning in the operative theatre. The resident should demonstrate substantial achievement of the following attributes and goals before advancing to the fourth year of training:

Operative/Intraoperative:

Demonstrate professional behavior to all staff
Knowledge of prep and drape of major OHNS cases
Full terminology of all aspects of the operative theatre
Develop surgical skills and decision-making in the planning and performance of more complex OHNS procedures
Participate in the pre-intra-post-operative care of all patients

Clinical/Didactic/Educational:

Clinical knowledge appropriate for all operative experiences
Teach and supervise junior housestaff and medical students in the Emergency Department and floor
Supervise basic techniques for medical students in the OR
Critically evaluates literature for clinical merit
Engages senior housestaff and attending in preoperative and postoperative discussions
Attends and participates in appropriate service clinics
He/she will complete the planned research experience under the guidance of their faculty mentor

Fourth Year (PGY4)

OBJECTIVE: The fourth year resident is becoming a recognized leader in the OHNS Division and Medical Center. He/she is immersed in the technical aspects of OHNS and is devoted to participating in the total management of the surgical patient. The PGY4 progressively demonstrates a readiness to assume the responsibility of OHNS Chief Resident at the DUMC and Durham VAMC. The resident should demonstrate substantial achievement of the following attributes and goals before advancing to the fifth year of training:

Operative Requirements:

Has full understanding, knowledge and technical steps of operative OHNS major cases
Progressive autonomous function in the OR with appropriate available supervision
Integration of OR assistants
Fully able to set operation (retractors, assistants, equipment, etc.)
Understands and can formulate indications, contraindications and develops appropriate intraoperative decision making when treatment plans must be changed

Clinical/Didactic/Educational:

Teaches and supervised junior housestaff and medical students in the wards, Emergency Department or OR
Consistently consults and applies current literature (evidenced based medicine) to clinical management of patients
Actively participates in didactic sessions
Demonstrates knowledge of indications, contraindications and potential complications of assigned operative procedures
Attends and participates in appropriate service clinics
Completes research project by finishing data analysis, writes manuscript and submits work for presentation at national OHNS meeting

Chief Resident (PGY5)

OBJECTIVE: The Chief Resident is an acknowledged leader, able to assume control of emergency situations and demonstrate a measured and knowledgeable approach to surgical disease. He/she is well versed in the current literature and is primed to pass the written and oral portions of the American Board of Otolaryngology Examinations. A dedicated teacher for medical students and residents alike, the Chief Resident manages a busy OHNS Service with efficiency and attention to detail. The resident should demonstrate substantial achievement of the following attributes and goals before being allowed to graduate from the residency and sit for his/her Board examinations:

Operative Requirements:

Fully autonomous
Leadership role in all cases
Sufficient operative cases

Clinical/Didactic/Educational:

Administrative supervision of rotation schedule for all residents
Command of entire service in conjunction with faculty
Service oriented teaching of medical students and junior residents
Evaluates progress of team members
Full integration of basic and clinical science in leading a ward service
Management of patients in close cooperation of attendings. Leads Durham VAMC surgical service demonstrating autonomy
Submits research for publication