鈥⑻� 听At the JGH there is a modern, state-of-the-art clinical out-patient facility, with 8 examination-treatment rooms, an electronystagmography testing room, 3 audiological testing suites, speech language-pathology offices, a conference room, and a dedicated residents鈥� room.
鈥⑻� 听The Department runs the following clinics: General Otolaryngology Clinic, Head and Neck Oncology Clinic, Resident鈥檚 Clinic for in-patient and out-patient consultations, Otology Clinic, Nasal and Sinus Clinic, Voice/dysphagia Clinic, and a Laser Clinic. In addition, extensive Speech-Language Pathology Services are integrated into the services for Head and Neck cancer patients, with a Laryngectomy Support Group and an Oncology Nurse Pivot.
鈥⑻� 听The CanMEDS roles have been implemented into our training process and now serve as the foundation upon which we structure our practice and teaching. The following will serve to demonstrate the educational objectives, strategies and evaluation process at the JGH.
鈥⑻� 听Available resources for Residency Training include:
-听听 听Complete audiological services including ABR and OAE.
-听听 听Computerized electronystagmography testing.
-听听 听Speech therapy department, including a speech and swallowing therapist for the oncology service.
-听听 听Clinical services within the department include head & neck radiology, head & neck pathology, and multi-disciplinary teams for skull base surgery and oncology patients.
-听听 听Departmental conference room and library.
-听听 听Designated Residents鈥� Room.
1.听 MEDICAL EXPERT
鈥⑻� 听The PGY2 year will focus on acquiring expertise in obtaining an appropriate history and performing a comprehensive head and neck examination.
鈥⑻� 听Residents at the PGY2 level should focus on acquiring a sound basic science knowledge base in head and neck anatomy and physiology as they pertain to otolaryngology.
鈥⑻� 听The PGY2 residents will learn basic office-based ENT procedures such as laryngoscopy, biopsies, minor excision of head and neck lesions as well as basic operative procedures.
鈥⑻� 听The OR responsibility will progress with the resident鈥檚 seniority and individual abilities.
鈥⑻� 听Junior residents (PGY2 & PGY3) at each hospital site are evaluated according to their specific exposure using the one45 system. Evaluations forms are different from the senior residents (PGY4 & PGY5) evaluation.
鈥⑻� 听The PGY2 residents will learn basic office-based ENT procedures such as laryngoscopy, biopsies, minor head and neck lesion excisions as well as basic operative procedures. The OR responsibility will progress with the resident鈥檚 seniority and individual abilities. Their technical training is designed to meet the requirements as outlined in the rotational objectives of the 平特五不中 Department of Otolaryngology 鈥� Head & Neck Surgery Residency Handbook.听 All of the general otolaryngology clinics, sub-specialty clinics and surgeries are supervised by Attending Staff. Regular informal quizzing as well as structured written and oral examinations serves as part of the evaluation process, using the One45 framework.听 All residents must undergo a STASER or STACER evaluation by a JGH staff person during each of their rotations at the hospital.
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鈥⑻� 听The main exposure / evaluation of the residents at the JGH in descending priority order are in the domains of:
听听听听听 - head and neck surgery
听听听听听 - otology
听听听听听 - rhinology
听听听听听 - laryngology
听听听听听 - facial plastic reconstructive surgery
听听听听听 - general otolaryngology
鈥⑻� 听The Expert Role specific objectives are
General skills
-听听 听Take a relevant, appropriately-detailed history from a patient presenting for otolaryngology assessment
-听听 听Perform a detailed, thorough head and neck examination
-听听 听Perform effective flexible nasopharyngolaryngoscopy with accurate interpretation of findings
-听听 听Perform effective anterior and posterior nasal packing for epistaxis
-听听 听Incise and drain a peritonsillar abscess including recognition of the signs and symptoms associated with a peritonsillar abscess
-听听 听Manage a tracheostomy/change a tracheostomy tube
-听听 听Perform rigid esophagoscopy with or without removal foreign body
-听听 听Promptly and effectively assess patients with airway emergencies including airway obstruction
-听听 听Perform open and percutaneous tracheostomies
-听听 听Accurately assess patients suffering facial trauma including ordering appropriate investigations
-听听 听Participate in the post-operative ward and office management of patients who have undergone ENT surgery
-听听 听Pre-operative assessment and preparation of patient for surgery
-听听 听Management of post-operative patient care issues (e.g., pain, labs, wounds)
-听听 听Interpret X-ray and cross-sectional imaging of the head and neck
Head and Neck Oncologic Surgery
-听听 听Diagnose and accurately stage malignancies of the upper aero-digestive tract
-听听 听Principles of communication/ speech/swallowing and the challenges encountered in head and neck cancer patients
-听听 听Perform fine needle aspiration of neck lesions
-听听 听Effectively biopsy nasal or oral cavity lesions
-听听 听Manage head and neck oncology in-patients with attention to the unique airway and nutritional needs of these patients
-听听 听Pack a pharyngocutaneous fistula and provide ongoing wound care/debridement
-听听 听Effectively assist at major head and neck ablative surgical procedures (pharyngolaryngectomy, neck dissection etc.)
-听听 听Effectively plan incisions, dissect tissues, and close wounds
-听听 听Demonstrate attention to issues surrounding end-stage malignancies such as end-of-life care and palliation
-听听 听Demonstrate a basic grasp of adjuvant therapies for the treatment of head and neck malignancies (radiotherapy, chemotherapy) and management of their complications
Facial Plastic and Reconstructive Surgery
-听听 听Demonstrate basic understanding of the hierarchy of reconstructive options for defects in the head and neck
-听听 听Understand indications for and design of local and regional flaps/grafts in the cervicofacial region.
-听听 听Harvest split and full-thickness skin grafts
-听听 听Effectively assist at major reconstructive surgical procedures (e.g. harvest of pedicled or free tissue transfer)
-听听 听Refinement of tissue handling, tying, and suturing techniques
Laryngology
-听听 听Develop a differential diagnosis of dysphonia
-听听 听Develop a differential diagnosis for dysphagia
-听听 听Diagnose basic pathology of the larynx
-听听 听Diagnostic approach for and management of vocal cord paralysis
-听听 听Understanding of laser applications in Head and Neck surgery
Neurotology/Otology
-听听 听Take a relevant, appropriately-detailed history from a patient presenting for vestibular/dizziness assessment
-听听 听Perform a detailed, thorough examination of the vestibular system
-听听 听Perform myringotomy and tube insertion with consultant supervision
-听听 听Participate in the post-operative ward and office management of patients who have undergone otologic surgery and lateral skull base surgery
-听听 听Interpret X-ray and cross-sectional imaging of temporal bones and soft tissues of the head and neck
-听听 听Be able to interpret conventional audiometry and tympanometry in adults
-听听 听Understand the principles and application of auditory brainstem response (ABR) and otoacoustic emissions (OAEs)
-听听 听Understand the principles and application of electronystagmography including interpretation of findings
-听听 听Accurately diagnose benign positional vertigo and demonstrate a rational approach to its treatment
-听听 听Perform, in an effective manner, the particle repositioning maneuver
Rhinology
-听听 听Perform a relevant history on patients presenting with sinonasal complaints
-听听 听Perform diagnostic nasal endoscopy (rigid and flexible) including preparation of the nose and accurate interpretation of findings
-听听 听Perform biopsy of sinonasal lesions
-听听 听Provide post-operative care for patients post sinus surgery including appropriate medical therapy and endoscopic debridement
-听听 听Develop an appreciation of the indications for endoscopic sinus surgery
-听听 听Gain experience with basic endoscopic sinus surgery such as handling of endoscopes and instruments, local anesthetic infiltration, polypectomy
-听听 听Acquire familiarity with indications for surgery and approaches for management of nasal obstruction including nasal septoplasty
-听听 听Perform inferior turbinate reduction with direct consultant supervision
2.听 Communicator
The vital importance of effective communication in the practice of medicine is taught to the residents. Both verbal and written communication is emphasized. The Jewish General Hospital is situated in the heart of the most multi-ethnic neighborhood in Montreal and our trainees have the opportunity to communicate with patients from a multitude of cultural, ethnic and linguistic backgrounds. The residents are encouraged to enlist the assistance of interpreters when necessary. The importance of establishing a doctor-patient relationship based on trust and understanding is crucial. The resident evaluation process is multi-faceted and includes: observation during the implementation of their clinical duties, STACER evaluation, review of their written notes, evaluations of their OR dictations and patient discharge summaries. The department uses the 平特五不中 Simulation Center on an annual basis, using actors acting like patients to teach residents the communicator role of CanMEDS.
The communicator role is evaluated especially on:
-听听 听Demonstrate effective establishment of therapeutic relationships with patients and their families
-听听 听Present histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
-听听 听Obtain and synthesize relevant history from patients, their families, and communities
-听听 听Demonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
-听听 听Prepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
-听听 听Demonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
-听听 听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
-听听 听Prepares, participates, and presents effectively in organized rounds and seminars
-听听 听Respect diversity and difference, including gender, religion and cultural beliefs on decision-making
-听听 听Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
3.听 Collaborator
The practice of medicine today has evolved to a point where working in isolation is not possible or desirable.听 Medicine, particularly in a tertiary care academic institution, is practiced in a multi-disciplinary team format. The residents must actively participate in tumor boards, and multi-specialty teaching rounds. They are encouraged to recognize the appropriate time to enlist help. Their training also teaches them how to collaborate with the patients as well as family members in the decision-making and management process. They have the opportunity to collaborate with supervisors on their various research projects. The progression from R2 to R5 mirrors the progression of responsibility in the various seminars and teaching rounds. The evaluation process for this aspect of their training seeks feedback from other specialists, peers and allied health professionals (360 degree evaluation). The department uses the 平特五不中 Simulation Center annually, hiring actors to portray patients in certain scenarios, to teach residents the collaborator role of CanMEDS.
The collaborator role is evaluated especially on:
-听听 听Demonstrate an understanding of the team structure of an in-patient service (the resident team) and fulfill his/her role in this structure
-听听 听Demonstrate recognition and respect for the opinions & roles of other team members
-听听 听Recognize the advantages for optimal patient care provided by a Multidisciplinary head and neck oncology team.
-听听 听Demonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
-听听 听Recognize the expertise and role of allied health professionals such as speech language pathologists, audiologists, technicians, nurses, and clerical staff
4.听 Manager
Effective management skills come in to play at many levels of medical practice. The residents must demonstrate judicious use of medical tests and resources. They will be able to explain the particular purpose of each test ordered. They will learn to perform a type of cost-benefit analysis. The residents will be sensitized to the critical issue of bed utilization. A crucial component of their training is the acquisition of personal time management skills. They will be expected to respect schedules, commitments and call schedules. They will be taught to use information technology to access information and manage their responsibilities. The senior residents will be expected to delegate effectively and organize the work distribution of junior residents and medical students. Residents will be evaluated by way of observation, written and oral exams and creation of case scenarios. They will be assessed based on timely completion of assigned tasks and projects. The department uses the 平特五不中 Simulation Center annually, hiring actors to portray patients in certain scenarios, to teach residents the manager role of CanMEDS.
The manager role is evaluated especially on:
-听听 听Utilize resources effectively to balance patient care duties, learning needs, educational responsibilities & outside activities
-听听 听Allocate finite health care resources in a wise, equitable, and ethical fashion
-听听 听Utilize information technology to optimize patient care and life-long learning including facile use of hospital IT resources (e.g. filmless radiology, electronic charting)
-听听 听Actively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
-听听 听Accurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
-听听 听Serve in administrative and leadership roles, such as participate effectively in committees and meetings.
5.听 Health Advocate
The residents will become advocates of their patients鈥� health. They will learn to counsel their patients regarding health risks such as smoking and alcohol, noise exposure and occupational hearing health, and will provide tools for change. The residents will be encouraged to involve themselves in public health education, such as public lecture series held in the hospital or university. The evaluation of these attributes and skills will be conducted via close observation of their doctor-patient interactions.
The health advocate role is evaluated especially on:
-听听 听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
-听听 听Encourage behaviors that promote hearing protection and conservation at work and at home
-听听 听Facilitate patients' access to local and national resources available for the hearing impaired
-听听 听Encourage behaviors that reduce/eliminate risk factors for the development of head & neck cancer (e.g., tobacco, alcohol, sun exposure)
6.听 Scholar
The residents will be expected to develop a reading plan from their R2 year onwards. They will use actual cases as well as the literature to constantly update their knowledge. Our weekly rounds and frequent journal clubs will provide them with ample opportunity to critically review the literature. The supervisors will encourage the utilization of evidence-based medicine as it applies to decision-making. The residents will be inspired towards life-long learning and will be encouraged to develop a teaching dossier early on in their careers. During their progression from R2 to R5 years, their teaching responsibility will increase. A variety of modalities will be implemented to evaluate their scholarly activity. Staff will review their research proposals and manuscripts. Their presentations will be evaluated and supervisors will assess their teaching assignments. Every resident presents a research project once a year that is presented at our Annual Resident Research Day/James D. Baxter Lectureship held in the spring.
The scholar role is evaluated especially on:
-听听 听Actively participate in the teaching of medical students (didactic, in clinics, and on wards/in OR)
-听听 听Facilitate learning in patients and other health professionals
-听听 听Actively participate in preparation and presentation of weekly rounds and grand rounds
-听听 听Demonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
-听听 听Develop, implement, and monitor a personal educational strategy and seek guidance for this educational strategy as appropriate
-听听 听Contribute to the development of new knowledge through participation in clinical or basic research studies
-听听 听Demonstrate commitment to evidence based standards for care of common problems in Otolaryngology
-听听 听Demonstrate the evolving commitment to, and the ability to practice life-long learning.
7.听 Professional
The residents will demonstrate appreciation and sensitivity for cultural diversity. They will be expected to treat colleagues as well as all hospital employees with dignity and respect. They will be able to disagree with fellow physicians in a diplomatic and constructive fashion. The importance of punctuality will be highlighted. We will expect the care that they provide to be of the highest level, delivered ethically and with compassion. The evaluation process will be achieved by close observation, and feedback will be solicited from allied health professionals, senior residents and office support staff (360 degree evaluation). The department uses 平特五不中 Simulation Center annually, hiring actors to portray patients in certain scenarios, to teach residents the ethics role of CanMEDS.
The professional role is evaluated especially on:
-听听 听Deliver highest quality care with integrity, honesty, and compassion
-听听 听Exhibit appropriate professional and interpersonal behaviors
-听听 听Practice medicine and Otolaryngology in an ethically responsible manner
-听听 听Recognize limitations and seek assistance as necessary
-听听 听Seek out and reflect on constructive criticism of performance
-听听 听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
-听听 听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