- Rotation-specific CanMEDS objectives have been elaborated. The residents rotate throughout the three teaching hospitals: the Montreal General, Jewish General and Royal Victoria hospitals. 听
- The PGY5 residents will be able to see patients and define a treatment plan independently; the resident should possess sufficient basic and clinical knowledge and technical skills to undertake the management of patients under the supervision of the appropriate staff.
- At this level, the resident will be responsible for the supervision and teaching of more junior residents, medical students, the management of patients on the wards, and ensuring coverage of emergency and inpatient consultations.
- The senior resident will be responsible for many activities within the post-graduate program to include: sitting on post-graduate committees, organization of education activities including rounds, journal clubs and seminars as well as organization of all the vacation schedules.
- 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.
- Senior residents (PGY4 & PGY5) at each hospital site are evaluated according to their specific exposure using the One45 system. Evaluations forms are different from the junior residents (PGY2 & PGY3) evaluation. All residents must undergo a STASER or STACER evaluation by attending staff person every six months. They are also evaluated by 360 degree inter-professional evaluation (feedback from allied health care personnel, nurses, secretaries)
- During their final year in otolaryngology, residents are expected to develop proficiency in the following:
Medical Expert
Operative objectives / experience
Obtain proficiency in the following:
Otology
鈥⑻� 听excision of exostosis
鈥⑻� 听tympanoplasty
鈥⑻� 听mastoidectomy and tympanomastoidectomy
鈥⑻� 听ossiculoplasty
鈥⑻� 听Canaloplasty
鈥⑻� 听stapedectomy
Neurotology
鈥⑻� 听facial nerve decompression
鈥⑻� 听intratympanic injections
鈥⑻� 听surgical excision of middle ear tumors e.g. paraganglioma tympanicum
Rhinology
鈥⑻� 听surgical management of epixtasis
鈥⑻� 听external sinus procedures
鈥⑻� 听drainage of intra-orbital abscess
鈥⑻� 听Maxillectomy
Head and neck
鈥⑻� 听radical neck dissection,
鈥⑻� 听composite resection,
鈥⑻� 听laryngectomy
鈥⑻� 听thyroid surgery
鈥⑻� 听parathyroid surgery
鈥⑻� 听parotidectomy,
鈥⑻� 听regional flaps,
鈥⑻� 听Zenker鈥檚 diverticulum repair surgery
鈥⑻� 听major flap reconstruction
Facial Plastics and Reconstructive
鈥⑻� 听rhinoplasty
鈥⑻� 听cartilage graft
鈥⑻� 听bone graft e.g. calvarial
鈥⑻� 听composite graft e.g. auricular
鈥⑻� 听cervicofacial cosmetic surgery (face lift, blepharoplasty)
鈥⑻� 听facial trauma and reconstructive surgery
Laryngnology
鈥⑻� 听microlaryngeal surgery,
鈥⑻� 听endoscopic partial laryngectomy,
鈥⑻� 听medialization thyroplasty
鈥⑻� 听laser procedures of the airway,
鈥⑻� 听repair of laryngeal fracture
鈥⑻� 听laryngotracheal reconstruction
Obtain some experience in the following:
Otology
鈥⑻� 听endolymphatic shunts
鈥⑻� 听vestibular neurectomy
鈥⑻� 听posterior fossa surgery
Rhinology
鈥⑻� 听advanced rhinoplasty
鈥⑻� 听advanced endoscopic sinus surgery techniques for the management of sinonasal neoplasms听听听听 听
PGY5 - The Expert Role specific objectives the JGH / RVH / MGH
General Skills
鈥⑻� 听Understands medical literature its limitations and can argue based on the published literature
鈥⑻� 听Participate in the post-operative ward and office management of patients who have undergone major head and neck ablative and Reconstructive surgery
鈥⑻� 听Demonstrate a sophisticated approach to imaging studies including independent interpretation of findings
鈥⑻� 听Perform fine needle aspiration of neck lesions
鈥⑻� 听Biopsy nasal or oral cavity lesions
鈥⑻� 听Insert or change a tracheoesophageal puncture prosthesis
鈥⑻� 听Incise and drain a wound abscess including a demonstrated understanding of the indications for the procedure
鈥⑻� 听Pack a pharyngocutaneous fistula and provide ongoing wound care/debridement
鈥⑻� 听Effectively manage pain associated with surgery and malignancy
鈥⑻� 听Demonstrate understanding of the indications for tracheotomy in a critical care setting
鈥⑻� 听Promptly and effectively assess patients with airway emergencies including airway obstruction and supervise junior colleagues in this situation
鈥⑻� 听Perform open and percutaneous tracheostomies
鈥⑻� 听Perform percutaneous tracheostomy/translaryngeal tracheotomy with limited consultant supervision
鈥⑻� 听Provide effective counseling for patients regarding tracheotomy/stoma care
鈥⑻� 听Effectively manage pain associated with surgery (e.g. mastoidectomy, skull base surgery)
鈥⑻� 听Participate in the post-operative ward and office management of patients who have undergone otologic surgery, lateral skull base surgery, and general otolaryngological surgery
鈥⑻� 听Interpret X-ray and cross-sectional imaging of temporal bones and soft tissues of the head and neck
Head and Neck Oncologic Surgery
鈥⑻� 听Rapidly stage malignancies of the head and neck and develop approach to surgical management
鈥⑻� 听Appropriate use and recommendation of alternate/adjuvant therapies for management of malignancies of the head and neck
鈥⑻� 听Effectively perform a transnasal esophagoscopy and understand the findings
鈥⑻� 听Comprehensive management of complications from Head and Neck surgery with limited consultant intervention
鈥⑻� 听Comprehensive understanding and management of Head and Neck emergencies such as airway obstruction and trauma
鈥⑻� 听Perform pan-endoscopy independently with accurate interpretation of findings
鈥⑻� 听Perform lymph node and neck mass biopsy limited consultant intervention
鈥⑻� 听Effectively perform cervical echography and ultrasound guided fine needle biopsy
鈥⑻� 听Perform excision of submandibular glands with limited consultant intervention
鈥⑻� 听Perform excision of branchial cleft cysts and thyroglossal duct cysts with gradually decreasing degree of consultant intervention
鈥⑻� 听Perform parotidectomy with increasing degree of autonomy
鈥⑻� 听Perform neck dissections with increasing degree of autonomy
鈥⑻� 听Perform thyroidectomy, parathyroidectomy with limited consultant intervention
鈥⑻� 听Perform excision of oral cavity lesions with and without laser
鈥⑻� 听Perform medial maxillectomy with consultant supervision
鈥⑻� 听Perform composite resections as well as pharyngolaryngectomies with increasing degree of autonomy
鈥⑻� 听Perform more extensive maxillectomies with consultant supervision
鈥⑻� 听Assist at anterior craniofacial resections
Facial Plastic and Reconstructive Surgery
鈥⑻� 听Demonstrate sophisticated understanding of the hierarchy of Reconstructive options for defects in the head and neck
鈥⑻� 听Formulate plan for reconstruction of head and neck defects with attention to form and function
鈥⑻� 听Design and harvest flaps for major Reconstructive surgical procedures with direct consultant supervision
鈥⑻� 听Perform or assist at microvascular anastomosis for vessels and nerves in free tissue transfers
鈥⑻� 听Perform or assist at microvascular anastomosis for vessels and nerves in free tissue transfers
鈥⑻� 听Diagnosis and treatment of facial nerve disorders and reanimation strategies
鈥⑻� 听Diagnose, evaluate and perform treatments of cutaneous malignancies including appropriate reconstruction.
鈥⑻� 听Observe, assist in and perform various types of local and regional flaps in cervicofacial reconstruction
鈥⑻� 听Approach to facial analysis of patient presenting for esthetic surgery
鈥⑻� 听Observe, assist in and perform septorhinoplasty including an evaluation of the nasal valve, open vs. closed approaches, as well as grafting techniques
鈥⑻� 听Perform septorhinoplasty with direct consultant supervision.
鈥⑻� 听Observe, assist in cervicofacial cosmetic surgery such as blepharoplasty, rhytidectomy, forehead lifts, and various facial implants.
鈥⑻� 听Observe, assist in and perform Facial reanimation including skin resurfacing, chemical peels, microdermabrasion, and laser peels
鈥⑻� 听Observe, assist in and perform cosmetic procedures such as botox injection and soft tissue injectable fillers (hyaluronic acid derivatives, collagen, etc.)
鈥⑻� 听Observe, assist in and perform scar revision including techniques such as Z - plasty, W - plasty, and geometric broken line closure, etc.
鈥⑻� 听Management of patients suffering from facial trauma including the techniques of soft tissue repair and closed/open reduction of facial fractures and post-operative care.
鈥⑻� 听Perform surgical repair of mandible fractures including the use of M-M fixation and plates.
鈥⑻� 听Management of mid facial fractures including choice of incisions and repair materials.
鈥⑻� 听Perform or assist at repair of orbitozygomatic and frontal sinus fractures
Laryngology
鈥⑻� 听Perform indirect rigid laryngoscopy and video-stroboscopy
鈥⑻� 听Develop a differential diagnosis and management plan for dysphonia
鈥⑻� 听Develop a differential diagnosis and management plan for dysphagia
鈥⑻� 听Management of vocal cord paralysis including investigation, medical therapy, and surgical therapy
鈥⑻� 听Perform office-based laryngeal procedures
鈥⑻� 听Perform rigid suspension laryngoscopy
鈥⑻� 听Perform microlaryngeal surgery with microlaryngeal instruments, CO2 Laser, microdebrideur
鈥⑻� 听Understanding of intraoperative airway management during microlaryngeal surgery
鈥⑻� 听Perform thyroplasty and other laryngeal framework surgeries
鈥⑻� 听Perform, with supervision, endoscopic laser resections of early tumors of the larynx
鈥⑻� 听Diagnosis and management of airway and aerodigestive trauma
鈥⑻� 听Assist at and begin to perform airway reconstruction (e.g. laryngotracheoplasty)
Neurotology / Otology
鈥⑻� 听Accurately assess patients suffering temporal bone trauma including ordering appropriate investigations
鈥⑻� 听Be able to perform and interpret conventional audiometry and tympanometry in adults
鈥⑻� 听Understand the principles and application of auditory brainstem response (ABR) and Otoacoustic Emissions (OAEs)
鈥⑻� 听Understand the principles and application of electronystagmography including interpretation of findings
鈥⑻� 听Accurately diagnose benign positional vertigo and demonstrate a rational approach to its treatment
鈥⑻� 听Perform the particle repositioning maneuver
鈥⑻� 听Develop a rational approach to vestibular rehabilitation and participate in delivery of this care
鈥⑻� 听Participate in and demonstrate understanding of the indications for surgical treatment of vertigo (includes labyrinthectomy, vestibular nerve section, endolymphatic sac surgery, and posterior canal occlusion)
鈥⑻� 听Observe performance of and interpret electrocochleography
鈥⑻� 听Perform and interpret electro-diagnostic testing of the facial nerve
鈥⑻� 听Elevate a tympanomeatal flap with limited consultant intervention
鈥⑻� 听Perform tympanoplasty with limited consultant intervention
鈥⑻� 听Perform ossiculoplasty with consultant supervision
鈥⑻� 听Perform mastoidectomy with consultant supervision
鈥⑻� 听Demonstrate a rational, organized approach to medical management of disorders of the facial nerve
鈥⑻� 听Demonstrate a rational approach to selection of patients for cochlear implant surgery
鈥⑻� 听Assist in performance of cochlear implant surgery and actively participate in post-operative rehabilitation and assessment
鈥⑻� 听Assist at/observe surgery for treatment of otosclerosis
鈥⑻� 听Assist at and demonstrate a logical approach to surgery for treatment of lateral skull base lesions including acoustic neuromas, other benign CPA lesions, and petrous apex lesions
鈥⑻� 听Attend Skull Base Clinic and understand controversies in patient management
鈥⑻� 听Present cases at Skull Base Tumor Board
鈥⑻� 听Participate at skull base surgeries and perform some of the procedure under supervision
Rhinology
鈥⑻� 听Perform effective rigid nasal and sinus endoscopy
鈥⑻� 听Biopsy nasal cavity lesions
鈥⑻� 听Participate actively in the post-operative office management of patients who have undergone sinus surgery including pharmacotherapy and debridement
鈥⑻� 听Interpret X-ray and cross-sectional imaging of the paranasal sinuses
鈥⑻� 听Demonstrate a sophisticated approach to selection of the surgical candidate for treatment of nasal obstruction and chronic rhinosinusitis, including indications for endoscopic sinus surgery and the extent of the procedure to be performed.
鈥⑻� 听Effectively prepare patients for endonasal surgery such as septoplasty and endoscopic sinus surgery, including he informed consent process (description of risks/possible complications)
鈥⑻� 听Perform nasal septoplasty including choice of incision, method of septoplasty, and closure materials with decreasing degree of direct consultant supervision
鈥⑻� 听Perform inferior turbinate reduction with limited consultant supervision
鈥⑻� 听Refine knowledge of paranasal sinus anatomy and perform surgical techniques of endoscopic polypectomy, uncinectomy, ethmoidectomy, and middle meatal antrostomy with decreasing degree of direct consultant supervision
鈥⑻� 听Perform endoscopic sphenoidotomy and frontal recess dissection with direct consultant supervision
鈥⑻� 听Acquire familiarity and assist at endoscopic approaches to the pituitary gland
鈥⑻� 听Perform surgical treatments for epistaxis including endoscopic sphenopalatine artery ligation and anterior ethmoid artery ligation as well as internal maxillary artery ligation
鈥⑻� 听Acquire familiarity with techniques for the management of benign sinonasal neoplasms such as inverted papilloma (e.g. endoscopic medial maxillectomy)
听
Communicator Role
As a communicator the otolaryngology resident should effectively facilitates the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. The resident is thought and evaluated on these issues:
鈥⑻� 听Demonstrate effective establishment of therapeutic relationships with patients and their families
鈥⑻� 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
鈥⑻� 听Recognize unique biopsychosocial issues related to deafness and the deaf community and recognize their unique communication requirements
鈥⑻� 听Demonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
鈥⑻� 听Obtain and synthesize relevant history from patients, their families, and communities
鈥⑻� 听Prepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
鈥⑻� 听Present histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
鈥⑻� 听Respect diversity and difference, including gender, religion and cultural beliefs on decision-making
鈥⑻� 听Discuss common procedures with patients and their families in a clear and understandable form including risks/benefits, informed consent, and post-operative care
鈥⑻� 听Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
鈥⑻� 听Participate, and present effectively in organized rounds and seminars
The communicator role is evaluated especially on:
鈥⑻� 听Demonstrate effective establishment of therapeutic relationships with patients and their families
鈥⑻� 听Present histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
鈥⑻� 听Obtain and synthesize relevant history from patients, their families, and communities
鈥⑻� 听Prepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
鈥⑻� 听Discuss more complex procedures (e.g. tympanoplasty, thyroidectomy) with patients and their families in a clear and understandable form including risks/benefits, informed consent, and post-operative care
鈥⑻� 听Prepare, participate, and present effectively in organized rounds and seminars
鈥⑻� 听Demonstrate the capacity to recognize the psychological, occupational and social consequences of speech and voice disorders, particularly relevant to vocational demands
鈥⑻� 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
鈥⑻� 听Respect diversity and difference, including gender, religion and cultural beliefs on decision-making
鈥⑻� 听Address challenging communication issues effectively, such as obtaining informed consent, delivering bad news, and addressing anger, confusion and misunderstanding
听
Collaborator Role
As collaborators the otolaryngology residents effectively work within a health care team to achieve optimal patient care. The resident is thought and evaluated on these issues:
鈥⑻� 听Demonstrate an understanding of the team structure of an in-patient service ('the resident team') and fulfill his/her role in this structure
鈥⑻� 听Demonstrate recognition and respect for the opinions & roles of other team members
鈥⑻� 听Identify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
鈥⑻� 听Demonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
鈥⑻� 听Recognize the expertise and role of allied health professionals such as speech language pathologists, audiologists, technicians, nurses, and clerical staff
鈥⑻� 听Recognize the advantages for optimal patient care provided by an multidisciplinary Head and Neck oncology team
The collaborator role is evaluated especially on:
鈥⑻� 听Identify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
鈥⑻� 听Demonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
鈥⑻� 听Recognize the expertise and role of allied health professionals
鈥⑻� 听Recognize the advantages for optimal patient care provided by a multidisciplinary head and neck oncology program
听
Manager Role
As managers the otolaryngology residents are integral participants in health care organizations, making decisions about allocating resources, and contributing to the effectiveness of the health care system. The resident is thought and evaluated on these issues:
鈥⑻� 听Utilize resources effectively to balance patient care duties, learning needs, educational / teaching responsibilities & outside activities and personal life
鈥⑻� 听Allocate finite health care resources in a wise, equitable, and ethical fashion
鈥⑻� 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)
鈥⑻� 听Actively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
鈥⑻� 听Accurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
鈥⑻� 听Use patient information tools effectively
鈥⑻� 听Demonstrate an appreciation of the importance of quality assurance/improvement, such as patient safety initiatives
鈥⑻� 听Take care of charts and use head and neck patient database
鈥⑻� 听Demonstrate ability to lead a health care team
鈥⑻� 听Serve in administrative and leadership roles, such as participate effectively in committees and meetings
The manger role is evaluated especially on:
鈥⑻� 听Demonstrate ability to lead a health care team
鈥⑻� 听Utilize resources effectively to balance patient care duties, learning needs, Educational/teaching responsibilities and outside activities
鈥⑻� 听Allocate finite health care resources in a wise, equitable, and ethical fashion
鈥⑻� 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)
鈥⑻� 听Demonstrate an appreciation of the importance of quality assurance/improvement
鈥⑻� 听Actively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
鈥⑻� 听Accurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
鈥⑻� 听Recognize the advantages for optimal patient care provided by a multidisciplinary head and neck oncology program
听
Health Advocate Role
As Health Advocate the otolaryngology residents responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations. The resident is thought and evaluated on these issues:
鈥⑻� 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
鈥⑻� 听Encourage behaviors that promote hearing protection and conservation at work and at home
鈥⑻� 听Facilitate patients' access to local and national resources available for the hearing impaired
鈥⑻� 听Encourage behaviors that reduce/eliminate risk factors for the development of head & neck cancer (e.g., tobacco, alcohol, UVA/UVB sun exposure)
The health advocate role is evaluated especially on:
鈥⑻� 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.
鈥⑻� 听Demonstrate familiarity with important determinants of health relevant to Otology such as environmental noise exposure
鈥⑻� 听Encourage behaviors that promote hearing protection and conservation at work and at home
鈥⑻� 听Facilitate patients' access to local and national resources available for the hearing impaired
鈥⑻� 听Encourage behaviors that reduce/eliminate risk factors for the development of head and neck cancer (e.g.: tobacco, alcohol, UVA/UVB sun exposure)
听
Scholar Role
As Scholars the otolaryngology residents demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge. The resident is thought and evaluated on these issues:
鈥⑻� 听Actively participate in the teaching of medical students (didactic, in clinics, and on Wards / in OR)
鈥⑻� 听Facilitate learning in patients and other health professionals
鈥⑻� 听Actively participate in preparation and presentation of weekly hospital and grand rounds
鈥⑻� 听Demonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
鈥⑻� 听Develop, implement, and monitor a personal educational strategy and seek guidance for this educational strategy as appropriate
鈥⑻� 听Contribute to the development of new knowledge through participation in clinical or basic research studies
鈥⑻� 听Demonstrate commitment to evidence based standards for care of common problems in Otolaryngology
鈥⑻� 听Demonstrate the evolving commitment to, and the ability to practice, life-long learning
The scholar role is evaluated especially on:
鈥⑻� 听Actively participate in the teaching of medical students (didactic, in clinics, and on wards/in OR)
鈥⑻� 听Facilitate learning in patients and other health professionals
鈥⑻� 听Actively participate in preparation and presentation of weekly hospital and Grand Rounds
鈥⑻� 听Demonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
鈥⑻� 听Practice the skill of self-assessment
鈥⑻� 听Develop, implement, and monitor a personal Educational strategy and seek guidance for this Educational strategy as appropriate
鈥⑻� 听Demonstrate the evolving commitment to, and the ability to practice, life-long learning
鈥⑻� 听Contribute to the development of new knowledge through participation in clinical or basic research studies
鈥⑻� 听Demonstrate commitment to evidence based standards for care of common problems in Otolaryngology
鈥⑻� 听Actively participate in weekly academic rounds series including advance preparation for the topic(s)
鈥⑻� 听Demonstrate the evolving commitment to, and the ability to practice, life-long learning
Professional Role
As professionals the otolaryngology residents are committed to the health and well-being of individual s and society through ethical practice, profession-led regulation, and high personal standards of behavior. The resident is thought and evaluated on these issues:
鈥⑻� 听Deliver highest quality care with integrity, honesty, and compassion
鈥⑻� 听Exhibit appropriate professional and interpersonal behaviors
鈥⑻� 听Practice medicine and Otolaryngology in an ethically responsible manner
鈥⑻� 听Recognize limitations and seek assistance as necessary
鈥⑻� 听Seek out and reflect on constructive criticism of performance
鈥⑻� 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
鈥⑻� 听Demonstrate a commitment to their patients, profession and society through participation in profession-led regulation, e.g. recognize and respond to others unprofessional behavior in practice, understand the legal and ethical codes of practice
The Professional role is evaluated especially on:
鈥⑻� 听Deliver highest quality care with integrity, honesty, and compassion
鈥⑻� 听Exhibit appropriate professional and interpersonal behaviors
鈥⑻� 听Practice medicine and Otolaryngology in an ethically responsible manner
鈥⑻� 听Recognize limitations and seek assistance as necessary
鈥⑻� 听Seek out and reflect on constructive criticism of performance
鈥⑻� 听Endeavor 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
鈥⑻� 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