OTOU-4002 - Acting Internship in Otolaryngology

OTOU-4002 - Acting Internship in Otolaryngology

Elective Type: clinical
    
Title
Acting Internship in Otolaryngology
Course Number
OTOU-4002
Duration/Weeks
3
Prerequisites: Successful completion of Year 3 
      Additional Requirements:
While the AI elective is designed for 4th year students planning on applying for a residency in otolaryngology, exceptions to the prerequisites will be made on a case by case basis and at the discretion of the director of the course.
Responsible Faculty Director:
Harold Pine, M.D.
Other Faculty:
Orly Coblens, MD; Shiva Daram, MD; Robert Darling, MD; Tomoko Makishima,MD, PhD; Brian McKinnon,MD, MBA; Vicente Resto,MD, PhD, FACS; Farrah Siddiqui,MD; Wasyl Szeremeta, MD; Dayton Young,MD
Location to Report on First Day
7.104 John Sealy Annex at 9:00 a.m.
Periods Offered
1-17
including holiday periods 9 & 10
Maximum Enrollment
6

Goals
1. To give a fourth year student a realistic appreciation of otolaryngology including life in the clinic and in the operating room.
2. To give a fourth year student exposure to all the different sub specialties within otolaryngology.
3. To give a fourth year student ample opportunity to see what spending a 5 year otolaryngology residency would be like at UTMB Galveston.
4. To give a fourth year student applying for an otolaryngology residency opportunities to meet and interact with our chairman, our residency director, and our director of medical student education.

Objectives
At the completion of a four week elective the student should be able to: 1. Obtain and evaluate the history of a patient with symptoms of disorders of the ear, nose, sinuses, mouth, pharynx, larynx and neck. 2. Perform a thorough examination of the above structures. 3. Evaluate and institute the appropriate treatment for the common causes of pain and discharge of the ear, deafness, tinnitus and vertigo. 4. Evaluate and institute the appropriate treatment for the common causes of nasal obstruction and discharge, epistaxis, sinus disease and face pain. 5. Evaluate and institute the appropriate treatment for the common causes of hoarseness, dysphagia, pain or discomfort in the throat, lumps in the neck and obstruction to the airway. 6. Evaluate and manage trauma of the head and neck regions (e.g. foreign bodies, ingestion of caustics, facial fractures, open and closed injuries to the neck). 7. Interpret an audiogram and results of vestibular testing and apply them to the patients complaints. 8. Demonstrate appropriate use of the otoscope, microscope and flexible laryngoscope.

Description of course activities
The Department of Otolaryngology is divided into different teams which are comprised of a faculty members and residents. These different teams have varying clinical responsibilities and also reflect the subspecialty interests in otolaryngology. The student will be encouraged to attach himself/herself to a number of these teams during his/her stay. In this way, he/she will be able to assist the ENT residents in the course of his/her
duties and obtain some continuity of care of individual patients. The duties will comprise working in the outpatient clinics (both adult and pediatric), on the wards and in the operating room. The student will be encouraged to visit the center for audiology and speech pathology and also the vestibular clinic. A selection of audiovisual aids from the departments library are recommended for the students use. Attendance at conferences, clinical ward rounds, and didactic sessions are strongly encouraged. A reading list is given to the student at the beginning of the rotation. As an acting intern, the student is a full time member of our departmental team, and is encouraged to accept a greater degree of clinical responsibility. There will be minimal on call obligation. Call is taken from home. This may include one weekend during the month long rotation. We recommend this elective for students contemplating otolaryngology as a career choice.

Type of students who would benefit from the course
Fourth year students interested in applying for an otolaryngology residency. All visiting students from other medical schools should sign up for this particular course.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 6:30 6:30
  Tuesday 6:30 6:30
  Wednesday 6:30 6:30
  Thursday 6:30 6:30
  Friday 6:30 6:30
  Saturday Variable and only if on call
  Sunday Variable and only if on call
   Average number of patients seen per week: 35  
   Call Schedule:   flexible for the students; 1-2 a week; one weekend a month; home call.  

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time variable
Self-Directed Study encouraged
Data-Collection/Analysis
Other There may be opportunities to get involved with a clinical research project during this rotation

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    daily
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback
Other

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty, residents and other students
  B. Frequency / Duration of Presentation(s)?
    Opportunities exist to give a short 20 minute oral presentation
  C. Format - What guidelines are set for the student's presentation?
    faculty discretion
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    There are no formal written assignments except to fill out an evaluation form at the end of the rotation. The students should be expected to help with clinic notes and H&P`s at the discretion of the individual teams and faculty.
  B. Format - What guidelines are set for the student's written work?
    hospital guidelines
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
   
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
   
  F. Audience - Who assesses the student’s written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
  Format
    Oral   Written multiple choice   Written essay / short answer   OSCE
Other

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    The acting Intern should be expected to participate in all the departmental activities for the particular month they are rotating on service.

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".
    None

7.  Other Modes of Evaluation
  Please explain below.
    Most students rotating through this elective will eventually want a letter of recommendation to help support their application for otolaryngology residency. Completion of this elective does not guarantee a letter of this kind and additional work on the part of the student may be required to garner such a letter. For visiting students who may request a letter, it is best to initiate this process early in the elective time. (Please make an appointment with the faculty member to discuss)

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.
    In the clinic setting and in the operating room, students will be given immediate feedback regarding their clinical skills. This may involve helpful hints for laceration closure, technical advice on use of our endoscopic equipment, and guidance for streamlining the head and neck exam and reading ENT related radiology films.
 
B.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.
    1. There are opportunities to work on soft tissue skills either by helping in the OR for incision closures or by helping in the ER for laceration repairs.
2. Students will get a chance to master tympanometry
3. Students should get an opportunity to perform flexible laryngoscopy
 
C.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?
    1. Depending on the caseload, students should get exposure to the facial nerve monitor.
2. Students may get exposure to ultrasound uses in the head and neck possible FNA of neck masses.
3. Students have opportunities to participate in advanced audiological testing and vestibular testing.
 
D.

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?
    At the current time, AIs do not have the official capability to write notes in EPIC or place orders in EPIC. We are working on unique ways to help students understand how to navigate the EMR system.
 
E.

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?
    Doing an AI in otolaryngology is a must for any student seriously considering a residency in this field. Students at this point are given more responsibility for knowing about their patients and helping to deliver care. Students will be exposed to the ACGME Otolaryngology Milestones and we will try and ensure that students have met all of the level 1 milestones before the end of the rotation.
 
F.

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?
    Verbal feedback will be given by the course director. Any striking deficiencies noted by the residents or faculty will be remediated on a case by case basis.
 
G.

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?
    Students should get a fair amount of time with most of our clinical ENT faculty. We will certainly make allowances to ensure face time with our chairman and residency director. Completing this AI rotation does not guarantee an automatic letter of recommendation. The student is highly encouraged to make a separate appointment with faculty somewhere in the middle of their rotation to ask for letters.
 
H.

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student’s abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.
    Students doing an AI will be supervised by both residents and faculty. Doing an AI does not guarantee they will be offered a letter of recommendation. Students need to approach individual faculty on a case-by-case basis and ask for a letter.