OTOU-4001 - Clinical Otolaryngology

OTOU-4001 - Clinical Otolaryngology

Elective Title: Clinical Otolaryngology
Course Number: OTOU-4001
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 6
Prerequisites: Successful completion of Year 2
Additional Requirements: N/A
Responsible Faculty Director: Harold Pine, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Roxann Ortiz, Patricia Garza, Melinda Trevino Other Faculty: Orly Coblens, MD; David Bracken, MD; Robert Darling, MD; Yusif Hajiyey, MD, PhD; Tomoko Makishima,MD, PhD; Brian McKinnon,MD, MBA; Viran Ranasinghe, MD; Vicente Resto,MD, PhD, FACS; Farrah Siddiqui,MD; Sepehr Shabani, MD; Dayton Young,MD
Location to Report on First Day:
email will be sent out & information for 1st day as student will report to a clinic or OR

1. To manage common ENT problems that are encountered in an otolaryngology practice 2. To identify patients that require prompt referral for effective management and cure (e.g. otitis media with impending intracranial complications, early cancer of upper respiratory tract).

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 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 patient's complaints.

Description of course activities
The Department of Otolaryngology is divided into different teams which are comprised of a faculty member and resident. 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 at least two of the teams during his/her stay. In this way, he/she will be able to assist the ENT resident in the course of his/her duties and obtain some continuity of care of individual patients. The duties will comprise of working in the outpatient clinics (both adult and pediatric), on the wards and a variable period of observation 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 department's library are recommended for the student's use. Conferences and clinical ward rounds are regularly scheduled. A reading list is given to the student at the beginning of the rotation.

Type of students who would benefit from the course
All types of students, especially those intending a career in otolaryngology. This rotation would also be suited for anyone considering a career in family medicine or pediatrics. It is a fast paced rotation that involves time in the clinic and operating room.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM
Monday 7:00 5:00
Tuesday 7:00 5:00
Wednesday 7:00 5:00
Thursday 7:00 5:00
Friday 6:30 5:00
Saturday none none
Sunday none none

 Average number of patients seen per week: 35
 Call Schedule: optional but encouraged for those seeking a career in otolaryngology

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study
Other No research activities required but are willing to help with clinical projects at the request of individual students

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?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
  B. Frequency / Duration of Presentation(s)?
    Two cases per week.
  C. Format - What guidelines are set for the student's presentation?
    Patient presentations, recitations based on (provided) textbook.
  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)?
    Each student will receive a booklet that helps you keep track of the faculty you work with and the kinds of procedures you participate in. Get the residents and faculty to help sign off on the various things we want you to accomplish while on service. We also expect at the end of the rotation that the student will fill out an evaluation form.
  B. Format - What guidelines are set for the student's written work?
  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
    Oral   Written multiple choice   Written essay / short answer   OSCE

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)?
    We expect the students on this rotation to participate fully with all the activities of the department. This includes didactic sessions for the residents and departmental wide conferences like M&M and Grand Rounds. While taking call in not required, for students planning on applying to ENT, this may be a useful additional activity which we can arrange on a case by case basis. Any call would be from home.

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".

7.  Other Modes of Evaluation
  Please explain below.
    Practical examination: observed performing ENT exams, book with assigned chapters (recitation,) students may create multiple-choice questions that are compiled for a possible quiz if necessary.

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.

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.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

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)?

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?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

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.