R2– FIRST YEAR OF RESIDENCY TRAINING IN OTOLARYNGOLOGY – HEAD AND NECK SURGERY

The residents rotate, for a period of 3 months duration, throughout the four teaching hospital sites:  

• Montreal Children’s  
• Montreal General
• Jewish General
• Royal Victoria hospitals

Junior residents (PGY2 & PGY3) at each hospital site are evaluated according to their specific exposure using the One45 system. These evaluations are different from the senior residents (PGY4 & PGY5) evaluations.

During the first year of residency in Otolaryngology – Head and Neck Surgery, residents are expected to develop proficiency in:

1.    Obtaining the otolaryngological history and performing physical examination.  This includes:

• use of head mirror and headlight
• nasopharyngoscopy using the mirror, the flexible nasopharyngoscope and the telescopes
• indirect laryngoscopy using mirror and flexible nasopharyngolaryngoscope
• use and interpretation of videostrobolaryngoscopy with flexible and rigid scopes
• otoscopy
• use of the operating microscope in the examination and management of ear disease
• evaluation of facial nerve function

2.    Performance and interpretation of audiological and vestibular tests

3.    Interpretation of medical imaging techniques

4.    Management of common otolaryngological emergencies:

• epistaxis (cautery, anterior and posterior packing)
• airway problems (foreign body, epiglottitis, croup, upper airway obstruction)
• Perform open and percutaneous tracheostomy
• esophageal emergencies (foreign body, caustic ingestion)
• peritonsillar and deep neck infections
• facial trauma
• the dizzy patient
• acute otitis media, otitis media with effusion and otitis externa

5.  Operative objectives
a)    Gain experience and proficiency in the following:

• Pre and post operative patient care management
• Clinical procedures, fine needle aspiration, cytotology (FNAB), biopsy, excisional biopsy
• Tonsillectomy and Adenoidectomy (T&A)
• Myringotomy and ventilating tubes
• Microdebridement of ears
• Development of principles of soft tissue surgery, e.g.: suturing techniques
• Tracheotomy
• Direct laryngoscopy, bronchoscopy and esophagoscopy
• Assistance at major head and neck surgery

b)    acquire experience in the following procedures with adequate supervision near the
end of the first year of training:

• Septoplasty
• Nasal polypectomy
• Sinus surgery
• Removal of lumps and bumps
• Microlaryngeal surgery

6. Residents are introduced to the techniques of temporal bone surgery by attending a bone drilling course held annually at the temporal bone lab.

7. Didactic objectives: Residents should be involved in seminars, lectures, rounds and teaching of medical students and clerks.

8. In this first year of otolaryngology, careful attention is directed to matters of ethical and responsible behavior, and ability to work with and relate well to fellow members of the medical team.

MONTREAL CHILDREN’S HOSPITAL (R2 PEDIATRIC JUNIOR ROTATION)

R2 Residents rotate as a junior pediatric otolaryngology resident at the MCH.
Junior pediatric R2 residents at the MCH are evaluated according to their specific objectives using the one45 system. These evaluations are different from the senior residents (R3) evaluation. The ITER Junior MCH forms are available in One-45)

The expert objectives are:

Clinic:    
•    Attend clinics and coordinates his/her time with the OR schedule
•    Do consultations during the weekdays and discuss them with the senior resident and attending staff.
•    Perform flexible endoscopy in infants and children
•    Microsopic ear examination and debridment
•    Nasal packing, foreign body removal, cautery epixtasis
•    Pre-op clinic

In-patients:          
•    Responsible for the consultations when the senior resident is not available
•    Performs rounds with the senior resident and/or attending staff and plans the management and follow-up on admitted patients on the different hospital wards, emergency room including ICU

O.R.:
•    Responsible for minor cases (T&As, PET tubes, etc..)    
•    Assist the senior resident on all other surgeries
•    Assist in the O.R. on all cases when “On Call”

Pediatric Audiology Montreal Children’s Hospital Rotation

Each resident will be responsible to spend a sufficient amount of time in the Audiology department at the MCH during his/her rotation.  The resident will be required to gain knowledge of pediatric audiometric testing.  An oral exam will be given to each resident on audiology prior to completion of the rotation.  The results of the examination will be recorded.

JEWISH GENERAL HOSPITAL (R2 JUNIOR RESIDENT ROTATION):

• The R2 year will focus on acquiring expertise in obtaining an appropriate history and performing a comprehensive head and neck examination.
• Residents at the R2 level should focus on acquiring a sound basic science knowledge base in head and neck anatomy and physiology as they pertain to otolaryngology.
• The R2 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
• The OR responsibility will progress with the resident’s seniority and individual abilities.
• Junior residents (R2 & R3) at each hospital site are evaluated according to their specific exposure using the one45 system. Evaluations forms are different from the senior residents (R4 & R5) evaluation. (The JGH Junior ITER is available on one45)
• The main exposure / evaluation of the residents at the JGH in descending priority order are in the domains of:

• head and neck surgery
• otology
• rhinology
• laryngology
• facial plastic reconstructive surgery
• general otolaryngology

Royal Victoria Hospital (R2 JUNIOR RESIDENT ROTATION):

• Junior residents (R2 & R3) at each hospital site are evaluated according to their specific exposure using the one45 system. Evaluation forms are different from the senior residents (R4 & R5) evaluation.. The Junior RVH ITER is available on One-45.
• The main exposure / evaluation of the residents at the RVH in descending priority order are in the domains of:

o    head and neck surgery
o    Neurotology, skull base neurotology procedures are performed at the Montreal Neurological Institute (MNI)
o    rhinology
o    facial plastic reconstructive surgery
o    otology
o    laryngology
o    general otolaryngology

MONTREAL GENERAL HOSPITAL (R2 JUNIOR RESIDENT ROTATION):

• Junior residents (R2 & R3) at each hospital site are evaluated according to their specific exposure using the One45 system. Evaluation forms are different from the senior residents (R4 & R5) evaluation. The Junior MGH ITER is available on One-45.
• The main exposure / evaluation of the residents at the MGH in descending priority order are in the domains of: 
• Laryngology, residents are exposed to numerous laryngological procedures in  the voice lab and dysphagia clinic
• Otology 
• Head and neck surgery
• General otolaryngology