PGY3 residents rotate as a senior pediatric otolaryngology resident at the MCH for 3 months. Senior pediatric PGY3 residents at the MCH are evaluated according to their specific objectives using the One45 system. Evaluations forms are different from the junior residents (PGY2) evaluation. (The senior MCH ITER is available on One-45). All residents must undergo a STASER (Standardized Assessment of a Clinical Encounter) or STACER (Standardized Assessment of a Surgical Encounter) evaluation by a MCH staff person during each of their rotations at the hospital. They are also evaluated by 360 degree inter-professional evaluation (feedback from allied health care personnel, nurses, secretaries)
1. MEDICAL EXPERT
The residents attend the different specialty clinics, pediatric tumor boards and interact with other members of clinical departments. Their role as medical experts is illustrated in such activities. They express, discuss, teach and learn the various opinions regarding the investigation and treatment of challenging medical conditions and therapeutic protocols.
The Expert Role specific objectives are:
• General skills
- Assess children with ENT emergencies and manage them with limited consultant intervention
- Assess the pediatric airway in ER, PICU, NICU with formulation of diagnosis and management plan
- Participate in the post-operative ward and office management of patients who have undergone general head and neck surgery, otologic surgery, and pediatric otolaryngological procedures
- Demonstrate a sophisticated approach to imaging studies including independent interpretation of findings
- Interpret X-ray and cross-sectional imaging of temporal bones, paranasal sinuses, and soft tissues of the head and neck in children
- Become familiar and run the specialty clinics in Laryngology, Combine Reflux/ENT, Rhinology, Otology, drooling and dysphagia
• Pediatric Otolaryngology
- Know the indications for pediatric tracheotomy, perform the procedure, and manage the patient post-operatively
- Perform rigid esophagoscopy with or without removal foreign body with limited consultant intervention
- Perform pediatric rigid bronchoscopy with or without removal of foreign body
- Assist at and begin to perform airway reconstruction in the pediatric population (e.g. laryngotracheoplasty)
- Differential diagnosis and management of a pediatric neck mass
- Endoscopic sinus surgery in children
- Pediatric syndromes and management of associated H&N problems
- Know the indications, complications and anatomy of common performed surgeries
• Pediatric Otology
- Be able to perform and interpret conventional audiometry and tympanometry in children
- Understand the principles and application of auditory brainstem response (ABR) and Otoacoustic Emissions (OAEs) & ENG testing
- Classification scheme and approach to management of common congenital and acquired causes of pediatric hearing loss
- Demonstrate a sophisticated approach to auditory and vestibular rehabilitation including surgical and non-surgical options
- Perform tympanoplasty with limited consultant intervention
- Perform ossiculoplasty with consultant supervision
- Perform mastoidectomy with consultant supervision
- Know the indications, complications and anatomy of common performed surgeries
• Pediatric Head and Neck Surgery
- Effectively manage pain associated with head and neck surgery
- Participate in the post-operative ward and office management of patients who have undergone general head and neck surgery
- Interpret X-ray and cross-sectional imaging of soft tissues of the head and neck
- Perform lymph node and neck mass biopsy with decreasing degree of consultant intervention
- Perform excision of submandibular glands with decreasing degree of consultant intervention
- Perform parotidectomy with increasing degree of autonomy
- Perform neck dissections with increasing degree of autonomy
- Perform excision of branchial cleft cysts and thyroglossal duct cysts with gradually decreasing degree of consultant intervention
- Perform thyroidectomy, parathyroidectomy with decreasing degree of consultant intervention
- Perform excision of oral cavity lesions with and without laser
- Know the indications, complications and anatomy of common performed surgeries
• Pediatric Laryngology
- Perform indirect rigid laryngoscopy and videostroboscopy
- Participate actively in the Voice Lab including focused history and relevant physical examination
- Diagnose and manage pathology of the glottis (e.g. nodules, cysts)
- Management of vocal cord paralysis including investigation, medical therapy, and surgical therapy
- Perform microlaryngoscopy with gradually decreasing consultant intervention
- Perform microlaryngeal surgery with microlaryngeal instruments, CO2 Laser, microdebrideur
- Understanding of intraoperative airway management during microlaryngeal surgery
- Perform, with supervision, endoscopic laser resections of early tumors of the larynx
- Diagnosis and management of airway and aerodigestive trauma
- Know the indications, complications and anatomy of common performed surgeries
The expert objectives duties are carried by:
Clinic:
• staff the clinic
• do consultations during the weekdays and discuss them with the attending staff
• pre-op clinic (if junior is not available)
In-patients:
• responsible for the consultations
• organizes rounds with the junior resident and attending staff regarding admitted patients
O.R.:
• responsible for surgical procedures other than minor cases
o head and neck cases
- excision benign and malignant masses, e.g. thyroglossal duct cyst, branchial cleft cyst, neck nodes and masses
- incision of superficial and deep neck abscess
- pediatric tracheostomy
o otology cases
- tympanoplasty
- various types of mastoidectomy
- pre-auricular sinus excision
- exposure for BAHA (bone anchored hearing aids)
o rhinology cases
- endoscopic sinus surgery – FESS
- external sinus surgery
- nasal polypectomy
- septoplasty
- turbinate surgery
- epistaxis control procedures
o endoscopic cases
- laryngoscopy
- bronchoscopy
- esophagoscopy
o facial plastics and reconstructive surgery cases
- Otoplasty
- Rhinoplasty
• assist in the O.R. when “On Call”
• assign the junior resident operating room schedule
Other:
• cross-cover the other adult hospital when on call at the MCH
• shares responsibilities for weekend coverage of admissions and in- patients with the junior resident
Pediatric Audiology Montreal Children’s Hospital Rotation
Each resident will be responsible to spend 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 prior in Audiology prior to completion of the rotation. The results of the examination will be recorded.
Temporal Bone Dissections
Each resident will be responsible for completing one anatomical dissection of a temporal bone during his/her pediatric rotation. The results of the dissection will be recorded. This dissection is MANDATORY as a requirement in order to pass the rotation at the MCH.
MCH Resources for Residents
• Pediatric Otology:
Training of residents in all aspects of medical and surgical pediatric otology that include otitis media and performing different types of tympanoplasties and mastoidectomies including ossicular chain reconstruction. The resident also gain experience in pediatric audiology. Different sessions are given in combination with the Audiology Department on aural rehabilitation and hearing aid assessment for children. The resident will have experience in BAHA surgery as the MCH is a leader in that field.
• Nose and Sinuses:
All medical and surgical aspects of rhinology are covered. The residents perform endoscopic sinus surgery.
• Aerodigestive diseases:
This includes diagnosis and treatment of foreign bodies of the aerodigestive tract, congenital and acquired laryngotracheal problems. The O.R. at the MCH is equipped with laser technology and is one of the few centers in North America that manages these kinds of pathologies. The resident is involved in the treatment of these conditions throughout his rotation at the hospital. There is a specialized airway clinic and the resident is exposed to a multidisciplinary approach to pediatric airway problems.
• Specialty clinics: residents exposed to specialty clinics in otology, airway, reflux, dysphagia, and saliva. These clinics focus on more complicated cases involving these domains.
• Pediatric oncology:
In association with the Hematology/Oncology departments and Radiotherapy, the residents are involved in the treatment of head and neck tumors including lymphomas, rhabdomyosarcomas, etc.
• Research:
The resident is involved with different basic and clinical research projects during his/her rotation at the MCH. All our physicians are keen on research. The newly established McGill Auditory Sciences Laboratory under the supervision of Dr. S. Daniel is located at the hospital and provides an excellent opportunity for basic science research.
• Formal teaching sessions:
In addition to hospital rounds, formal teaching sessions are provided on a weekly basis by the residents which are supervised by an attending staff.
• Feedback and Evaluation:
The residents should expect to get at a minimum 2 one-on-one feedback session with the director Dr Sam Daniel who will summarize the feedback provided by the staff physicians and discuss any issues pertaining to the service. Also the attending staff gives verbal feedback at mid-rotation and at the end of rotation.
2. COMMUNICATOR
The resident is evaluated throughout his rotation by the members of the staff as a communicator with the parents and patients. The interview, gathering of clinical information, explanation of the different therapeutic modalities as well as performing the different clinical tasks are the bases of the evaluating process. Both verbal and written communication is emphasized. An important percentage of our patient population has different ethnic background. An interpreter is always present during these interviews. This constitutes an additional challenge to the resident who is an essential part of the clinic team. The department uses the McGill Simulation Center annually, hiring actors to portray patients in certain scenarios, to teach residents the communicator role of CanMEDS.
The communicator role is evaluated especially on:
- Demonstrate effective establishment of therapeutic relationships with patients and their families
- Present histories, physical findings, and management plan to consultants in an organized, efficient, and confident manner
- Obtain and synthesize relevant history from patients, their families, and communities
- Prepare clear, accurate, concise, appropriately detailed clinical notes, consultation notes, discharge summaries, and operative reports
- 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
- Prepares, participates, and presents effectively in organized rounds and seminars
- Know the indications, complications and anatomy of common performed surgeries
3. COLLABORATOR
The resident role as collaborator is evident during daily interactions with the other physicians and allied health professionals. He is the first member of the team to evaluate the patient’s needs and direct the family to the appropriate professional. Examples include: social workers, occupational therapy, audiology, speech therapy, physiotherapy, etc. The collaboration with the different divisions and departments is also of paramount importance. The daily contact with these services constitutes a major task in the resident’s clinical activity and reflects an important image on the role of Otolaryngology within the MCH. The department uses the McGill 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:
- Identify the situations and instances where consultation of other physicians or health care professional is useful or appropriate
- Demonstrate collegial and professional relationships with other physicians, office and clinic support staff, operating room personnel, and emergency room staff
- Recognize the expertise and role of allied health professionals such as speech language pathologists, audiologists, technicians, nurses, and clerical staff
4. MANAGER
The resident role as manager is also elucidated in his daily activities, managing and planning his schedule and supervising the junior members of the team. The wise and proper use of the different hospital services is taken into consideration during the evaluation process. Ordering laboratory, radiological investigations and adopting different therapeutic modalities reflect important points in this process. The members of the team help to guide the senior and junior residents throughout the hospital rotation to this important aspect of medical practice. The department uses the McGill 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:
- Demonstrate ability to lead a health care team
- Utilize resources effectively to balance patient care duties, learning needs, Educational/teaching responsibilities and outside activities
- Allocate finite health care resources in a wise, equitable, and ethical fashion
- Utilize information technology to optimize patient care and life-long learning including facile use of hospital IT resources (e.g. filmless radiology, electronic charting)
- Demonstrate an appreciation of the importance of quality assurance/improvement
- Actively participate in preparation, presentation, analysis, and reporting of morbidity and mortality rounds
- Accurately identify criteria for patient admission to hospital in the urgent/emergent situation as well as the implications of such decisions
5. HEALTH ADVOCATE
He/she is a health advocate and role model for the young parents and teenagers, teaching them about the dangers and prevention of noise induced hearing loss, promote choking prevention in children, as for teenagers promote risk reduction of head and neck malignancy through smoking cessation, responsible alcohol use and UVA/UVB protection.
The manager role is evaluated especially on:
- Recognize and respond to opportunities for advocacy within Otolaryngology, both for your patients as well as for the community in which we practice
- Demonstrate familiarity with important determinants of health relevant to Otology such as environmental noise exposure
- Encourage behaviors that promote hearing protection and conservation at work and at home
- Recognize and promote policies that enable early identification of hearing impairment through infant and childhood screening programs
- Facilitate patients' access to local and national resources available for the hearing impaired
- Promote choking prevention in children
- For teenagers promote risk reduction of head and neck malignancy through smoking cessation, responsible alcohol use and UVA/UVB protection
6. SCHOLAR
Hospital rounds are presented once a week on Mondays at 4pm. Attendance is compulsory for the attending staff, fellows, residents and medical students who happen to be doing “elective rotations” at this time. The senior resident is responsible for the contents and scientific material. The senior resident may delegate the presentation of the rounds to a junior resident or share this responsibility with a student. During the hospital rounds, many clinical cases are discussed. A review of the pertaining literature is usually presented, and the opinions of the different members are expressed. It is through this forum and other similar daily discussions that the resident’s role as a scholar is demonstrated. Every year a resident presents a research project at our annual Resident Research Day/James D. Baxter Lecture held in the spring.
The scholar role is evaluated especially on:
- Actively participate in the teaching of medical students (didactic, in clinics, and on wards/in OR)
- Facilitate learning in patients and other health professionals
- Actively participate in preparation and presentation of weekly Grand Rounds
- Demonstrate a critical appraisal of research methodology, biostatistics, and the medical literature as part of monthly Journal Clubs
- Practice the skill of self-assessment
- Develop, implement, and monitor a personal Educational strategy and seek guidance for this Educational strategy as appropriate
- Demonstrate the evolving commitment to, and the ability to practice, life-long learning
- Contribute to the development of new knowledge through participation in clinical or basic research studies
- Demonstrate commitment to evidence based standards for care of common problems in Otolaryngology
- Actively participate in weekly academic round series including advance preparation for the topic(s)
7. PROFESSIONAL
The residents must demonstrate professionalism by demonstrating the highest standards of excellence in clinical care and ethical conduct. This includes self-discipline, such as a sense of punctuality and respect for cultural diversity. They must address their peers, colleagues, staff and other allied health professionals with the utmost respect and courtesy. Residents are also expected to act as role models. Their sense towards responsibility toward the patients in terms of balancing their professional and personal lives is evaluated on an ongoing basis by their superiors, colleagues and other. The department uses the McGill Simulation Center annually, hiring actors to portray patients in certain scenarios, to teach residents the manager role of CanMEDS.
The professional role is evaluated especially on:
- Deliver highest quality care with integrity, honesty, and compassion
- Exhibit appropriate professional and interpersonal behaviors
- Practice medicine and Otolaryngology in an ethically responsible manner
- Recognize limitations and seek assistance as necessary
- Seek out and reflect on constructive criticism of performance
- 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