The Otolaryngology/Head & Neck Surgery Residency Training Program

Program Name: New York Presbyterian Hospital (Columbia & Cornell Campus) Program
ACGME ID#: [2803511074]
Sponsoring Institution: New York Presbyterian Hospital - Columbia and Cornell Centers (NYPH)
Participating Institution: Memorial Sloan Kettering Cancer Center (MSKCC)

Co-Program Directors:

Lanny Garth Close, MD
Howard W. Smith Professor & Chairman
Department of Otolaryngology/Head & Neck Surgery at NYPH-Columbia Center

Michael G. Stewart, MD, MPH
Professor & Chairman
Department of Otorhinolaryngology at NYPH-Weill Cornell Center

Site Directors:

Eli Grunstein , MD
at NYPH-Columbia Center

Samuel Selesnick, MD
at NYPH-Weill Cornell Center

Dennis Kraus, MD
at Memorial Sloan Kettering Cancer Center

Peter Costantino , MD
at St. Lukes-Roosevelt Hospital

Coordinator:

Iris Bernard
Residency Coordinator & Manager of Academic Affairs

Mailing Address:
Department of Otolaryngology/Head & Neck Surgery
630 West 168th Street, Box 21,New York, NY 10032
Office: (212) 305-3399 Main Office #: (212) 305-5820
Fax #: (212) 305-2249

Email Contact: ib2237@columbia.edu

Goals and Objectives – Columbia Site

CLICK HERE FOR A PDF OF THE GOALS AND OBJECTIVES

Adult Otolaryngology Consult Rotation

Goal:

The Otolaryngology/Head and Neck Surgery Residency Training Program of New York Presbyterian Hospital provides residents with complete education in the comprehensive medical and surgical care of patients with diseases and disorders that affect the ears, nose, throat, head, and neck. The educational program combines core basic knowledge of otolaryngology and the communication sciences with the clinical aspects of diagnosis and medical and/or surgical therapy for related ailments. At all levels of training, the ACGME Competencies are incorporated.

Learning Objectives:

The Adult Otolaryngology Consult resident is expected to develop skills and knowledge through a variety of mechanisms. During this year, the resident:

Continues to attend 2nd year of basic science series, during which content emphasized includes: radiologic oncology, laser physics, wound healing, laryngeal physics, voice measurement, language development, acoustics, auditory brainstem response, otoacoustic emissions, impact of hearing loss.

Understands the physiology of and repair techniques for small vessels.

Understands the rational, content, and implementation of diagnostic workup for neoplasms

Understand the rational and methodology for fracture evaluation, and the dynamics of fracture reduction

Builds on clinical skills developed as a first year resident

Develops skill with lasers after proper requirements are met

Performs direct laryngoscopy, esophagoscopy, and bronchoscopy in the operating room

Develops skill with the following procedures:

Submandibular gland excision

Thryoglossal duct cyst excision

Septoplasty

Turbinectomy

Nasal endoscopy

FESS

Caldwell Luc procedure

Develops skill in fracture management

Meets semiannually with peers to determine equity of distribution of operative cases

Develops a portfolio that reflects clinical, administrative, social, or psychological problems that have been encountered, how such problems should be solved, supportive relevant literature, and how future practice will be affected

Spends 3 months in a basic science laboratory or in an applied clinical research project

Carries out data collection with the mentor

Begins data analysis and drafting article in journal style

Develops skill in making professional research presentations

Schedules resident cases for surgery

Completes work hour surveys in a timely manner

Progression of Responsibilities:

By being in charge of the adult and ER consults, formulating diagnoses and treatment plans with the Attending and Chief resident, organizing the multidisciplinary Tumor Board conference, acting as the Fracture Resident, and by operating, the Adult Otolaryngology Consult resident acquires skills that prepare him/her for increasing responsibilities as a third year resident

Permitted to perform medical histories and physical examinations and to record such in patient charts. Also, formulation regarding diagnosis, treatment plans, progress notes, and doctor’s orders may be recorded in patient charts

Permitted to perform all the above and all procedures that a first year resident may perform plus the following additional procedures listed below

These procedures are performed under the direct visual supervision of an attending physician

After residents have completed the minimum required number, the resident may perform these procedures under direct supervision

Clinical skill progression:

By the end of the Adult Otolaryngology Consult rotation, and building on the skills developed in the previous years, the Adult Otolaryngology Consult resident should be able to perform the following procedures competently:

Cervical mass biopsy or sentinel node biopsy

Excision of soft tissue tumor

Repair complex laceration (all sites including intraoral)

Reduction of facial fractures – nasal

Resection of skin lesions and primary closure

Dermoid cyst excision

Cervical lymph node excision

Direct laryngoscopy – diagnostic except newborn

Flexible laryngoscopy

Stroboscopy

Diagnostic esophagoscopy (rigid or flexible)

Esophagoscopy and intervention

UPPP

Septoplasty

Turinbectomy/turbinoplasty

Tracheotomy < 4years of age

Interpret audiogram

Adult Otolaryngology Junior Rotation

Goal:

Learning Objectives:

The Adult Otolaryngology junior resident is expected to develop skills and knowledge through a variety of mechanisms. During this year, the resident:

Understands anatomy, physiology, embryology, pathology, genetics, the upper aerodigestive tract, the communication science (including audiology and speech pathology and rehabilitation), the chemical senses, prevention of disease, neoplasms, deformities, and disorders of the ears, face, neck, and mandible, plastic and reconstructive surgery, and allergy, and endocrinology and neurology as they relate to the head and neck

Develops thorough knowledge of head and neck anatomy

Identifies indications, risks, contraindications of a wide variety of Otolaryngologic surgical procedures for adult patients

Effectively presents description and analysis of cases

Develops understanding and knowledge of temporal bone anatomy, mastoid drilling technique, middle ear prostheses placement, implantable hearing devices.

Develops understanding of treatment of maxillofacial trauma using plating techniques

Effectively obtains medical histories and physical examinations of the head and neck

Effectively evaluates and treats common adult otolaryngologic problems (inpatient and outpatient)

Demonstrates effective placement of IV’s, drawing blood, performing ABG’s

Demonstrates responsibility in work assignments, including conference attendance

Provides preoperative and postoperative evaluations of patients

Manages Otolaryngologic admissions and discharges with complete documentation, prior to date of surgery or date of discharge

Communicates effectively with patients

Communicates effectively with other health care team members

Develops ability to triage and initiate care of adult otolaryngologic emergencies

Manages the service with guidance from the chief residents and relevant attendings

Develops facility with adult endoscopy, mangement of otitis media, sinusitis, dysphagia, and adult airway emergencies

Communicates effectively with patients

Begins to develop facility with tonsillectomy and adenoidectomy, microscopic otoscopy and myringotomy and tube (m&t) insertion

Develops facility with closed reduction of nasal fractures

Develops facility with flexible laryngoscopy

Develops facility with fine needle aspiration and oral biopsies

Develops facility with minor surgical procedures (ear lobe repair, incision and drainage, minor excisions, soft tissue trauma)

Develops facility with microscopic ear examination with cerumen removal

Develops facility with treatment of epistaxis

Meets semiannually with PGY peers to determine equity of distribution of operative cases

Develops skill in self-assesment regarding work quality

Applies ethical practice in clinical activities

Develops ability to work as part of a team

Develops ability to work within a health care network

Begins to develop facility in writing clinical administrative reports, as assigned

Begins to develop facility with instrumentation, i.e. fiberoptic laryngoscope

Demonstrates meticulous record keeping, entailing legible and accurate operative notes

Demonstrates legible and accurate notes in medical charts

Develops ability to obtain informed consent, with accurate and appropriate disclosure of risks and benefits of procedures

Completes work hour surveys in a timely manner

Progression of Responsibilities:

By learning to evaluate inpatient and emergency consults, by contributing to the post-operative care of a wide variety of Otolaryngology patients, by operating as outlined below, and by being in charge of the adult otolaryngology service, the Adult Otolaryngology junior resident acquires skills that prepare him/her for increasing responsibilities as a second year resident.

Clinical skill progression:

The surgical skills in the Adult Otolaryngology Junior Rotation build on those of the PGY1 year, with focus now on applications to Otolaryngology/HNS. By the end of the Adult Otolaryngology Junior Rotation, the resident will demonstrate competency in the following procedures:

Myringotomy/tympanostomy

Adenoidectomy

Tonsillectomy

Control of epistaxis (packing, endosopic control)

Incision and Drainage of deep neck space abscess

Adult Senior Resident Rotation

Goal:

Learning Objectives:

The Adult Senior Resident is expected to develop skills and knowledge through a variety of mechanisms. During this year, the resident:

Demonstrates an evolving mastery of the course content in Otolaryngology/HNS

Continues to acquire information about advanced topics in the field, such as medical and surgical aspects of disciplines of otology and neurotology, head and neck oncology, sinonasal surgery, and plastic and reconstructive surgery.

Builds on clinical skills developed as a first and second year resident

Develops skills to perform major head and neck procedures including parotidectomy, thyroidectomy, neck dissection, major vessel surgery, nerve grafting, craniofacial resection, and other ablative procedures

Develops skills to perform plastic procedures including myocutaneous flaps, free grafts, rhinoplasty, rhytidectomy, blepharoplasty, and facial reanimation

Develops microvascular surgical skills necessary to dissect, resect, manipulate, and repair small structures:

End-to-end arterial anastomosis techniques

Interrupted technique

Continuous suture technique

One-way-up technique

End-to-end venous anastomosis

Peripheral nerve reapir

Interpositional vein graft

Meets semiannually with peers to determine equity of distribution of operative cases

May participate with a faculty member in submission for grant funding, learning the method of grant preparation for various funding sources, and IRB requirements

Presents finding of required project or other research at local, regional, or national meeting

Submits article for publication

Carries out other guided research projects for faculty (may be other than research mentor)

Presents research findings

Supervises PGY2 and PGY3 residents

Observes the PGY2 residents and instructs them in clinic as well as in the operating room

Supervised the PGY3 year residents in the clinic as well as in the operating room for the following cases:

direct laryngoscopy

esophagoscopy

bronchoscopy

tracheotomy

Septoplasty

Turbinectomy

Basic facial fractures

Participates in major otologic surgery including middle ear exploration, acoutic neuromas, 8th nerve sections, stapedectomy, mastoidectomy, tympanoplasty, excision of glomus tumors, and reconstruction of aural atresia

Manages the outpatient otology clinic and generates ward cases where he/she is operative surgeon

Participates in all plastic procedures performed and runs the Tuesday plastic surgery clinic generating plastic surgery cases in which he/she will be operative surgeon

Participates in major head and neck as well as other major cases

Substitues for the chief while the chief is absent

Participates in all major Otolaryngologic surgeries in all realms of the specialty, including plastics, otology/neurotology, and head and neck surgery. Major head and neck procedures include parotidectomy, thyroidectomy, neck dissection, major vessel surgery, nerve grafting, craniofacial resection, and other ablative procedures. Plastic procedures include myocutaneous flaps, free grafts, rhinoplasty, rhytidectomy, blepharoplasty, and facial reanimation

Performs endoscopic sinus surgery

Performs medical histories and physical examination and records such in patient charts. Formulates diagnosis and treatment plans

Writes progress notes and doctor’s orders in patient charts

Completes work hour surveys in a timely manner, as specified by the program director

Progression of Responsibilities:

By functioning as the Adult Senior Resident, by overseeing the junior residents, by operating, and by substituting when the chief is away, and by taking back-up call overseeing more junior residents, the Adult Senior Resident acquires skills that prepare him/her for the increasing responsibilities as a fourth year resident

May assume some administrative duties as delegated by the program director

May act for chief resident in his/her absence

Develops increasing independence of function by taking back up call for junior residents.

Clinical skill progression:

The surgical skills in the Adult Senior Resident year build on those of previous years, with increasing emphasis on management of administrative responsibilities in addition to clinical skills. By the end of the Adult Senior Resident experience, the resident will demonstrate competency in the following procedures:

Drainage deep neck space abscess

Tympanoplasty

Mastoidectomy

Reduction of facial fractures – midface, mandible

Skin grafts

Thyroplasty

Laryngoscopy and intervention (micro)

Bronchoscopy, diagnostic (rigid or flexible)

Bronchoscopy and intervention

Sinus, endonasal and external approaches (nonendoscopic)

Sinonasal endoscopic

Incision and excision of oral cavity/tongue, benign

Submandibular gland excision

Excision lip

Pediatric Otolaryngology Junior Rotation

Goal:

Learning Objectives:

The Pediatric Otolaryngology junior resident is expected to develop skills and knowledge through a variety of mechanisms. During this rotation, the resident:

Develops thorough knowledge of head and neck anatomy

Identifies indications, risks, contraindications of a wide variety of Otolaryngologic surgical procedures for pediatric patients

Effectively presents description and analysis of cases

Develops understanding and knowledge of temporal bone anatomy, mastoid drilling technique, middle ear prostheses placement, implantable hearing devices.

Develops understanding of treatment of maxillofacial trauma using plating techniques

Effectively obtains medical histories and physical examinations of the head and neck

Effectively evaluates and treats common pediatric otolaryngologic problems (inpatient and outpatient)

Demonstrates effective placement of IV’s, drawing blood, performing ABG’s

Demonstrates responsibility in work assignments, including conference attendance

Provides preoperative and postoperative evaluations of patients

Manages Otolaryngologic admissions and discharges with complete documentation, prior to date of surgery or date of discharge

Communicates effectively with patients

Communicates effectively with other health care team members

Begins to develop facility with pediatric tracheotomy and trach changes

Develops ability to triage and initiate care of pediatric otolaryngologic emergencies

Manages the service with guidance from the Pediatric Otolaryngology senior resident and relevant attendings

Develops facility with pediatric endoscopy, management of otitis media, sinusitis, dysphagia, and pediatric airway emergencies

Communicates effectively with parents of pediatric patients

Begins to develop facility with tonsillectomy and adenoidectomy, microscopic otoscopy and myringotomy and tube (m&t) insertion

Develops facility with closed reduction of nasal fractures

Develops facility with flexible laryngoscopy

Develops facility with fine needle aspiration and oral biopsies

Develops facility with minor surgical procedures (ear lobe repair, incision and drainage, minor excisions, soft tissue trauma)

Develops facility with microscopic ear examination with cerumen removal

Develops facility with treatment of epistaxis

Provides support to audiologists in performing sedated ABR examinations of young children

Meets semiannually with PGY peers to determine equity of distribution of operative cases

Develops skill in self-assesment regarding work quality

Applies ethical practice in clinical activities

Develops ability to work as part of a team

Develops ability to work within a health care network

Begins to develop facility in writing clinical administrative reports, as assigned

Begins to develop facility with instrumentation, i.e. fiberoptic laryngoscope

Demonstrates meticulous record keeping, entailing legible and accurate operative notes

Demonstrates legible and accurate notes in medical charts

Develops ability to obtain informed consent, with accurate and appropriate disclosure of risks and benefits of procedures

Completes work hour surveys in a timely manner

Progression of Responsibilities:

By learning to evaluate pediatric inpatient and emergency consults, by contributing to the post-operative care of a wide variety of Pediatric Otolaryngology patients, by operating as outlined below, and by being in charge of the Pediatric Otolaryngology service, the Pediatric Otolaryngology junior resident acquires skills that prepare him/her for increasing responsibilities as a second year resident.

Clinical skill progression:

The surgical skills in the Pediatric Otolaryngology Junior Rotation

build on those of the PGY1 year, with focus now on applications to Pediatric Otolaryngology/HNS. By the end of the Pediatric Otolaryngology junior experience, the resident will demonstrate competency in the following procedures:

Tracheotomy (pediatric)

Myringotomy/tympanostomy

Adenoidectomy

Tonsillectomy

Control of epistaxis (packing, endosopic control)

Incision and Drainage of deep neck space abscess

Pediatric Senior Resident Rotation

Goal:

Learning Objectives:

The Pediatric Senior Resident is expected to develop skills and knowledge through a variety of mechanisms. During this year, the resident:

Demonstrates an evolving mastery of the course content in Otolaryngology/HNS

Continues to acquire information about advanced topics in the field, such as medical and surgical aspects of disciplines of pediatric otology, sinonasal surgery, plastic and reconstructive surgery, pediatric otolaryngology (including repairs of congenital defects and airway reconstruction)

Builds on clinical skills developed as a first and second year resident

Engages in surgeries to repair clefts of lips and/or palate, and follow up

Meets semiannually with peers to determine equity of distribution of operative cases

May participate with a faculty member in submission for grant funding, learning the method of grant preparation for various funding sources, and IRB requirements

Presents finding of required project or other research at local, regional, or national meeting

Submits article for publication

Carries out other guided research projects for faculty (may be other than research mentor)

Presents research findings

Supervises PGY2 and PGY3 residents

Observes the PGY2 residents and instructs them in clinic as well as in the operating room

Supervised the PGY3 year residents in the clinic as well as in the operating room for the following cases:

direct laryngoscopy

esophagoscopy

bronchoscopy

tracheotomy

Septoplasty

Turbinectomy

Basic facial fractures

Participates in major otologic surgery including middle ear exploration stapedectomy, mastoidectomy, tympanoplasty, and reconstruction of aural atresia

Manages the outpatient pediatric otolaryngology clinic and generates ward cases where he/she is operative surgeon

Substitues for the chief while the chief is absent

Participates in all major Otolaryngologic surgeries in all realms of the specialty, including otology, and pediatric ENT.

Performs endoscopic sinus surgery

Performs medical histories and physical examination and records such in patient charts. Formulates diagnosis and treatment plans

Writes progress notes and doctor’s orders in patient charts

Completes work hour surveys in a timely manner, as specified by the program director

Progression of Responsibilities:

By functioning as the Otology and Plastics resident, by serving as the pediatric senior in charge of the pediatric otolaryngology service and overseeing the pediatric junior residents, by operating, and by substituting when the chief is away, and by taking back-up call overseeing more junior residents, the Pediatric Senior Resident acquires skills that prepare him/her for the increasing responsibilities as a fourth year resident

May assume some administrative duties as delegated by the program director

May act for chief resident in his/her absence

Develops increasing independence of function by taking back up call for junior residents.

Clinical skill progression:

The surgical skills in the Pediatric Senior Resident year build on those of previous years, with increasing emphasis on management of administrative responsibilities in addition to clinical skills. By the end of the Pediatric Senior Resident experience, the resident will demonstrate competency in the following procedures:

Drainage deep neck space abscess

Tympanoplasty

Mastoidectomy

Reduction of facial fractures – midface, mandible

Skin grafts

Branchial cleft anomaly excision

Thyroglossal duct cyst excision

Lymphatic or vascular malformation excision

Choanal atresia

Thyroplasty

Diagnostic laryngoscopy – newborn

Laryngoscopy and intervention (micro)

Bronchoscopy, diagnostic (rigid or flexible)

Bronchoscopy and intervention

Sinus, endonasal and external approaches (nonendoscopic)

Sinonasal endoscopic

Incision and excision of oral cavity/tongue, benign

Tracheotomy Rotation

Goal:

Learning Objectives:

The Tracheotomy resident is expected to develop skills and knowledge through a variety of mechanisms. During this rotation, the resident:

Understands anatomy, physiology, and embryology, of the upper aerodigestive tract.

Understands the indications, benefits, risks, and alternatives of tracheotomy.

Develops thorough knowledge of head and neck anatomy

Develops understanding and knowledge of tracheal anatomy, tracheotomy technique, and the postoperative management of patients with a tracheotomy.

Effectively obtains medical histories and physical examinations of patients who are candidates for tracheotomy.

Effectively evaluates and treats patients with tracheotomy related complications.

Deonstrates ability to perform and interpret fiberoptic bronchsocopy via the tracheotomy stoma.

Provides preoperative and postoperative evaluations of tracheotomy patients

Communicates effectively with patients

Communicates effectively with other health care team members

Develops facility with tracheotomy tube changes

Manages the tracheotomy service with guidance from the chief residents and relevant attendings

Develops facility with flexible laryngoscopy

Meets semiannually with PGY peers to determine equity of distribution of operative cases

Develops skill in self-assesment regarding work quality

Applies ethical practice in clinical activities

Develops ability to work as part of a team

Develops ability to work within a health care network

Begins to develop facility in writing clinical administrative reports, as assigned

Demonstrates meticulous record keeping, entailing legible and accurate operative notes

Demonstrates legible and accurate notes in medical charts

Develops ability to obtain informed consent, with accurate and appropriate disclosure of risks and benefits of procedures

Completes work hour surveys in a timely manner

Progression of Responsibilities:

By learning to evaluate tracheotomy consults, by contributing to the post-operative care of tracheotomy patients, by operating as outlined below, and by being in charge of the tracheotomy service, the tracheotomy resident acquires skills that prepare him/her for increasing responsibilities as a second year resident.

Clinical skill progression:

The surgical skills in the tracheotomy rotation year build on those of the PGY1 year, with focus now on the ability to safely perform a tracheotomy in both elective and emergent situations. By the end of the tracheotomy rotation, the resident will demonstrate competency in:

Tracheotomy (adult)

Fiberoptic bronchoscopy via the tracheotomy stoma

Tracheotomy tube change

Flexible laryngoscopy

Columbia Chief Resident Rotation

Goal:

Learning Objectives:

The Columbia Chief Resident is expected to develop skills and knowledge through a variety of mechanisms. During this rotation, the resident:

Demonstrates mastery of the course content in Otolaryngology/HNS

Demonstrates mastery of the surgical techniques and medical management in Otolaryngology/HNS

Explores advanced techniques and adapts them to personal style

Under the supervision of the attendings, manages the service and is responsible for all patients on the otolaryngology service

Makes final decision regarding management under attending supervision

Runs the clinics under attending supervision

Supervises the ward service under attending supervision

Develops the resident call schedule

Assigns caseloads

Administers the service under attending supervision

Forms the link for resident feedback to the attending surgeons

Arranges grand rounds speakers

Completes work hour surveys in a timely manner, as specified by the program director

Participates in the education of junior residents

Teaches the medical students

Instructs junior resident in clinic and in the operating room

Meets semiannually with peers to determine equity of distribution of operative cases

Progression of Responsibilities:

Acts in a supervisory role within the operating room setting and when performing procedures outside the OR when the responsible attending is immediately available by telephone and readily available onsite when needed

The attending physician must be present for the key portion of the procedure. In an emergency situation, when a supervising physician is not present, the resident shall document the emergency treatment provided by said resident. This shall include the nature of the emergency, the treatment provided, and the contact of the supervising physician.

As chief resident, is fostered in development of skills in supervisory and administrative skills, such as organizing grand rounds schedule

Has an increased supervisory role over other residents (with attending coverage) and instruct them in clinic

Supervises (with attending coverage) in the operating room for the following cases:

direct laryngoscopy

esophagoscopy

bronchoscopy

tracheotomy

Septoplasty

Turbinectomy

Basic facial fractures

Attends a monthly meeting with the program director and associate director to explore resident concerns or feedback, and provide guidance on administrative responsibilities

Other administrative duties may be assigned as needed by the program director

Clinical skill progression:

The surgical skills in the Columbia Chief Resident rotation should reflect the development of a clinician who is prepared for general otolaryngologic practice or to enter into a fellowship training program to extend skills in a subspecialty. At the chief level, emphasis on development of administrative skills is important for future application in clinical practice. By the end of the Columbia Chief Resident rotation the resident will demonstrate competency in the following procedures:

Parotidectomy

Submandibular gland excision

Other salivary gland procedures

Excision lip

Incision and excision of oral cavity/tongue

Local resection tumor (tongue/floor of mouth)

Glossectomy

Neck dissection

Thyroidectomy, Parathyroidectomy

Ossicular reconstruction

Stapedectomy

Labyrinthectoy

Cochlear implant

Rhinoplasty

Reduction of facial fractures – frontal

Osteoplastic flap – frontal sinus

Endoscopic sinonasal, extended (frontal and sphenoid)

Regional flap reconstruction

Flap reconstruction facial defects (advancement, bilobe, rhomboid, etc)

Administer and interpret allergy skin test

Laryngoplasty

Resident Manual (Columbia Site)

Department of Otolaryngology/Head and Neck Surgery

New York Presbyterian Hospital

Columbia Campus

Columbia College of Physicians and Surgeons

Eli Grunstein, MD – Site Director

Lanny Garth Close, MD - Department Chairman and Co-Residency Program Director

CLICK HERE FOR A PDF OF THE RESIDENT MANUAL

INTRODUCTION

The resident staff at the Columbia Campus of the New York Presbyterian Hospital Department of Otorhinolaryngology consists of six residents: one chief resident, two PGY-4 residents, one PGY-3 resident, and two PGY-2 residents. Physician Assistants (P.A.) students, medical students, non-ENT residents (such as Anesthesiology), and PGY-1 Otolaryngology residents may rotate on the service, and are incorporated into the resident clinical and academic team. Written evaluations of their performance by the resident staff may be required.

ACADEMIC PROGRAM

Departmental Conferences:

It is the responsibility of the chief resident to distribute and collect the attendance sheets after each of the Departmental academic conferences below.

Columbia Monthly Grand Rounds

The Columbia Monthly Grand Rounds takes place on the 2nd and 4th Thursdays of each month from 7:00 AM until 9:00 AM. Grand Rounds are held in the Department conference room HP8. Guest speakers, Columbia faculty, and residents may present at Grand Rounds. Tumor board, M&M, QA/PI, and Journal club also occur during this time. This is followed by resident preparation for the boards from 9:00 AM until 10:00 AM.

Columbia Weekly Departmental Academic Conferences

There are several weekly departmental academic conferences.

A. Weekly Pediatric Otolaryngology meeting

Every Monday at 4:00 pm, the Pediatric Otolaryngology full-time faculty and residents attend a review of all in-patients and consultations on the service. In addition, any active quality management issues are also discussed. Emphasis is placed on improving patient care and avoiding complications.

B. Tumor Board

Otolaryngology head and neck attendings, residents, and Radiation Oncology and Medical Oncology faculty and residents attend Tumor Board, which occurs once per month on Thursdays at 8:00 am in the HP8 conference room. The cases are presented and organized by the PGY-3 Otolaryngology resident.

C. Radiology Rounds

Neuroradiology attendings, Otolaryngology attendings, and Otolaryngology residents attend weekly radiology rounds on Monday mornings at 8:00 am in the Neuroradiology reading room on Millstein 3rd floor. The interpretations and comments on the imaging studies presented are intended to aid the clinician in patient management, and to teach the resident staff.

D. Journal club

Otolaryngology attendings and residents attend Journal Club, which occurs once per month on Thursdays at 8:00 am in the HP8 conference room. Journal article discussions are held on relevant and contemporary articles.

Resident Head and Neck Dissection Course

Goals:

The anatomical dissection course gives the resident staff the opportunity to learn head and neck anatomy through coordinated didactic teaching and dissection.

Course Format

Each Wednesday night the course meets from 6:00 - 9:00PM for a 9 week period usually beginning in July and typically ending in September. The first and second year otolaryngology residents will meet in the Department of Otolaryngology Conference Room in the Weill Greenberg Center. Attendance is mandatory. Senior residents will be responsible for first call at each institution while the course is in session.

Recommended Texts:

Grant’s Atlas & Textbook of Anatomy

Lore’s Atlas of Head & Neck Surgery

Montgomery’s Atlas of Head & Neck Surgery

Netter’s Atlas of Anatomy

Session Format

One faculty member will oversee each session. Residents should arrive promptly in scrub attire. Each week a different resident will be assigned a topic for presentation. That resident will review anatomy textbooks and surgical atlases (i.e. Grant’s Anatomy, Lore’s Atlas of Head and Neck Surgery) to prepare a 15-minute presentation of relevant anatomy and surgeries of the region. The faculty member will then comment on the resident lecture material. A thorough outline of the presented material should be prepared by the assigned resident for distribution to all attendees. The didactic portion of the session should be limited to no more than one-half hour in total.

Residents then divide themselves into equal groups, and participate in the dissection in the Gross Lab, Room A – 001. The faculty member will oversee the cadaver dissections. At the conclusion of the dissection session, the resident staff will clean the dissection area and the instruments used during that session.

RESEARCH OPPORTUNITIES AT THE COLUMBIA CAMPUS

Clinical Research is supervised by the full-time and voluntary faculty of The Department of Otolaryngology. These projects may involve collaborative efforts with other clinical and basic science departments. Departments with which our Faculty and Residents have collaborated include Neurosurgery, Neurology, Pathology, and Radiology, Anesthesiology, Plastic Surgery, Oncology, Pediatrics, and Pulmonology.

The Otolaryngology Faculty also collaborate with many basic scientists. Please see individual faculty members to discuss these projects.

COLUMBIA CAMPUS FACILITIES

Conference Rooms

The Department of Otolaryngology Conference Room is located in the Harkness Pavilion at 180 Fort Washington Avenue, New York, NY. Depending on room configuration, up to 60 people can be accommodated.

Columbia Faculty Conference Room / Library is located on the 8th floor of the Harkness Pavilion. Depending on configuration, 25 attendees can be accommodated.

The Otolaryngology Resident Conference Room/Library is located on Millstein 7th floor.

The Columbia University Medical Library is located on the first floor of the Hammr Health Science building on Fort Washington Ave. and 168th Street.

FUNDING FOR RESIDENT RESEARCH TRAVEL – from Resident Policy Manual

The Reimbursement will be issued by the primary institution of the sponsoring physician. (Sponsoring physician = Author or co-author of paper)

Any resident presenting a paper or poster presentation at the American Academy of Otolaryngology – Head and Neck Surgery Fall Meeting or Triological Sectional or COSM Meeting will be allotted:

Maximum of $1000.00 for traveling expenses for a paper presentation.

Maximum of $550.00 for traveling expenses for a poster presentation.

Presentations at other meetings will be considered on a case-by-case basis.

Reimbursement will cover registration fee, transportation, lodging and meals only.

To be eligible for this funding the following must be met:

1. A written request must be submitted to the Chairman for approval at least 4 weeks before the event.

2. All requests must be written in memo form and addressed to the Chairman.

3. The request must include the following:

a. The type of Presentation: Paper or Poster Presentation

b. Event

c. Travel dates

d. Name of topic

e. Brief abstract of the presentation

f. Name of Sponsor

g. All original receipts must be submitted

CLINICAL PROGRAM

Clinical Resources: The Department of Otolaryngology Residents serve in the in-patient Millstein Hospital and the Morgan Stanley Children’s Hospital of The New York Presbyterian Hospital-Columbia Campus. The faculty offices are located on HP7 and HP8, and Babies Hospital 501 north.

Adult Service:

Morning Rounds: The chief resident leads adult ward rounds, and reviews the in-patient and consult list with the attending of record or the attending on call. The chief resident assigns floor tasks for the inpatients, and also assigns resident coverage for operative cases.

Adult Consultations: The PGY-3 resident is responsible for adult consults. Changes in assignment of consult residents must be approved by the Residency Site Director. Consultations are to be performed in a timely manner. All consults are reviewed with the chief resident and the attending on call.

Pediatric Service:

Morning Rounds: The pediatric PGY- 4 resident leads pediatric ward rounds, and reviews the in-patient and consult list with the attending of record or the attending on call. The PGY- 4 resident assigns floor tasks for the inpatients, and also assigns resident coverage for operative cases.

Pediatric Consultations: The PGY-2 pediatric resident is responsible for pediatric consults. All pediatric consults are discussed with the PGY- 4 or chief resident, and the on call attending.

For inpatient consultations, there is a consultation room with appropriate equipment in the 3 West pre-op area. However, some patients have conditions that preclude their transportation. For example:

1. Patients in an ICU setting.

2. Patients requiring telemetry.

3. Patients on ventilators.

4. Patients requiring a stretcher for transport.

5. Premature infants.

6. Patients with unstable respiratory conditions.

7. Patients unable to withstand 2 hours off the in-patient floor.

8. Patients with impaired mental status and those with physical limitations who could not be left unattended for short intervals of time.

9. Patients that are incontinent of bowel and/or bladder.

10. Patients with IV medication that require continuous monitoring

11. Patients with blood or blood product infusing.

Out Patient Clinic:

The Otolaryngology clinic is held on VC10. The clinic schedule is as follows:

Monday 9:00 am to 12:00 pm – Pediatric Otolaryngology clinic

Monday 1:00 pm to 4:00 pm – General Otolaryngology and Pediatric Otolaryngology clinics

Tuesday 1:00 pm to 4:00 pm – General Otolaryngology and Facial Plastic surgery clinics

Wednesday – no clinic

Thursday 1:00 pm to 4:00 pm – General Otolaryngology and Otology clinics

Friday 1:00 pm to 4:00 pm – General Otolaryngology and Head and Neck Surgery clinics

An assigned attending supervises the clinic. The clinic must always have two residents for coverage, and all available residents are expected to be in clinic unless required for a specific surgery, or an urgent consult. If a resident is on vacation or at a meeting, the Residency Site Director can limit the number of scheduled patients to be seen, if notified in advance. Follow-up of the results on all tests performed on clinic patients is the resident's responsibility. All outpatient charts are entered into the computerized Eclipsis system by residents and attendings. All surgical cases must be reviewed by the attending that will be supervising the surgery. For plastic surgery/reconstructive cases, preoperative and postoperative photos must be obtained for documentation.

Equipment: Flexible laryngoscopes and light sources are kept in the clinic, and in the resident conference room. Supplies for inpatient consultation are stored in the resident conference, and should be restocked on a regular basis by the clinic staff. Any problems with clinic supplies or equipment should be made known to the Residency Site Director or Administrator's office. Each resident should receive keys to the on-call room, and the resident conference room. In addition, each resident should receive a key to the pediatric otolaryngology office space.

Inpatients: When a patient is admitted to the hospital, the name of the attending physician responsible for that patient is listed on the admission orders. Orders are to be written on the day of admission, and upon transfer from one unit to another, and are to be reviewed with the attending. The resident is responsible for seeing that all ordered tests are completed and their results reviewed. All discharge summaries are to be written in the chart prior to discharge including prescriptions and follow-up clinic appointments. All transfers to the Otolaryngology service must be discussed with and accepted by the attending on call prior to officially accepting the transfer. When residents obtain consent from in-patients, they must also discuss the consent for blood transfusions with the patient when appropriate. If the patient does not consent to either the surgery or the blood transfusion, the responsible attending should be notified.

Tracheostomy patients: A list is maintained of postoperative tracheostomy patients so that they may undergo routine tracheostomy changes. These patients are followed by the PGY-2 “adult junior” resident as well as the rest of the resident staff. Tracheostomy consults are initially evaluated by the PGY-2 resident, who presents these patients to the attending on call. The team should aim to coordinate tracheostomy for as early as 24-48 hours from the time of initial consultation, as timely facilitation of these procedures is critical.

SURGICAL CASES AT COLUMBIA

Surgical Experience: There is always an attending present in the operating room for each surgical case. The attending surgeon teaches the resident operative techniques and surgical judgement. Assignment of residents to surgical cases is performed by the chief resident. Coverage of cases on weekends will vary. Prior to the OR, the resident should be familiar with the patient’s history and indications for surgery, and check the chart to ensure pre-operative readiness. The residents arrive in the OR before the attending, and should ensure that all relevant scans/x-rays and photos are available in the operating room.

For clinic patients, the residents are responsible for pre-operative laboratory work, imaging, and medical clearance if needed. Clinic patients are called the night before surgery to confirm the time of arrival and pre-operative instructions. ICU beds and special operative instrumentation are also booked preoperatively through perioperative reservations.

Emergency Surgery: When adding an emergency surgery to the OR schedule less than 24 hours in advance, the name of the patient, history number, location, procedure, diagnosis, anesthesia, length of procedure and resident/physician and attending physician are supplied to the OR desk. Otherwise, the preferable booking modality is to get the patient on the official schedule via the attending physician’s office. If a family is providing consent over the phone, an appropriate non-involved third party witness is mandatory.

Operative dictation: It is NYPH policy that surgical cases must be dictated within 1 hour of completion of the case. Residents should discuss with the attending physician who will be dictating the case and ensure compliance.

Case log entries: Residents should be careful to log all cases they are involved with into the ACGME caselog system. Entries should be kept current. The program directors have created some guidelines for the training program on whether to report yourself as Surgeon, Supervisor or Assistant – copied here.

SUMMARY OF CASE ASSIGNMENT INSTRUCTIONS
New York Presbyterian Hospital – Columbia and Cornell campus program

April 2007

Surgeon Definitions

Resident Surgeon: Does 50% or more of the procedure, including the key portion.

Resident Supervisor: Instructs or assists a junior resident, where the junior resident does 50% or more of the procedure, including the key portion.

Assistant Surgeon: Performs less than 50% of the operation, or more than 50% but not the key portion. In some cases, assistant surgeon also indicates exposure to a case that you did not perform. If actual assistance is not needed (for example, endoscopic sinus surgery, or stapedectomy), and the resident observes more than 50% of the procedure, including the key portion, then count the case as “Assistant surgeon.” On the other hand, if the case requires assistance, and resident A is the assistant while resident B is an additional observer, then resident B should not count the case as “Assistant.”

Cases

For all bilateral cases, including endoscopic sinus surgery: Count each side individually. If you do the anterior ethmoidectomy on both sides, you are surgeon on 2 cases.

Exceptions to bilateral coding:

Tonsillectomy: Count patients, not sides. If you do either side, or both sides, you are surgeon on 1 case.

Ear tubes: Count patients, not sides. If you do either side, or both sides, you are surgeon on 1 case.

Unbundling

Unbundle if appropriate for documentation.

Normally, laryngectomy with neck dissection is a single code, but if Resident A does the larynx and Resident B does the neck, each should report that as two cases.

Similarly, if Resident A does the right lobe of a total thyroidectomy and Resident B does the left side, then each should report themselves as surgeon on a unilateral lobectomy (and assistant on another lobectomy). For billing purposes after training, however, you should use the single CPT code for total thyroidectomy.

ADMINISTRATIVE RESPONSIBILITIES

Medical Records: All operative dictations must be performed within 1 hour after the conclusion of the case. All residents use their individual NYPH physician code for dictation. This transcript is subsequently reviewed and verified for accuracy then signed. To use the system, the resident obtains an ID and password from medical records.

On Call Schedule: There are 2 on call rooms – one on 7GN, and one on Harkness 11. There is computer access for checking results from the hospital. The on call schedule is prepared by the chief resident or his or her designate. The schedule is then approved by the Site Director. It is the responsibility of the resident to verify each day with the hospital operator to insure that the paging system is working properly. The adult and pediatric consult pagers should be carried by the resident on call, and should not be signed out to each other or another pager. Any change in the call schedule is cleared by the Site Director. Each resident contacts the resident on call Sunday night to plan for Monday's rounds.

WORKING HOURS POLICY/ PROCEDURE AT COLUMBIA ARE DETAILED IN THE GME RESIDENT POLICY MANUAL

Resident Vacation Requests: The Residency Site Director is the approval authority for all vacation, holiday, and other travel requests. Requests for days off for religious observances, meetings, conferences and interviews are discussed with the resident director before the start of the rotation. All absences of an extended nature during the day must be cleared with the Residency Site Director in advance, including attendance at courses.

Resident Professional Leave Time:

POLICY:

It is understood that residents will require time for interviews for fellowship and post-residency employment. A resident is permitted a maximum of 5 business days per year for such interviews. Any time beyond this 5-day allotment will be taken as vacation time. The total number of vacation days that can be taken may not exceed the total allotted for that resident during that rotation.

Arrangements for taking time for interviews will be coordinated by a request to the Chief Resident and then the Residency Director at that location. The request will be evaluated to make certain that there will not be a negative impact on patient care or unfair distribution of responsibilities to the remaining residents.

The Department Chairman will review extraordinary requests on a case-by-case basis.

PROCEDURE:

A written request must be submitted to the Chief Resident for approval at least 4 weeks before the event. The Chief Resident will make accommodations in the clinical schedule accordingly.

VACATION POLICY:

Each resident is allotted 4 nonconsecutive weeks off per academic year (July 1-June 30).

As a program with 3 hospital sites, vacation will be distributed proportionate to the number of residents assigned to each site.

No vacation time will be approved during the weeks of the AAO-HNS fall meeting or the Triological spring meeting.

In allocating vacation time, the administrative chief resident must be certain that NYS Resident Work hour policies are not violated (example: every 3rd day on call).

Chief residents are the only residents permitted to take the last week of the academic year as vacation, as long as they also do not take any other week in June as vacation or academic leave.

The vacation schedule for the academic year must be submitted to the Residency Program Director by July 1st of that academic year. The vacation schedule must be approved by all the Site Directors before it can be distributed to the residents and support staff.

Click here to go to the NYPH Residency Site

Click here to meet the Members of our Graduate Staff (Residents)

A few words from our Residents…

Welcome to the Residency Program in the Department of Otolaryngology/ Head and Neck Surgery at New York Presbyterian Hospital - Columbia /Cornell Centers (NYPH).

Information about our program developed by a member of our graduate staff

Residents in our program rotate at the following institutions:

The New York Presbyterian Hospital-Columbia Center
This site is directed by Lanny Garth Close, MD & Eli Grunstein, MD

The New York Presbyterian Hospital-Weill Cornell Center
This site is directed by Michael G. Stewart, MD, MPH & Samuel Selesnick, MD

The Memorial Sloan Kettering Cancer Center
This site is directed by Dennis Kraus, MD

The St. Lukes-Roosevelt Center
This site is directed by Peter Costantino , MD

New York Presbyterian Hospital - Graduate Medical Education: Internal Access | External Access

Fourth Year Electives

About the Program

Application Process

The Otolaryngology/Head & Neck Surgery Residency Training Program

Co-Program Directors:

Site Directors:

Coordinator:

Goals and Objectives – Columbia Site

Resident Manual (Columbia Site)

Department of Otolaryngology/Head and Neck Surgery

Eli Grunstein, MD – Site Director

Lanny Garth Close, MD - Department Chairman and Co-Residency Program Director

INTRODUCTION

ACADEMIC PROGRAM

Departmental Conferences:

Columbia Monthly Grand Rounds

Columbia Weekly Departmental Academic Conferences

A. Weekly Pediatric Otolaryngology meeting

B. Tumor Board

C. Radiology Rounds

D. Journal club

Resident Head and Neck Dissection Course

Goals:

Course Format

Recommended Texts:

Session Format

RESEARCH OPPORTUNITIES AT THE COLUMBIA CAMPUS

COLUMBIA CAMPUS FACILITIES

Conference Rooms

FUNDING FOR RESIDENT RESEARCH TRAVEL – from Resident Policy Manual

CLINICAL PROGRAM

SURGICAL CASES AT COLUMBIA

SUMMARY OF CASE ASSIGNMENT INSTRUCTIONS New York Presbyterian Hospital – Columbia and Cornell campus program

April 2007

Surgeon Definitions

Cases

Unbundling

ADMINISTRATIVE RESPONSIBILITIES

WORKING HOURS POLICY/ PROCEDURE AT COLUMBIA ARE DETAILED IN THE GME RESIDENT POLICY MANUAL

SUMMARY OF CASE ASSIGNMENT INSTRUCTIONS
New York Presbyterian Hospital – Columbia and Cornell campus program