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Resident Training

Our Otolaryngology - Head & Neck Surgery resident training program matches four residents each academic year.

oto residents practicing

PGY-1 residents in The University of Kansas OTOHNS Residency Program complete one year of training in an integrated OTOHNS Surgery internship under the supervision of the department Residency Program Director. Residents rotate at The University of Kansas Hospital, St. Luke's Hospital, Children's Mercy, the Kansas City VA Medical Center, and Truman Medical Center.

PGY-1 residents spend six months on Otolaryngology-based rotations, to include (1) month on KU Blue, (1) month on KU Red, (2) months at Children's Mercy, (1) month on the ENT service at Truman Medical Center, and (1) month on the ENT service at the VA Medical Center. The remaining six months are spent rotating in the following clinical areas: Critical Care, General Surgery, Plastic Surgery, and Neurological Surgery.

During the PGY-1 year, residents are closely involved in pre- and postoperative care of patients, making daily inpatient rounds, performing simple surgical procedures, and assisting in more complex operations. During the second month of the KU Blue rotation, PGY-1s assume increased responsibilities, carrying the consult pager and taking buddy-call, as they begin the transition to their PGY-2 year. Residents attend departmental and divisional conferences in surgery and otolaryngology. Residents apply for membership to the American Academy of Otolaryngology - Head & Neck Surgery (AAO-HNS) in their PGY-1 year.

In the PGY-2 year, residents experience the breadth and depth of the specialty. Rotations include (2) months on KU Blue, (2) months on KU Red, (3) months at the VA, (3) months at Children's Mercy Hospital and (2) months on the KU Purple rotation. Residents take primary call during the PGY-2 year.

The PGY-2s are integral members of the KU Blue and KU Red Services. They are responsible for pre- and post-operative patient care, as well as for inpatient consults. Rotations in the OTOHNS subspecialty clinics introduce and instruct residents in the OTOHNS physical examination and basic clinic procedures, such as fiberoptic laryngoscopy, nasal endoscopy, and binocular microscopy. During the KU Purple rotations, residents get to see more outpatient and subspecialty care. Residents also spend time in Audiology/Vestibular Rehabilitation, Speech Language Pathology and Allergy Clinics on the Purple rotation.

At Children's Mercy Hospital, the PGY-2 is on a team with the fellow and 1-2 other residents. Residents learn to assess and manage a range of pediatric OTOHNS disorders, from the common to the more complex conditions seen at a tertiary care pediatric institution. Typical cases include myringotomy with tube placement, adenotonsillectomy, lymph node biopsy, tracheostomy, excision of congenital neck masses, and routine laryngoscopy/bronchoscopy. Residents also assist in endoscopic sinus surgery, otologic surgery and airway reconstruction during this rotation.

A faculty member and a chief resident supervise the PGY-2 resident on the VAMC rotation. This rotation is an opportunity for the PGY-2 resident to perform inpatient consultations, clinic evaluations, as well as surgical procedures, more independently and with increased responsibility. In the OR, the resident is predominately responsible for aerodigestive tract endoscopy, myringoplasty, tonsillectomy, uvulopalatopharyngoplasty, septoplasty, simple facial trauma, and soft tissue excision with local flap reconstruction. In addition, the resident assists in the more extensive surgical oncologic cases, and begin learning the basics of open head and neck procedures.

In the PGY-2 year, residents begin to build their clinical and surgical skills. Residents typically finish the year having performed 700-800 surgeries.

PGY-2 residents attend the AO Management of Facial Trauma course in anticipation of increased participation in FPRS cases during the PGY-3 year.

Residents assume increased teaching responsibilities for junior residents and medical students in the PGY-3 year. Residents spend 3 months on the KU Blue and KU Red Teams, where their time is divided between ICU/ward duties, inpatient and ER consults and the OR. PGY-3 residents begin to perform limited endoscopic sinus procedures and work on facial trauma cases, such as repair of mandibular and simple mid-face fractures. In addition, residents assist in increasingly complex oncologic procedures. Residents begin to have increased autonomy and manage more complex general otolaryngology and head and neck cases. PGY-3 residents run their own service while on rotation at St. Luke's Hospital (SLH), while experiencing a wide variety of General Otolaryngology cases, to include thyroidectomy, FESS and sleep surgery.

During the third year, residents participate in an annual temporal bone dissection course, learning anatomy and performing a range of otologic and neurotologic procedures on cadaveric temporal bones. This course allows residents to begin assisting in more involved otologic procedures in the OR suite. PGY-3 residents also attend a Sinus Course early in the year, providing them a foundation in endoscopic sinus skills prior to performing in FESS.

During the PGY-3 year, OTOHNS residents have a dedicated three-month block of time for research, which is supervised by Dr. Dianne Durham, Dr. Sufi Thomas and Dr. Kevin Sykes. The Resident Research Committee monitors the research and the results are presented at the department's Graduation Day Research Symposium in June.

During the fourth year, residents take on more administrative responsibility and a greater leadership role in the department, while significantly expanding their surgical skills. Residents spend time on the KUMC Blue (3 months) and Red Teams (3 months). The PGY-4 residents also rotate at Truman Medical Center (3 months), where they run their service under the supervision of rotating faculty. PGY-4 residents increasingly perform major outpatient surgical procedures such as revision sinus surgery, facial plastic surgery, phonosurgery, tympanomastoidectomies, and major head and neck oncologic/reconstructive procedures. While a large part of the PGY-4 year is spent in the operating room, PGY-4 residents continue to spend at least one day a week in clinic to maximize the longitudinal exposure to OTOHNS outpatient subspecialties and pre- and post-operative care.

PGY-4 residents also have a 3-month research block. This allows residents to continue their PGY-3 research, as well as to complete their required Practice-Based Improvement Project (PBLI).

PGY-5 residents preside as the service Chiefs on the KUMC Blue and Red Teams, and on the KCVA Otolaryngology Service (3 months, each). The remaining three months are divided between KU Purple, CMH and SLH (1 month, each). The chief resident is responsible for maintaining the highest standards of care while supervising the management all hospitalized OTOHNS patients, ER patients, and inpatient consults.

Surgically, the chief resident participates in the most complex procedures including major head and neck/reconstructive operations, skull-based procedures, facial plastic procedures, laryngeal framework surgery, and neurotology cases. Chiefs are responsible for scheduling OTOHNS resident OR assignments for their Team. Under the Program Director's supervision, they assure even distribution of surgical case types throughout the residency to allow uniform development of resident surgical skills.

At KUMC, chief residents participate in one day of subspecialty clinic per week. This allows chief residents to gain in-depth outpatient experience in the different subspecialties and provides continuity of patient care. At the VAMC, chief residents run the outpatient and inpatient Otolaryngology Service with faculty guidance. The VAMC rotation consists of three days in the clinic and two days in the operating room. In the OR, the chief residents are involved in head and neck cancer surgical planning, the primary excision, and the reconstructive portions of the operation. Chief residents are also responsible for leading junior residents through portions of cases.

All chief residents attend the American Academy of Otolaryngology-Head and Neck Surgery Annual Meeting in the fall and are the guests of honor at the departmental Graduation dinner in June.

Our faculty are dedicated to the academic development and mentorship of our residents. It is our goal to give residents a comprehensive experience in all areas of the specialty in order for residents to become independent and knowledgeable clinicians and surgeons. Residents are given significant, but well-supervised latitude in the management of both clinical and operative cases. Clinical, teaching, and research, activities are closely monitored by OTOHNS faculty with residents gaining increasing responsibility according to training level and capability.

At the end of each month, professional demeanor, clinical acumen and judgment, surgical technical skills, administrative abilities, and research and teaching accomplishments. Global assessments based on the six ACGME clinical competencies are also included in these evaluations. Semi-annual summaries are transcribed, along with duty hour calculations, operative experience report summaries, and in-training exam results. The Program Director and Co-Associate Program Directors review these assessments and provide constructive criticism to each resident confidentially during the semi-annual reviews. In addition, semi-annual 360 degree evaluations are also provided, which include input from patients, nursing, and administrative staff. All residents complete confidential evaluations of the teaching faculty. These evaluations become a part of the faculty's permanent record and are considered important evidence of the faculty's teaching and mentoring abilities.

Resident performance on the American Board of Otolaryngology in-training examination is used along with the above evaluations in the overall assessment of individual residents. The annual in-training examination helps to show how successfully each resident has integrated material from the curriculum. A high level of performance on this exam is expected from residents. Performance on this test is predictive of ultimate resident performance on the American Board of Otolaryngology Certification Examination. At the end of the residency, the Chairman and/or Program Director perform exit interviews of all outgoing residents.

Each year, the department holds a winter conference. In addition to educational conferences, faculty-resident group discussions are held, and all aspects of the residency program are openly examined.

All residents (PGY-1 through PGY-5) participate in an educational program based on the American Board of Otolaryngology (ABO) Curriculum and the Accreditation Council of Graduate Medical Education (ACGME) Core Competency Curriculum.

At the core of our educational program are didactic conferences. On Monday evenings, all residents attend conference at KUMC. The didactic program is based on a two-year cycle, ensuring that each resident is exposed to core concepts in OTO-HNS at least twice during training. The didactic program is reviewed and updated annually to reflect the most current requirements and recommendations of the ACGME and ABO. Additionally, the OTO-HNS department sponsors a year-long Grand Rounds series on the third Monday of each month. Presenters include invited faculty from KU and other programs across the nation.

Didactics are supplemented with instruction focused on surgical skill developments. This includes small-group drilling sessions in the temporal bone lab with our Neurotology faculty, and a hands-on injectables and fillers practicum proctored by the Facial Plastics faculty. Additionally, residents attend national and regional courses on facial trauma and endoscopic sinus surgery.

In addition to our Monday night didactics, our residents also participate in monthly Patient Safety and Quality Conference, quarterly journal clubs, and weekly interesting case discussion.

In the Interesting Case Conference, each program hospital is responsible for presenting a patient. The Model Patient Conferences are led by a succession of OTOHNS subspecialty faculty and provide the opportunities to delve into specific subspecialty subjects. This educational experience is in the format of the OTOHNS Oral Board Exam, uses physician-patient interaction as a learning tool, and serves to simulate clinical competency.

Journal club is a roundtable review of specific subjects and involves discussion of pertinent literature. Journal clubs are hosted by the faculty three to four times per academic year.

The Patient Safety and Quality conference takes place monthly. It involves discussion of pertinent OTOHNS cases from program institutions. Other conferences include the multidisciplinary Head and Neck Tumor Board and Thyroid Tumor Board. OTOHNS faculty, residents and nurses, as well as representatives of Neuroradiology, Radiation Oncology, Medical Endocrinology, Pathology, and Social Services attend the biweekly Tumor Boards. Similar multidisciplinary Tumor Boards occur at VAMC, SLMC and TMC.

Embedded in the Otolaryngology Conference Curriculum is our ACGME Core Competency Curriculum that is based on a 48 month cycle. The Core Competency Curriculum encompasses training in the ACGME identified competencies. This includes Patient Care, Medical Knowledge, Practice Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-Based Practice. Residents actively participate in all conferences and are asked to comment on these presentations, assisting faculty in their ability to upgrade and improve the lectures on a regular basis.

The clinical schedule at all institutions is adjusted to allow attendance at all educational events. Additionally, residents are encouraged to attend and present at the AAO-HNS Annual Meeting, the Annual Association for Research in Otolaryngology Meeting, the Combined Otolaryngology Spring Meetings, Society for Ear, Nose and Throat Advances in Children Meeting, the annual Kansas City Otolaryngology Society meeting, the Pediatric Consortium, the Midwest Head and neck Consortium, as well as to the departmental Winter Meeting.

KU School of Medicine

University of Kansas Medical Center
Department of Otolaryngology–
Head & Neck Surgery
3901 Rainbow Boulevard
Mailstop 3010
Kansas City, KS 66160