Description of Rotations

PGY 1

Mount Sinai Hospital – Otolaryngology (3 months)

Mount Sinai and Affiliate Hospitals (Elmhurst, Bronx VA, Englewood) – variety of General Surgery, Anesthesia, ICU, Emergency Room, and Neurosurgery rotations (9 months)

The PGY1 year divides as follows:

  • Two months on the Otolaryngology service at Mount Sinai Hospital
  • One month each on Anesthesia, ICU, Emergency Room, and Neurosurgery
  • The remaining 5 months rotating on a variety of General Surgery services (one month is reserved for vacation)

During ENT rotation, residents are expected to develop the skills to perform complete head and neck examination including indirect laryngoscopy, fiberoptic nasopharyngoscopy, microscopic otoscopy and pneumatic otoscopy. They will acquire skills to take a general and a targeted history and physical exam through supervised patient encounters in the outpatient clinics, learn to present new and established patients in a concise and focused manner, and become adept at preoperative assessment and postoperative patient care.

As part of this rotation, residents become familiar with the perioperative management of otolaryngology patients including

  • Management of patients undergoing major head and neck surgery
  • Treatment of hypo and hypercalcemia
  • Management of complex wounds
  • Diagnosis and treatment of salivary and chyle fistulae
  • Management of nutritional and metabolic deficits
  • Perioperative pharmacotherapy including antibiotics and analgesics
  • Management of electrolyte imbalances

Residents will acquire core knowledge in all areas of otolaryngology through Bailey review sessions and departmental lecture series. Furthermore, they will glean basic understanding of diagnostic radiology of the head and neck through bi-weekly interactive radiology conferences and bi-weekly radiology lectures. The PGY1 resident participates on daily rounds with the ENT team, helps with floor work and resident clinic, and assists on a variety of operative cases.

General Surgery Rotations

Junior residents learn the anatomy, physiology, and pathophysiology of diseases and conditions that affect the abdominal cavity. They manage and have full knowledge of a variety of medical problems and co-morbidities that surgical patients may have. Residents have exposure to patients with the full range of general surgical problems including GI Surgery, pancreatic, colorectal, oncology, hepatobiliary, endocrine, hernia, and breast surgery.

They also learn the applications of laparoscopy in general and bariatric surgery patients, the physiologic implications of laparoscopic surgery, and assist on operations and perform simple procedures such as excision of cysts and soft tissue masses, venous access procedures, inguinal hernia procedures, breast biopsies, diagnostic laparoscopy, liver biopsy, and appendectomy.

On a practical level, residents learn to obtain a detailed surgical history and physical exam, develop a complete differential diagnosis, maintain a personal patient log, obtain written informed consent for basic procedures, document treatment plans, and dictate operative notes and discharge summaries. Regarding perioperative patient care, residents learn to order and interpret basic laboratory tests and screening X-rays, understand acid-base and fluid balances, evaluate and manage postoperative fever, perform metabolic assessment of surgical patients, and evaluate medical comorbidities. In the operating room, residents learn proper sterile technique, understand patient positioning, preparation, and draping, and learn basic techniques of tissue handling and dissection while first-assisting on appropriate procedures. During these rotations, the residents function in a variety of circumstances, including managing the inpatient service with guidance from senior residents and attendings, assisting in the operating room, and seeing patients in resident clinic. Schedules vary according to rotation.

ICU Rotation Month

During the ICU rotation month, residents learn how to manage critically ill patients and understand the interrelationship and problems of the various organ systems during the patient’s stay in the ICU. They attain specific knowledge of the physiological responses of the organ systems, understand and properly use common medications in the ICU setting, and learn the principles of nutritional support, both enteral and parenteral. Residents acquire skills necessary to manage airway complications and respiratory conditions and various cardiac and circulatory problems. From a practical standpoint, they participate on daily rounds with the fellow(s) and attending(s), and become adept at many basic procedures in the ICU, such as placement of various lines, catheters, and monitors.

Anesthesia Rotation

During the month of Anesthesia, residents receive daily assignments requiring preoperative assessment of patients with a wide range of coexisting medical diseases and airway pathology, as well as formulation and implementation of an anesthetic plan in consultation with their colleagues. They learn to effectively evaluate the ENT patient in the perioperative period and understand the factors influencing the anesthetic plan. They become adept at establishing IV access, ASA monitoring, intubating, and detecting and treating basic intraoperative problems, including airways obstruction, hypoxemia, and hypo- and hypertension.

Emergency Room Rotation

The Emergency Room rotation, designed to provide a well-rounded experience in the emergency department, pays special attention to appropriate triage of acute and subacute problems, both medical and surgical. Residents learn to manage a large volume of patients, assess them accurately and efficiently, order the appropriate diagnostic tests, and contact relevant consulting services.

The PGY1 resident works shifts with a group of physicians from various specialties (including emergency department physicians) in the emergency room, thus acquiring basic professional and communication skills necessary for team-oriented care of the acute patient. Specific to otolaryngology, the resident learns to manage the acute airway, as well as proper initial management of patients with ENT problems presenting to the emergency room.

Neurosurgery Rotation

On the Neurosurgery month, residents learn an introduction into the evaluation, diagnosis, and management of neurosurgical patients in the intensive care unit, inpatient floor, operating room, outpatient and emergency room setting. Residents acquire basic skills in the interpretation of neuroradiological films, including MRI, CT, and angiography of the brain and spine. The rotation is designed to provide basic fundamental knowledge in the care of neurosurgical patients with special emphasis on interactions with otolaryngology, as our departments have many combined patients and cases, and enjoy a very collegial relationship.

PGY 2

Mount Sinai Hospital – Pediatrics

The pediatric ENT works closely with the attendings on the otolaryngology surgical service, outpatient clinic, pediatric emergency department, and inpatient consult service. Residents will develop the skills to perform complete head and neck examination including indirect laryngoscopy, fiberoptic nasopharyngoscopy, microscopic otoscopy and pneumatic otoscopy on pediatric patients. Additionally, they acquire skills to take a general and a targeted history and physical exam through supervised patient encounters in the outpatient clinics, learns to present new and established patients in a concise and focused manner, and becomes adept at preoperative assessment and postoperative care of pediatric patients.

Core knowledge in pediatric otolaryngology is acquired, including pediatric sleep apnea, tonsillitis, otitis media and externa, disorders the supraglottic, glottis, and subglottic airway, and sinusitis. Residents are supervised in their evaluation of outpatients in the pediatric otolaryngology clinic, reading of appropriate core material and performance of relevant surgery as well as through participating in scheduled didactic activities under the supervision of the attending pediatric otolaryngologist.

They acquire a basic understanding of diagnostic pediatric radiology of the head and neck through bi-weekly interactive radiology conferences and bi-weekly radiology lectures, and acquire training and proficiency in basic surgical procedures including but not limited to

  • Tracheostomy
  • Myringotomy and ventilation tube insertion
  • Tonsillectomy and adenoidectomy
  • Management of the pediatric airway

Once a month, the resident attends a multidisciplinary cleft lip/palate conference for a discussion of the surgical and medical management of these children with Plastic Surgery, Oral Surgery, Speech and Swallow Therapy, Social Services, and Nutrition. Together, the pediatric resident’s responsibilities provide an invaluable source of education regarding the comprehensive care of the pediatric otolaryngology patient.

Mount Sinai Hospital – Ward/Tracheostomy

The ward/trach junior resident is responsible for overseeing the perioperative inpatient care of the otolaryngology service. With guidance from senior and chief residents as well as attending staff, residents are responsible for evaluating patients in the emergency department, the active surgical inpatient service, the intensive care unit, the step-down unit, and the general ward.

PGY2 residents benefit from the opportunity to manage the patients throughout the course of the hospital admission. Patients admitted to the intensive care unit are followed by the PGY2 under the supervision of the chief resident and the intensivist. The PGY2 resident in the step-down unit and the general ward manages patients discharged from the ICU. The resident develops skills to take a general and a targeted history and systems review through supervised patient encounters in the outpatient clinics, learns to present new and established patients in a concise and focused manner, and becomes adept at performing complete head and neck examination, including indirect laryngoscopy, fiberoptic nasopharyngoscopy, microscopic otoscopy and pneumatic otoscopy.

During this rotation, residents become familiar with the perioperative management of otolaryngology patients including: management of patients undergoing major head and neck surgery, treatment of hypo and hypercalcemia, management of complex wounds, diagnosis and treatment of salivary and chyle fistulae, management of nutritional and metabolic deficits, perioperative pharmacotherapy including antibiotics and analgesics, and management of electrolyte imbalances. Core knowledge is acquired in all areas of otolaryngology through Bailey review sessions and departmental lecture series, and basic understanding of diagnostic radiology of the head and neck is gleaned through bi-weekly interactive radiology conferences and bi-weekly radiology lectures.

During this rotation, it is a priority to learn the anatomy, indications, and contraindications of performing a tracheostomy. Residents learn the management of issues related to adult tracheostomy including

  • Formal tracheostoma vs. routine tracheostomy
  • Methods for decannulation, tracheostomy tube changes, management of complications related to tracheostomy
  • Indications and uses of a variety of tracheostomy tubes including metal Jackson tubes, plastic Shiley tubes, stoma vents, t-tubes, tracheoesophageal prostheses

Elmhurst Hospital – Junior

With the guidance of senior and chief residents, as well as attending staff, PGY2 residents are expected to evaluate patients in the emergency department, an outpatient clinic, a consult service, and an active surgical service. Elmhurst Hospital is a Level 1 Trauma Center located in Elmhurst, Queens. The emergency department provides an excellent source of training in blunt and penetrating trauma. The hospital supports a variety of outpatient clinics in addition to otolaryngology, including oral surgery, endocrine, and neurosurgery. These services provide comprehensive patient care and teach residents the value of integrated multidisciplinary patient care. The otolaryngology clinic provides resident training in all aspects of otolaryngology. The inpatient service is an active ward where the PGY2 residents receive instruction on the management of inpatient general otolaryngology.

Additionally, head and neck surgical patients are admitted to the surgical intensive care unit, where the PGY2 resident participates in the management of such patients. They learn to take a general and a targeted history including a systems review through supervised patient encounters in the outpatient clinics, present new and established patients in a concise and focused manner, and become comfortable performing complete head and neck examinations including indirect laryngoscopy, fiberoptic laryngoscopy, microscopic otoscopy and pneumatic otoscopy.

Under the supervision of the chief resident and attending otolaryngology staff, residents learn diagnosis and management of basic disorders of the ears, nose, and throat, including:

  • Basic general diseases of the upper aerodigestive tract
  • Pediatric or congenital disorders including inflammatory diseases, thyroid/endocrine disorders, basic head and neck oncology, disorders of general otology, hearing, and balance, blunt and penetrating trauma, and cosmetic and reconstructive plastic surgery

Residents also develop skills in interpretation of diagnostic medical imaging modalities including: plain radiography, computerized tomography, magnetic resonance imaging, positron emission tomography, and contrast studies of the aerodigestive tract (i.e., barium swallow). Furthermore, they are introduced to diagnostic modalities common to the evaluation of otolaryngology patients, through direct interaction with attending radiologists, speech and hearing personnel, and attending otolaryngologists including audiology, vestibular testing, and electrophysiologic evaluation of the facial nerve.

In addition to learning the basic knowledge and patient care issues related to head and neck cancer and tracheostomy care as in the Mount Sinai Hospital PGY2 rotations, residents further learn

  • Microbiology of acute/chronic sinusitis, middle ear infections, pharyngeal infections, deep neck infections as well as the selection of appropriate antimicrobial therapy for each
  • Acquire basic understanding of benign and malignant diseases affecting the nose and paranasal sinuses
  • Begin to perform endoscopic and open sinus surgery using conventional and endoscopic approaches, building a strong foundation in basic rhinology

Finally, because of the wide range of ethnicities and demographics seen in these patient populations, residents develop an acute sensitivity for cultural and religious factors that may impact the delivery of care.

PGY 3 –

Mount Sinai Hospital – Sinus/Plastics

The Mount Sinai Facial Plastics and Sinus Service is designed to instruct the PGY3 on the management of patients with sinus and allergy disease and facial plastics. There is an active outpatient office and inpatient census, and collaboration exists within the allergy and immunology services. Under the direction of Dr. William Lawson, PGY3 residents manage patients seen in the attending clinic, resident clinic, and inpatient service with disorders of the nose and sinuses, as well as patients undergoing surgical facial plastic surgery. The PGY3 resident also receives training by helping to manage the inpatient consult service.

During this rotation, residents develop an understanding for the important psychological evaluation of patients presenting for facial aesthetic surgery. This involves a thorough understanding and appreciation of the indications and contraindications for aesthetic surgery. They also learn the range of aesthetic procedures including conventional rhinoplasty, facelift, liposuction, blepharoplasty, use of facial augmentation prosthetics, otoplasty, the role of botulin toxin in ameliorating wrinkles, the use of lasers for facial resurfacing, and the use of the chemical peel. They learn the use of intravenous sedation and local and regional anesthesia for ambulatory surgery including the pharmacology of those medications and the management of allergic and toxic reactions.

They also become intimately familiar with anatomy, physiology, and imaging of the paranasal sinuses, and understand the potential complications of acute and chronic sinusitis as well as their diagnosis and management. They practice medical management and learn the role of sinus surgery in the treatment of sinus disease, and develop an appreciation for the multidisciplinary management of patients with allergic disorders and sinus disease (including RAST and skin testing and the role of immunotherapy). The residents acquire both basic and advanced understanding of benign and malignant diseases affecting the nose and paranasal sinuses, and learn the performance of sinus surgery using conventional and endoscopic approaches.

Elmhurst/Queens Hospital

Under the direction of a supervising attending and/or senior residents, the PGY 3 is responsible for the surgical care of patients seen in the resident clinic at both Elmhurst (three days a week) and Queens Hospital (two days a week). The PGY3 is allowed the opportunity to independently examine, diagnose, and treat the patients seen in this clinic under the supervision of the attending physician, and is responsible for the perioperative care of the clinic patients. Both hospitals offer a busy clinic setting and adequate operating room time to provide an excellent clinical experience. Because the PGY3 is the only resident staffing Otolaryngology at Queens Hospital, the institutional contribution is derived from the opportunity for the PGY3 to evaluate and manage all clinic patients and develop a sense of independence.

During this rotation, residents further develop examination skills and diagnostic capabilities through the evaluation and treatment of patients in the outpatient clinic. Because of the wide range of ethnicities and demographics seen in these patient populations, residents develop an acute sensitivity for cultural and religious factors that may impact the delivery of care. The PGY3 resident continues to increase proficiency for evaluation of consults requested from the otolaryngology service under the supervision of senior residents and attending otolaryngology staff. They advance their knowledge of all areas covered during the PGY2 year through continued reading and participation in all teaching activities. Materials selected for reading are based on current clinical material encountered in the hospital setting, and core areas of the educational curriculum guiding the selection of topics for Grand Rounds and Journal Clubs. Finally, because of the wide range of ethnicities and demographics seen in these patient populations, residents develop an acute sensitivity for cultural and religious factors that may affect the delivery of care.

Bronx VA – Junior

The Bronx Veterans Hospital rotation for the PGY3 contributes a great learning experience in general otolaryngology, facial plastic surgery and head and neck oncology. The Bronx Veterans Hospital provides a resident clinic that is attended by a PGY5 resident, a PGY3 resident, and a supervising attending. During this rotation, there is a particular focus on developing an understanding for the diagnosis and management of patients with allergy. This includes skin testing and immunotherapy. Furthermore, a complex hearing and balance center provides full services for exposure and learning about adjunct hearing and balance testing, as well as the interpretation of these results.

The veteran population also, of course, provides a constant stream of head and neck cancer cases, which are treated with the most current diagnostic and management methods. Multidisciplinary cancer care is available at the VA, and a bi-weekly Tumor Board conference is held with the collaborating services. This resident is also responsible for detailed preparation of morbidity and mortality conference material including a thoughtful evaluation of the cases presented so that a coherent analysis can be formulated along with a plan to avoid such complications in the future.

Mount Sinai Hospital – Research

Icahn School of Medicine is fortunate to have many active basic and clinical science laboratories. During the research rotation, the PGY 3 resident can choose from the several laboratories within the department or perform research in a related department. In addition to the research experience offered in the department of otolaryngology, the institution offers a wide variety of opportunities in other departments including immunology, radiation oncology, neurosurgery, plastic surgery, neurology, and others.

It is the purpose of this rotation to allow the resident, under the guidance of a faculty research mentor, todevelop a hypothesis, a method to test the hypothesis and an expected result. They learn skills in scientific investigative techniques and data analysis: basic science techniques, chart review and data collection, statistical analysis of data, formulation of research proposals, and presentation to research committees. They are required to present their data at scheduled research meetings, resident research review at departmental Grand Rounds, and the annual Resident Research Day Conference. Furthermore, they are expected to prepare a manuscript for publication and submit an abstract to regional or national meeting.

PGY 4 –

Mount Sinai Hospital – Otology/Neurotology

The Mount Sinai Otology division is an active service during which the PGY4 is instructed on the management of patients with otologic and skull base disease, both from chronic infection and neoplastic processes, as well as cochlear implants and bone anchored hearing aids. A multidisciplinary program comprised of the otolaryngology, neurosurgery, a cochlear implant program, and audiology services contributes to patient care and resident education. PGY4 residents manage patients admitted to the otology and neurotology services.

The institution also provides busy consult and outpatient services, and offers resident training in balance and locomotion. During this rotation, residents are expected to become competent in the diagnosis and management of otologic and neurotologic disease, develop competent surgical skills in the management of otologic disease, and become adept at the assessment and management of the vertiginous patient. Furthermore, they develop a thorough knowledge of the anatomy of the temporal bone and the skull base region, the pathophysiology of acute and chronic otologic disease, and imaging studies of the temporal bone and the cerebellopontine angle region. They become well-versed in the diagnostic tests used to evaluate the middle and inner ear, including both the vestibular system and hearing.

Residents develop a thorough knowledge of the bacteriology and virology associated with middle ear, mastoid complex, and inner ear disease, as well as the antibiotic pharmacology utilized for the management of otologic infectious diseases. They learn the indications and contraindications for use of assistive hearing devices and fully understand the selection, evaluation and surgery for candidates for cochlear implants. They also become intimately familiar with the anatomy of the facial nerve and the disease processes that can lead to facial paralysis, and are knowledgeable about surgery of the facial nerve and methods for rehabilitation of the paralyzed face. Through the surgical experience on the rotation as well as instruction in the temporal bone laboratory, they develop competency in surgical approaches to the middle ear, inner ear, temporal bone and cerebellopontine angle. The residents develop a thorough understanding of the reconstructive options following otologic surgery. They also understand the potential etiologies for cerebrospinal fluid leak and know the diagnostic modalities available for localizing and management of CSF leaks.

Outside of patient care, residents develop leadership and teaching skills by instructing junior residents in the operating room and in the temporal bone laboratory. They further gain depth in the critical review of the current literature, and in the methods and conclusions derived from that literature.

Mount Sinai Hospital – Laryngology

The Mount Sinai Laryngology service is a rotation during which the PGY4 is instructed on the management of patients with voice, speech and swallowing disorders. A multidisciplinary program in laryngology is comprised of the otolaryngology, speech pathology, professional voice and neurolaryngology. During this rotation, residents become competent in the diagnosis and management of disorders of the larynx and cervical esophagus, and learn important surgical skills in the management of laryngeal and cervical esophageal pathology. Under the guidance of attendings, residents learn the relevant endoscopic anatomy of the larynx, trachea, pharynx and esophagus and achieve competence in office and surgical phases of endoscopic evaluation and treatment of diseases of the upper airway. They identify the indications for diagnostic laryngoscopy, microlaryngoscopy, esophagoscopy, and bronchoscopy, and develop a core knowledge (indication, instrumentation, limitation, contraindications) on commonly performed endoscopic procedures of the upper airway including phonomicrosurgery, microlaryngoscopy and biopsy, microlaryngoscopy with laser, transoral endoscopic resection of carcinoma, laser safety and use of various lasers, direct laryngoscopy, management of caustic ingestion injuries of the pharynx and esophagus, partial laryngectomy, cordotomy, arytenoidectomy, and arytenoidpexy.

While working closely with attending staff in the office, residents perform and achieve competence in office flexible laryngoscopy and esophagoscopy, videostroboscopy, and endoscopic evaluation of swallow. They further learn office treatment options for spasmodic dysphonia, vocal fold paralysis and are exposed to office tests for dysphonia and dysphagia, including 24-hour ph probe testing, laryngeal electromyography, and phonatory function testing.

Elmhurst Hospital – Trauma/Plastics

Elmhurst Hospital is a busy trauma emergency ward and general otolaryngology service. The active trauma service provides comprehensive training in head and neck blunt and penetrating trauma. The otolaryngology team works together with the oral-maxillofacial and plastic surgery departments to provide a multidisciplinary trauma service (basic and advanced principles of repair of maxillo-mandibular fractures including open/closed techniques, internal fixation, evaluation and re-establishment of occlusal relations and the diagnosis and management of post-operative complications). Elmhurst Hospital also provides a high volume of patients in need of facial plastic surgery and complex otologic care. This service yields a consistent experience in general facial plastic surgery and general otology in addition to general otolaryngology and head and neck trauma.

While at Elmhurst, PGY4 residents

  • Develop a thorough understanding for diagnosing and managing advanced blunt and penetrating trauma
  • Learn advanced skills in the evaluation and treatment of patients requesting facial plastic surgery
  • Develop both basic and advanced understanding of benign and malignant diseases of the nose and paranasal sinuses and the performance of sinus surgery using conventional and endoscopic approaches
  • Learn various diseases affecting the temporal bone, as well as gain an understanding of the indications, contraindications, and surgical techniques of procedures performed on the temporal bone
  • Gain proficiency in the evaluation and formulation of a treatment plan for patients presenting with otologic symptoms and diseases

Finally, because of the wide range of ethinicities and demographics seen in these patient populations, residents develop an acute sensitivity for cultural and religious factors that may impact the delivery of care.

St. Barnabas Hospital – Trauma

St. Barnabas Hospital is a busy Level I trauma hospital, where residents rotate during the PGY4 year in order to gain additional experience in management of facial trauma. There is also a general otolaryngology service, where the residents helps out in clinic and on ward consults, as well as assisting on appropriate cases.

On trauma cases, the PGY4 resident works together with the oral-maxillofacial surgery department to utilize basic and advanced principles of repair of maxillo-mandibular fractures, including open/closed techniques, internal fixation, evaluation and re-establishment of occlusal relations, and the diagnosis and management of post-operative complications. Furthermore, the resident participates in the care of patients with isolated dental trauma, learning about the anatomy and clinical care of teeth, as well as the workup and performance of orthognathic surgery.

PGY 5 –

Mount Sinai Hospital – Head and Neck Chief

The Mount Sinai Head and Neck service provides a busy, largely inpatient rotation during which PGY5 residents receive instruction on the management of patients with head and neck cancer and skull-base disease. A multidisciplinary program in head and neck cancer is comprised of the otolaryngology, neurosurgery, radiation oncology, and medical oncology services. The PGY5 resident works with the speech and language pathologist and the palliative care team on select patients. There exists an active inpatient census, a high office-based outpatient volume, and a hospital-based patient clinic.

During this rotation, residents gain a comfort level with the diagnosis and management of head and neck malignancies, develop an appreciation for the multidisciplinary management of head and neck cancer, and closely conduct perioperative management of complex head and neck surgical patients, including the management of patients who have undergone microvascular free tissue transfer. They develop a thorough knowledge of the therapeutic options for the management of head and neck cancer, as well as the indications and contraindications for surgery, radiation therapy, and chemotherapy.

Residents learn to manage complex wounds and understand the use of perioperative antibiotics and pharmacotherapy and the management of difficult wounds in the head and neck region. By working with the attendings in the operating room, they develop thorough knowledge of the anatomy, pathology, and biologic behavior of neoplasms involving the upper aerodigestive tract and salivary glands, as well as the surgical procedures that are utilized in the management of these neoplastic conditions. They also acquire both basic and advanced understanding of head and neck reconstructive surgery with respect to the options for reconstruction of various defects. The thyroid/parathyroid volume is very large, and the residents acquire a complete knowledge of endocrine surgery involving the thyroid and parathyroid glands, including the anatomy, embryology and the potential complications associated with this surgery.

This rotation demands the most organization and administration of all the chief year rotations. This resident applies administrative skills through independent planning of all Mount Sinai otolaryngology resident and medical student activities, and the integration of these with ongoing departmental educational activities. This resident is also responsible for detailed preparation of morbidity and mortality conference material including a thoughtful evaluation of the cases presented so that a coherent analysis can be formulated along with a plan to avoid such complications in the future.

Mount Sinai Hospital – Clinic Chief

There is a large resident-run clinic at the Mount Sinai Hospital, overseen by a number of attending physicians in conjunction with the “clinic chief resident.” The PGY5 resident helps to mentor junior residents and physician extenders by seeing patients together with them and presenting treatment plans to supervising attendings. Involvement with this busy clinic provides a great experience in longitudinal care of the otolaryngology patient, and allows learning, both in an office setting and in the operating room, of all the different subspecialties of our diverse field.

Elmhurst Hospital – Chief

Elmhurst Hospital has an active trauma emergency ward and general otolaryngology service. The trauma service provides comprehensive training in head and neck blunt and penetrating trauma, and our service collaborates with the oral-maxillofacial and plastic surgery departments to provide a multidisciplinary trauma service. Elmhurst Hospital also provides a high volume of patients in need of facial plastic surgery and otology. This service yields a consistent experience in general facial plastic surgery and general otology in addition to general otolaryngology and head and neck trauma. During this rotation, the PGY5 oversees the Elmhurst otolaryngology inpatient and outpatient services, thus gaining a sense of what is involved in becoming an independent practitioner and developing a sense of continuity of patient care. The PGY5 manages patients with the guidance of the attending staff. On this rotation, chief residents have more opportunities to develop leadership and teaching skills by instructing junior residents in the operating room and on the ward.

Residents utilize and continue to hone administrative skills through the independent planning of all resident activities and the integration of these with ongoing departmental educational activities and scheduling of patients for operative intervention. This resident is also responsible for detailed preparation of morbidity and mortality conference material including a thoughtful evaluation of the cases presented so that a coherent analysis can be formulated along with a plan to avoid such complications in the future. Finally, because of the wide range of ethnicities and demographics seen in these patient populations, residents develop an acute sensitivity for cultural and religious factors that may impact the delivery of care.

Bronx VA – Chief

The Bronx Veterans Hospital rotation for the PGY5 contributes a great learning experience in general otolaryngology, facial plastic surgery, and head and neck oncology. The Bronx Veterans Hospital resident clinic is attended by the PGY5 resident, a PGY3 resident, and a supervising attending. All patients requiring surgery receive examinations and work-up from the PGY5 resident.

Developing an understanding for the diagnosis and management of patients with allergy is the focus during this rotation, including skin testing and immunotherapy. Furthermore, a complex hearing and balance center provides full services for exposure to and learning about adjunct hearing and balance testing, as well as the interpretation of these results.

The Bronx VA makes the most advanced diagnostic and management methods and multidisciplinary cancer care available to the veteran population among whom a stream of head and neck cancer cases occurs. Bi-weekly Tumor Board conferences are held with the collaborating services. This resident is also responsible for detailed preparation of morbidity and mortality conference material including a thoughtful evaluation of the cases presented to formulate a coherent analysis along with a plan to avoid such complications in the future.


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Heather Joseph
Resident Education Coordinator
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