Residency

At Weill Cornell Medical College, we jointly sponsor a residency training program with our colleagues in the Department of Otolaryngology-Head and Neck Surgery at Columbia University College of Physicians and Surgeons. Our residency program is fully accredited by the ACGME and includes rotations at New York-Presbyterian Hospital/Weill Cornell Center on East 68th Street, New York-Presbyterian Hospital/Columbia Center on West 168th Street, and Memorial Sloan-Kettering Cancer Center. We were recently approved to expand the residency program to 4 residents per year. The Department Chairman at Columbia is Lanny Garth Close, MD.

Read more about the residency program, and on the rotations at NewYork-Presbyterian/Columbia and Memorial Sloan-Kettering.

Applications for Residency Training. Like all other Otolaryngology programs, we will be using the NRMP for the 2006 residency match. Applications for residency can be completed using the MyERAS website – http://www.aamc.org/students/eras/start.htm. Apply to ACGME program #2803511074: NewYork-Presbyterian Hospital/Columbia and Weill Cornell. Interview dates will be announced in the near future.

Residency Rotations. Of a total of 48 months of Otolaryngology training, residents spend 16 months at Weill Cornell, 24 months at Columbia, 4 months at Memorial Sloan-Kettering, and 4 months on research. Some detailed information on the rotation at Weill Cornell is included below.

General Goals and Objectives: All Sites

The Otolaryngology/Head and Neck Surgery Residency Training Program of NewYork-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 science knowledge of otolaryngology and the communication sciences with the clinical aspects of diagnosis and medical and/or surgical therapy for related ailments.

General Goals and Objectives: NewYork-Presbyterian/Weill Cornell

First Year Residents (PGY2 [OTO 1])

Educational Program

Knowledge Base: At the completion of the first year of specialty training, the resident will have the following knowledge:

Basic science knowledge as contained in the 1st year of the Basic Science Course, including anatomy, physiology, embryology, pathology, genetics, the upper aerodigestive tract; the communication sciences (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, endocrinology and neurology as they relate to the head and neck
Thorough knowledge of head and neck anatomy [through detailed dissection during the Head and Neck Anatomy course]
Understanding of the indications, risks, contraindications of a wide variety of Otolaryngologic surgical procedures for adult and pediatric patients.
Understanding and knowledge of temporal bone anatomy, mastoid drilling technique, middle ear prostheses placement, implantable hearing devices
Understanding of treatment of maxillofacial trauma using plating techniques
Knowledge level demonstrated by above average performance, as compared to Program Year peers nationally, on annual in-service examination

Clinical Skills Development

By the end of the first year of training, the resident should have been trained in the following skills and procedures:

Medical histories and physical examinations of the head and neck
Evaluation and treatment of common adult otolaryngologic problems [both inpatient and outpatient]
Placement of IV's; drawing blood; performing ABG's
Case presentations at morning and afternoon rounds
Preoperative and postoperative evaluations of patients, admissions and discharges
Management of the service with guidance from the chief residents and relevant Attendings, and/or Director of Resident Education
Triaging and initiating care of otolaryngologic emergencies [both adult and pediatric] with supervision of Chief Residents and Attendings
Performance of the following procedures: Tracheotomy, trach changes, tonsillectomy and adenoidectomy, closed reduction of nasal fractures, microscopic otoscopy and myringotomy and tube (M&T) insertion, fiberoptic laryngoscopy, flexible laryngoscopy, fine needle aspiration biopsies, oral biopsies, minor surgical procedures (ear lobe repair, incision and drainage, minor excisions, soft tissue trauma), microscopic ear examination with cerumen removal, treatment of epistaxis.
Development of personal style should include: self-assessment regarding work quality, ethical practice; ability to work as part of a team, and within a health care network; short-term planning, long-term planning; meticulous record keeping, including medical chart notes, informed consent, clinical administrative reports as assigned; efficient work habits.

Resident Duties

These include:

Responsible for the daily care of the adult inpatient service
Performs medical histories and physical examinations
Identifies and treats common problems, i.e. Place IV's, draw blood, perform ABG's, present at morning and afternoon rounds
Performs preoperative and postoperative evaluations of patients, admissions and discharges
Manages the service with guidance from the chief residents and relevant Attendings, and/or Director of Resident Education
Required to be in clinic as assigned by the Program Director and/or Chief Resident
Participates in the weekly basic science lecture series
Attends all required courses and conferences
Responsible for emergency room consults (with the supervision of an Attending and Chief Resident)
As the tracheotomy resident, schedules and performs preoperative evaluations, including several components. The resident reviews the chart, subsequently discusses the appropriateness of the procedure with the Attending, and coordinates with Anesthesia and the primary care team regarding time and date of the surgery.

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 tracheotomy service, the first resident acquires skills that prepare him/her for increasing responsibilities as a second year resident.
Clinical Skill Progression

Definitions used throughout this description regarding clinical procedures and operations:

General Supervision (the treatment/procedure is furnished under the Supervising Physician's overall direction and control, but the Supervising Physician's presence is not required during the performance of the procedure/treatment).
Direct supervision (the Supervising Physician must be present in the office suite or in the unit (as applicable), and immediately available to furnish assistance and direction throughout the performance of the treatment/procedure. It does not mean that the Supervising Physician must be present in the room when the treatment/procedure is being performed).
Direct Visual Supervision (the Supervising Physician must be in attendance with the patient and the resident while supervising the performance of the treatment/procedure).

Procedures are performed under direct visual supervision of an attending physician.
After a resident is duly assessed, the Attending will supervise directly the following procedures:

	Procedures and Supervision


Procedure	Level of Supervision	Supervisor	Number Required	Comments

Tracheotomy Trach Changes	Direct-Visual Direct	Attending	24	They will not perform this procedure unsupervised, except in a life threatening emergency. Direct visual supervision until determined by the chief resident that they may do it alone.

Tonsillectomy and Adenoidectomy	Direct-Visual	Attending	20	After adequate experience is determined by the Attending they will be able to perform this technique under direct visual supervision.

Closed Reduction of Nasal Fractures	Direct-Visual	Attending	3	After 3-5 complete reductions, as determined by the Attending, they will be able to perform this technique under direct visual supervision.

Microscopic otoscopy and myringotomy and tube (M&T) insertion	Direct-Visual	Attending	16	After performing 20 procedures they should be able to perform this technique under direct visual supervision.

Second Year Residents (PGY3 [OTO 2])

Educational Program

Knowledge Base: Ther Resident:

Continues to attend 2nd year of (2 year cycle) 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.
Via Microvascular Surgery Course, understands the physiology of and repair techniques for small vessels [This course may be taken in either the 2nd or 3rd year of specialty training.]
Understands the rationale, content and implementation of diagnostic workup for neoplasms; accomplished by literature review, and case presentations at the interdisciplinary Head and Neck Tumor Board.
Knowledge level demonstrated by above average performance, as compared to Program Year peers nationally, on annual in-service examination

Clinical Skills Development

The resident:

Builds on clinical skills developed as a first year resident.
Develops skill with lasers including CO₂, YAG and Argon beam after proper requirements are met (under direct visual supervision of Attendings)
Develops skill with the following procedures: submandibular gland excision, thyroglossal duct cyst excisions, septoplasty, turbinectomy, and basic nasal endoscopy including minimal FESS as well as Caldwell Luc procedures
Develops skill in fracture management

Resident Duties

Performs all first year responsibilities under direct visual supervision; progressively adds additional procedures and responsibilities to armamentarium.
Presents tumor cases at tumor conferences. Under guidance of Attendings, organizes the content of presentations for this conference.
Performs Panendoscopy (direct laryngoscopy, esophagoscopy and bronchoscopy) in the operating room.[1]
Performs laser procedures[1]
Assists in all tumor surgical cases.
As Consult Resident, is responsible for seeing and following adult consults service, as well as tending to adult ER consultations. This resident should formulate a plan and institute it after discussing the cases with the chief and/or Attending.
Responsible for scheduling surgeries.
Carries out mandible, trimalar and other basic fracture cases. [1]
Other surgeries for the second year include submandibular gland excision, thryoglossal duct cyst excisions, septoplasty, turbinectomy, and basic nasal endoscopy including minimal FESS as well as Caldwell Luc procedures. [1]
Assists on major surgical procedures.
Develops skill with lasers including CO2, YAG and Argon beam after proper requirements are met. These surgeries should be performed under direct visual supervision with the exception of septoplasty and turbinectomy, which can be performed under direct supervision after the resident has completed more than 20 -30 cases.
Attends rounds every AM & PM and is expected to take night call.
Attends all required courses and Grand Rounds.

Progression of Responsibilities

By being in charge of the adult and ER consults, formulating diagnoses and treatment plans with the Chief Resident and Attending, participating in the multidisciplinary Tumor Board conference, and by operating, the 2nd year resident acquires skills that prepare him/her for the increasing responsibilities of the OTO 3 year.
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.

	Procedures and Supervision


Procedure	Level of Supervision	Supervisor	Number Required	Comments

Submandilar Gland Excision	Direct-Visual	Attending	4	They will not perform this procedure unsupervised, except in a life threatening emergency. Direct visual supervision until determined by the chief resident that they may do it alone.

Local Resection Cancer Mouth	Direct-Visual	Attending	3

I&D Neck Abscess	Direct-Visual	Attending	3

Lymphangioma, Cystic Hygroma	Direct-Visual	Attending	2

Fracture Reduction Maxilla - Le Fort Le Fort II Le Fort III Malar (zygomatic) Mandibular Closed Open	Direct-Visual Direct-Visual Direct-Visual Direct-Visual Direct-Visual Direct-Visual	Attending Attending Attending Attending Attending Attending	5 2 2 5 5 5

Esophagoscopy Diagnostic With foreign body removal With structure dilation	Direct-Visual Direct-Visual Direct-Visual	Attending Attending Attending	5 5

Endoscopy Diagnostic, new born	Direct-Visual	Attending	10

Third Year Resident (PGY 4 [OTO 3])

Educational Program

Knowledge Base: At the completion of the third year of specialty training:

the resident should demonstrate an evolving mastery of the course content in Otolaryngology/Head and Neck Surgery.
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, plastic and reconstructive surgery and advanced cases in pediatric otolaryngology, including repairs of congenital defects and airway reconstruction.
Knowledge level demonstrated by above average performance, as compared to Program Year peers nationally, on annual in-service examination.

Clinical Skills Development

By the end of the third year of training, the resident:

Builds on clinical skills developed as a first year and second year resident.
Develops skills to perform major head and neck procedures include parotidectomy, thyroidectomy, radical 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. [1]
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 repair; interpositional vein graft [Accomplished via the Microvascular Course, if not taken as a second year resident].

Resident Duties

In charge of the Pediatric Consult Service
Supervises first and second year residents
Observes the first year residents and instructs them in clinic as well as in the operating room.
Supervises the second year residents in the clinic as well as in the operating room for the following cases; panendoscopy, tracheotomy, septoplasty, turbinectomy, and basic facial fractures.
Functions as the otology and plastic resident. Participates in major otologic surgery including middle ear exploration, acoustic neuromas, VII nerve sections, stapedectomy, mastoidectomy, tympanoplasty, excision of glomus tumors and reconstruction of aural atresia. [1]
Participates in major head and neck as well as other major cases.
Substitutes for the chief while the chief is absent.
Participates in all major Otolaryngological Surgeries in all realms of the specialty, including Plastics, Otology/Neurotology, Head and Neck surgery and Pediatric ENT. Major head and neck procedures include parotidectomy, thyroidectomy, radical 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. [1]
Performs endoscopic sinus surgery. [1]
Participates in the microvascular surgery course (if not completed as a second year resident)
Performs medical histories and physical examinations and to record such in patient charts. Formulates diagnosis and treatment plans.
Writes progress notes and doctor's orders in patient charts.

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 resident, by operating, and by substituting when the Chief is away, and by taking back-up call overseeing more junior residents, the third year resident acquires skills that prepare him/her for the increasing responsibilities as a program year four 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 first year and second year residents.

Fourth Year Residents (Chief) (PGY 5 [OTO 4])

Educational Program

Knowledge Base: The fourth year resident:

Should demonstrate mastery of the course content in Otolaryngology/Head and Neck Surgery
Knowledge level demonstrated by above average performance, as compared to Program Year peers nationally, on annual in-service examination

Clinical Skills Development:

Builds on clinical skills developed in prior years, and gives evidence to Attendings of maturity in approach to patient care and follow-up; i.e. the fourth year resident should demonstrate mastery of the surgical techniques and medical management in Otolaryngology/Head and Neck Surgery.
Explores advanced techniques and adapts them to personal style.

Resident Duties

Clinical:

Under the supervision of the Attendings, manages the service and is responsible for all patients on the otolaryngology service
Makes final decisions regarding management under Attending supervision
Can operate with direct visual supervision when he/she feels comfortable with a particular case.
Runs the clinics under Attending supervision
Supervises the ward service under Attending supervision.

Administrative:

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

Educational:

Participates the education of junior residents
Teaches the medical students
Instructs junior residents in clinic and in the operating room.

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. With arrival of the supervising physician, he/she will concur with the resident and contact the Attending physician for appropriate management decisions.
As Chief Resident, is fostered in development of skills in supervisory and administrative skills, such as organizing Grand Round 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: panendoscopy, tracheotomy, septoplasty, turbinectomy, and 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.

[1] Under direct visual supervision of Attendings