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PGY4 at the JGH- The Expert Role specific objectives

General Skills
•    Participate in the post-operative ward and office management of patients who have undergone major head and neck ablative and Reconstructive surgery
•    Demonstrate a sophisticated approach to imaging studies including independent interpretation of findings
•    Perform fine needle aspiration of neck lesions
•    Biopsy nasal or oral cavity lesions
•    Insert or change a tracheoesophageal puncture prosthesis
•    Pack a pharyngocutaneous fistula and provide ongoing wound care/debridement
•    Effectively manage pain associated with surgery and malignancy
•    Demonstrate understanding of the indications for tracheotomy in a critical care setting
•    Promptly and effectively assess patients with airway emergencies including airway obstruction and supervise junior colleagues in this situation
•    Perform open and percutaneous tracheostomies
•    Pre-operative assessment and preparation of patient for surgery
•    Management of post-operative patient care issues (e.g., pain, labs, wounds)
•    Participate in the post-operative ward and office management of ENT patients
•    Interpret X-ray and cross-sectional imaging of temporal bones, paranasal sinuses, and soft tissues of the head and neck

Head and neck Oncologic Surgery
•    Rapidly stage malignancies of the head and neck & develop approach to management
•    Perform pan-endoscopy independently with accurate interpretation of findings
•    Perform lymph node and neck mass biopsy
•    Perform excision of branchial cleft cysts and thyroglossal duct cysts
•    Perform parotidectomy with increasing degree of autonomy
•    Perform neck dissections with increasing degree of autonomy
•    Perform thyroidectomy, parathyroidectomy with limited consultant intervention
•    Perform excision of oral cavity lesions
•    Perform composite resections as well as pharyngolaryngectomies with increasing degree of autonomy
•    Perform more extensive maxillectomies with consultant supervision

Facial Plastic and Reconstructive Surgery
•    Demonstrate sophisticated understanding of the hierarchy of reconstructive options for defects in the head and neck
•    Formulate plan for reconstruction of head and neck defects with attention to form and function
•    Design and harvest flaps for major Reconstructive surgical procedures with direct consultant supervision
•    Perform or assist at microvascular anastomosis for vessels and nerves in free tissue transfers
•    Diagnosis and treatment of facial nerve disorders and reanimation strategies
•    Assessment for septorhinoplasty including an appreciation of the nasal valve, open vs. closed approaches, as well as grafting techniques.
•    Perform septorhinoplasty with direct consultant supervision.
•    Management of patients suffering from facial trauma including the techniques of soft tissue repair and closed/open reduction of facial fractures.

Laryngology
•    Develop a differential diagnosis and management plan for dysphonia
•    Develop a differential diagnosis and management plan for dysphagia
•    Management of vocal cord paralysis including investigation, medical therapy, and surgical therapy
•    Perform rigid suspension laryngoscopy
•    Perform microlaryngeal surgery with microlaryngeal instruments, CO2 Laser
•    Understanding of intraoperative airway management during microlaryngeal surgery
•    Perform, with supervision, endoscopic laser resections of early tumors of the larynx
•    Assist at and begin to perform airway reconstruction (e.g. laryngotracheoplasty)

Neurotology / Otology
•    Accurately assess patients suffering temporal bone trauma including ordering appropriate investigations
•    Be able to interpret conventional audiometry and tympanometry in adults
•    Understand the principles and application of auditory brainstem response (ABR) and otoacoustic emissions (OAEs)
•    Understand the principles and application of electronystagmography including interpretation of findings
•    Accurately diagnose benign positional vertigo and demonstrate a rational approach to its treatment
•    Perform the particle repositioning maneuver
•    Develop a rational approach to vestibular rehabilitation and participate in delivery of this care
•    Participate in and demonstrate understanding of the indications for surgical treatment of vertigo (includes labyrinthectomy, vestibular nerve section, endolymphatic sac surgery, and posterior canal occlusion)
•    Demonstrate an understanding of electro-diagnostic testing of the facial nerve
•    Elevate a tympanomeatal flap with limited consultant intervention
•    Perform tympanoplasty with limited consultant intervention
•    Perform ossiculoplasty with consultant supervision
•    Perform mastoidectomy with consultant supervision
•    Demonstrate a rational, organized approach to management of disorders of the facial nerve
•    Demonstrate a rational approach to selection of patients for cochlear implant surgery
•    Assist at surgery for treatment of otosclerosis
•    Assist at and demonstrate a logical approach to surgery for treatment of lateral skull base lesions including acoustic neuromas, other benign CPA lesions, and petrous apex lesions

Rhinology
•    Perform effective rigid nasal and sinus endoscopy
•    Biopsy nasal cavity lesions
•    Participate actively in the post-operative office management of patients who have undergone sinus surgery including pharmacotherapy and debridement
•    Demonstrate a sophisticated approach to selection of the surgical candidate for treatment of nasal obstruction and chronic rhinosinusitis
•    Perform nasal septoplasty including choice of incision, method of septoplasty, and closure materials with decreasing degree of direct consultant supervision
•    Perform inferior turbinate reduction
•    Refine knowledge of paranasal sinus anatomy and perform surgical techniques of endoscopic polypectomy, uncinectomy, ethmoidectomy, and middle meatal antrostomy with decreasing degree of direct consultant supervision
•    Acquire familiarity with indications for and performance of endoscopic sphenoidotomy and frontal sinusotomy
•    Perform external approaches to the paranasal sinuses such as external ethmoidectomy, frontal sinus trephine, and frontal sinus osteoplasty
•    Perform surgical treatments for epistaxis including endoscopic sphenopalatine artery ligation and anterior ethmoid artery ligation as well as internal maxillary artery ligation
•    Acquire familiarity with techniques for the management of benign sinonasal neoplasms such as inverted papilloma (e.g. endoscopic medial maxillectomy)

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