OTOLARYNGOLOGY  

DEFINITION:Otolaryngology is that branch of medicine concerned with the screening, diagnosis and management of medical and surgical disorders of the ear, the upper respiratory and upper alimentary systems and related structures and the head and neck.

GENERAL OBJECTIVES:Otolaryngologists must possess a sound knowledge in the general principles of medicine and surgery. During the course of training, the resident will acquire satisfactory knowledge of the principles common to all surgical practice. Otolaryngology embraces some components of neurology, neurosurgery, plastic surgery, dermatology, respirology, pathology, oral surgery and other specialties. Residents must have knowledge in these fields as relates to the specialty.

Residents must develop clinical competence and detailed knowledge of the scientific rationale for the medical and surgical management of otolaryngologic disorders in patients of all ages. This includes knowledge of the techniques of craniofacial surgery, neurotologic surgery, facial cosmetic surgery and reconstructive surgery of the head and neck.

On completion of the educational program, graduating physicians will be competent to function as a consultant otolaryngologist.

SPECIFIC OBJECTIVES:At the completion of training, the resident will have acquired the following competencies and will function effectively as:

Medical Expert/Clinical Decision-Maker

General Requirements

    • Demonstrate diagnostic and therapeutic skills for ethical and effective patient care.
    • Access and apply relevant information to clinical practice.
    • Demonstrate effective consultation services with respect to patient care, education and legal opinions.

Specific Requirements

Specific knowledge in the following areas:

    • Embryology, anatomy, histology, physiology, pharmacology, pathology, pathophysiology, microbiology, biochemistry, genetics and immunology of the ear, nose, paranasal sinuses and upper aerodigestive tract and adnexa and related neurological and cervicofacial structures.
    • Physics of sound and neurophysiology of hearing and vestibular functions including the principles underlying audiological and vestibular testing, electrophysiologic techniques and other related laboratory procedures.
    • Principles of oncology as they apply to the head and neck.
    • Principles of trauma management as it relates to head and neck.
    • Principles of therapeutic and diagnostic radiology and their application within the specialty including the interpretation of imaging techniques relevant to the head and neck.
    • Principles of laser therapy, cryotherapy, and electro surgery and their applications.
    • Principles and techniques used in evaluation and treatment of speech, hearing, voice and swallowing disorders.
    • All diagnostic and surgical procedures commonly performed in otolaryngology. This specifically includes competence in the areas of general otolaryngology, otology, sinonasal surgery, endoscopy, head and neck surgery and reconstruction, cervicofacial trauma, cervicofacial cosmetic surgery and the use of regional anesthesia.
    • In provision of pre- and post-operative care by demonstrating appropriate clinical judgement in selection of therapy.

Communicator

General Requirements

    • Establish therapeutic relationships with patients and their families.
    • Obtain and synthesize relevant history from patients/families/communities.
    • Discuss appropriate information with patients,/families and members of the health care team.
    • Listen effectively.

Specific Requirements

    • Demonstrate the capacity to recognize the psychological, occupational and social consequences of disorders of the head and neck and the ability to provide effective counselling to patients and their families. In particular residents will recognize the unique issues related to deafness and the deaf community, balance disorders, sleep apnea, malignancies of the head and neck and other pertinent disorders related to the otolaryngology patient.
    • Demonstrate the ability to explore patient's beliefs, concerns, and expectations about the origin, nature and management of his/her illness. Otolaryngologists need to be able to assess the impact of such factors as age, gender, ethno-culture background, social support, and emotional influences on a patient's illness.
    • Maintain clear, accurate and appropriate records.

Collaborator

General Requirements

    • Consult effectively with other physicians and health care professionals.
    • Recognize when optimal care is best provided by an interdisciplinary team and contribute effectively to team activities.

Specific Requirements

    • Demonstrate the ability to recognize team members' area of expertise.
    • Respect the opinions and roles of individual team members.
    • Contribute to healthy team development and conflict resolution, and contribute their own expertise to the team's task.

Manager

    • Utilize resources effectively to balance patient care, learning needs, and outside activities.
    • Allocate finite health care resources wisely.
    • Work effectively and efficiently in a health care organization.
    • Utilize information technology to optimize patient care, life-long learning and other activities.

Health Advocate

General Requirements

    • Identify the important determinants of health affecting patients.
    • Contribute effectively to improved health of patients and communities.
    • Recognize and respond to those issues where advocacy is appropriate.

Specific Requirements

    • Encourage behaviours that promote hearing protection and conservation at work and at home and the encouragement of behaviours that reduce patient's risks of malignancy of the head and neck through avoidance. This can be applied at the individual patient level, to a practice population, or at the general societal level.
    • Promote policies that encourage early identification of patients presenting with disorders of the head and neck through screening programs for hearing impairment and malignancy.
    • Facilitate patient's access to local and national resources available for the hearing impaired.
    • Actively educate other health care providers and the public regarding common head and neck problems that benefit from early intervention.

Scholar

General Requirements

    • Develop, implement and monitor a personal continuing education strategy.
    • Critically appraise sources of medical information.
    • Facilitate learning in patients, house staff, students and other health professionals.
    • Contribute to development of new knowledge.

Specific Requirements

    • Demonstrate the ability to select an appropriate question, efficiently search for and assess the quality of evidence in literature and keep up to date with evidence-based standards of care for the most common otolaryngology problems.
    • Demonstrate understanding of the important role of basic and clinical research, and of the critical analysis of scientific developments, in relation to the practice of contemporary otolaryngology, i.e., epidemiology and biostatistics and research techniques. While not all otolaryngologists will engage in active research, they must have the skills to participate in collaborative research projects, quality assurance, or guidelines development relative to the practice of otolaryngology.

Professional

    • Deliver highest quality care with integrity, honesty and compassion.
    • Exhibit appropriate personal and interpersonal professional behaviours.
    • Practice medicine ethically, consistent with the obligations of a physician.

 

CONTENT AND ORGANIZATION OF THE RESIDENCY PROGRAM:

There must be an organized program of rotations and other educational experiences, both mandatory and elective, designed to provide each resident with the opportunity to fulfill the educational requirements and achieve competence in the specialty.

The content and organization of each accredited program in otolaryngology must be consistent with the specialty training requirements.

In addition to offering the components noted in the specialty training requirements all accredited programs in otolaryngology should offer community-based learning experiences.

Residents must be provided with increasing individual professional responsibility, under appropriate supervision, according to their level of training, ability, and experience.

RESOURCES:There must be sufficient resources including teaching faculty, the number and variety of patients, physical and technical resources, as well as the supporting facilities and services necessary to provide the opportunity for all residents in the program to achieve the educational objectives and receive full training as defined by the specialty training requirements in otolaryngology.

In those cases where a university has sufficient resources to provide most of the training in otolaryngology but lacks one or more essential elements, the program may still be accredited provided that formal arrangements have been made to send residents to another accredited residency program for periods of appropriate prescribed training.

  1. Teaching Faculty

There must be a sufficient number of qualified teaching staff to supervise residents at all levels and in all aspects of the specialty, and provide teaching in the basic and clinical sciences related to the specialty.

  1. Number and Variety of Patients

The number and variety of patients and of surgical procedures in each category must be satisfactory.

  1. Clinical Services Specific to Otolaryngology.

 

    1. Teaching Services

Otolaryngology teaching services participating in the program must be organized into clinical teaching services, each with an adequate number of patients available for teaching and administered by a chief-of-service to whom the senior resident is directly responsible. The surgeons attached to the teaching services must hold certification in otolaryngology or other acceptable qualifications. Each institution must have a sufficient number of staff teachers in otolaryngology to provide adequate and continuous instruction and supervision for residents.

Clinical training must be based on adequate resources to ensure full training for each resident in all areas of otolaryngology in both adults and children. The description of the integrated program should specify how the responsibility for each of the components of the clinical program is shared by the participating hospitals.

The program must provide full training in the diagnosis and management of medical and surgical conditions in each of the areas listed below:

      1. Otology and Neurotology

There must be adequate numbers of patients and all necessary facilities to provide experience in the surgery of the external, middle, and internal ear, including microsurgical techniques and skull base surgery. Actual experience in audiological and vestibular assessment and supervised procedures on temporal bones must be provided.

      1. Rhinology

There must be adequate experience in both medical and surgical problems related to the nose and paranasal sinuses. This includes management of allergic and non-allergic conditions of the nasal mucosa as well as techniques of functional endoscopic sinus surgery in its application to diagnosis and treatment.

      1. Laryngology

There must be adequate experience in both the medical and surgical problems related to the larynx. This includes the management of voice disorders along with benign and malignant disease of the larynx, techniques of videostroboscopy, and assessment of neurologic disorders of the larynx through physiologic testing.

      1. Head and Neck Surgery

Residents must participate in the diagnosis and management of patients with major pharyngeal and laryngeal lesions and other disorders of the head and neck, such as those involving salivary glands and regional facial reconstruction. Where suitable patients for training in these areas are not available in sufficient numbers on teaching services in otolaryngology, there must be adequate arrangements with other surgical services or with other centres to ensure a satisfactory experience for residents in otolaryngology.

      1. Oncology

There must be sufficient numbers of patients with neoplastic diseases on the teaching services to provide full training in the methods of investigation and treatment. Assignment to interdisciplinary clinics or centres is highly desirable, in order that the respective role of surgery, radiotherapy, chemotherapy and immunotherapy may be clearly understood by residents.

      1. Trauma

There must be adequate numbers of patients available to provide each resident with training in the recognition and management of injuries related to the specialty. Participation in the initial management of multiple injuries as part of an interdisciplinary team is a valuable feature of training.

      1. Pediatric Otolaryngology

There must be an organized teaching service for the otolaryngology of children, with all appropriate supporting staff and facilities.

    1. Surgical Services

Operative experience ultimately including the major procedures in the specialty, must be provided under appropriate supervision. Each resident should keep a validated record of all operative procedures in which he or she has participated either as assistant or operating surgeon. There must be adequate operating room experience in appropriate facilities to provide appropriately increasing surgical responsibility.

    1. Consultation

Residents must participate in an active consultation service to gain experience in primary consultations to other services such as internal medicine, pediatrics, neurology, clinical immunology, and other branches of surgery. Residents must participate in consultations, both elective and emergency, on a continuing basis during training.

    1. Ambulatory

In-patient and out-patient teaching services should be integrated to provide continuity of observation of patients both in and out of hospital. Organized clinics or other facilities must provide opportunities for pre-admission investigation and post-discharge follow-up of patients in all categories listed above. It is essential that clinics provide a teaching milieu and that schedules of residents be so arranged as to ensure their attendance.

    1. Community Learning Experiences

Community experiences should be available which provide a learning environment with appropriate supervision and evaluation based on rotation specific objectives. This assumes administrative support and linkages with the program.

    1. Intensive Care

Units organized for teaching are required to provide experience in the broad field of supportive care of critically ill and injured patients. The organization of the intensive care units admitting otolaryngological patients must be directed to ensuring that residents assume major responsibility under appropriate supervision.

    1. Emergency Training

There must be systematic supervision of residents to ensure expertise in the initial management of all types of emergencies related to the specialty, including those presenting in the emergency department. Experience in responding to emergencies and providing a consultative service under such conditions is essential.

  1. Supporting Services — Clinical, Diagnostic, Technical
    1. Liaison with Other Specialties and Subspecialties

There must be appropriate liaison with teaching services in internal medicine, pediatrics, anatomical pathology or general pathology, anesthesia and diagnostic radiology. Hospitals with a major role in the otolaryngology program should also be engaged in medical undergraduate teaching including otolaryngology.

Liaison arrangements within the faculty must ensure that clinical training in surgery other than otolaryngology meets the needs of residents proceeding to certification in otolaryngology. Experience relevant to otolaryngology should be available through rotational and other arrangements with various surgical services including general surgery, neurosurgery, cardiac surgery, thoracic surgery, and plastic surgery.

    1. Audiology Service

There must be an audiology service with adequate laboratory staff and equipment, and arrangements for instruction in the performance and interpretation of audiological and vestibular tests. In addition, there must be provision for the teaching of speech pathology, including the physics of sound.

    1. Temporal Bone Laboratory

There must be a temporal bone laboratory with supervised experience in temporal bone studies available to all residents.

    1. Radiology Service

There must be a radiology service providing instruction in all diagnostic imaging techniques applicable to head and neck disease.

    1. Pathology Service

There must be a pathology service, with provision for the study of biopsies and other material relevant to otolaryngology under the direction of a qualified pathologist, and organized for teaching.

ACADEMIC AND SCHOLARLY ASPECTS OF THE PROGRAM:

The academic and scholarly aspects of the program must be commensurate with the concept of a university postgraduate education. The quality of scholarship in the program will in part, be demonstrated by a spirit of enquiry during clinical discussions, rounds, and conferences. Scholarship implies an in-depth understanding of basic mechanisms of normal and abnormal states and the application of current knowledge to practice.

  1. Organized Scholarly Activities

The program must include lectures and seminars, which may be interdisciplinary in nature, teaching rounds, special conferences, assignments of laboratory work, technical demonstrations, and journal clubs. In addition to adequate experience with patients, the institution must provide a balanced teaching program. More structured teaching may be provided by an integrated university program, but regular otolaryngology teaching rounds and conferences, as well as combined conferences with diagnostic and therapeutic radiology, surgical pathology, and audiology and vestibular function services, are essential features of teaching at each site. Attendance at rounds of other services should be arranged if educationally advantageous.

  1. Basic and Clinical Sciences Relevant to Otolaryngology

The program must include organized teaching in the basic sciences, in particular the relevant aspects of anatomy, physiology, pathology, microbiology, biochemistry, and pharmacology. In addition, teaching must be adequate in the advanced scientific and clinical knowledge essential to an understanding of the practice of otolaryngology in those areas outlined in the preceding sections.

  1. Biomedical Ethics

The academic program must ensure that residents gain an understanding of the basic principles and practice of biomedical ethics as it relates to otolaryngology.

  1. Communication Skills

The program must ensure that residents learn effective communication skills for interacting with patients and their families, colleagues, co-workers from other disciplines, and students. Clearly defined educational objectives for teaching these skills and mechanisms of formal assessment should be in place.

  1. Patient Care Team

Residents must be given opportunities to develop effective skills in collaborating with all members of the patient care team.

  1. Teaching Skills

Residents must be given opportunities to develop effective teaching skills by teaching junior colleagues and students, as well as through conference presentations, clinical and scientific reports, and patient education.

  1. Management Skills

Residents must be given opportunities to develop skills in management as applied to otolaryngology such as efficient practice and records management and the ethical use of health care resources. Residents should also be prepared for their role as a health care advocate.

  1. Quality Assurance/Improvement

The program must provide residents with opportunities to gain an understanding of the principles and practice of quality assurance/improvement. Opportunities should be provided for residents to participate actively in such programs in their hospital departments.

  1. Research Opportunities for Residents

There must be a faculty member with the responsibility to facilitate the involvement of residents in research and other scholarly work. The academic program must provide the opportunity for residents to learn biostatistics and the critical appraisal of research methodology and medical literature. Such teaching must include issues related to age, gender, culture, and ethnicity in research protocols and data presentation and discussion. Residents should be encouraged to participate in clinical research during the course of the residency program and to present their work at nationally and internationally recognized meetings.

  1. Faculty Research

A satisfactory level of research and scholarly activity must be maintained among the faculty identified with the program.

  1. Life-Long Learning

All programs must promote development of skills in self-assessment and self-directed life-long learning. To promote this end, the program should provide opportunities for residents to attend conferences outside their own university.

 

SPECIALTY REQUIREMENTS:

Approved training in otolaryngology including:

  1. Core training in surgery.
  2. Approved resident training in otolaryngology.

PROGRAMS (WITH TRAINING REQUIREMENTS):

Diplomas(Dip):

Six months of approved residency training.

Doctor of Medicine(M.D):

Eighteen months of approved residency training.

Doctor of Philosophy(Ph.D):

Forty eight months(four years)of approved residency training.