SECOND-YEAR RESIDENT (PGY-2)

The second year is the introductory year to otolaryngology. This year is designed to build a strong foundation in both the basic science and clinical practice of our specialty. Didactics begin with the Introduction to Clinical Otolaryngology Course and continue with the multitude of educational opportunities listed in the conference section.

Emphasis is placed on one-on-one proctorship with a staff attending at this level of training. Five months of this year are spent working closely with each of our full-time Oakland Otolaryngology -- Head and Neck Surgery (OHNS) staff. Each Resident rotates to a different supervising OHNS staff every one to two months. During each rotation, the Resident works exclusively with the supervising attending both in the clinic and the operating room.

In the Outpatient Department (OPD), the Resident learns to take a careful head-and-neck history and acquires skills in performing examinations. Physical findings and diagnoses are discussed. The rationale for management plans are emphasized so the Resident understands the need for appropriate diagnostic tests, medications, cost-effective medical decisions and surgical interventions. The art of medicine is also emphasized through the appreciation of cultural diversity, strengthening of interpersonal relationship skills and discussion of ethical issues.

A wide variety of OPD procedures are performed under direct supervision. A minor surgery clinic for patients referred from the dermatology, general surgery, medicine and plastic surgery departments is managed by a PGY-2 with staff supervision. These minor surgeries typically include biopsies, minor excisions and cosmetic repair of head and neck lesions. The PGY-2 also rotates on an outpatient fiberoptic bronchoscopy service weekly.

In the operating room, the PGY-2 initially assists in major head and neck cases. The PGY-2 also observes live and videotaped surgical procedures. After demonstrating surgical anatomy knowledge and satisfactory technical skills in a soft tissue course and in the OPD minor surgery clinic, the PGY-2 performs minor procedures with direct staff supervision. Later, more complicated procedures are performed with direct staff supervision.

After didactic tutoring with lasers (CO2, KTP, Argon, YAG), the Resident can participate in laser surgeries. The Resident assists on major head and neck cancer and plastic and reconstructive surgical cases and observes advanced otologic procedures until satisfactory completion of a temporal bone anatomy dissection course.

By the end of the PGY-2 year, the Resident is competent in performing a large number of surgical procedures such as excisional biopsies, myringotomies, complex lacerations, adenoidectomies, tonsillectomies, nasal polypectomies, closed and open reduction of facial fractures, all types of head and neck endoscopy and I&D of cervicofacial infections.

One half day each week is spent with the Audiology service. Otologic and neuro-otologic patients are interviewed, tests are performed and the results are discussed.

Kaiser Permanente speech pathologists give a series of lectures on speech and language development, diseases and management. The diagnostic evaluation and rehabilitation of speech patients is observed in the Speech Pathology Department.

A one-month rotation with the Anesthesia Department is provided. Work in the otolaryngology operating suites reinforces the specific anesthetic considerations of our specialty. Airway control and intubation skills are emphasized.

A one-month Pathology Department rotation involves reviewing current interesting head and neck cases as well as reviewing prepared slide collections with accompanying workbooks.

A one-month rotation with the Plastic Surgery Division is provided. Our plastic surgeon has a wide range of surgical skills including reconstructive and cosmetic procedures, cleft lip and palate work and microvascular free flaps. Since there is no plastic surgery Fellowship, our Residents work closely with this service.

A one-month rotation in research is allotted to identify and begin developing research projects. This is protected time without clinical responsibilities.

A two-month rotation at the Kaiser Permanente Medical Center (KPMC)-Redwood City Neurosurgical Service is included in the PGY-2 year. Redwood City is the neurosurgical center for Northern California KPMC and serves as a referral center for head and neck cancer, skull base surgery and neuro-otology for the KPMC in the West and South Bay. The PGY-2 works closely with the three full-time staff surgeons in both the operating room and outpatient department. The temporal bone dissection laboratory and educational resources of Project Hear are available for use.

A one-month rotation on the KPMC- San Francisco Allergy Service teaches basic allergy and immunology. It includes a lecture series and provides experience in the diagnosis and management of allergic diseases under direct staff supervision.