Otolaryngology/Head & Neck Surgery at Oakland
Resident Rotation Schedule
The preliminary surgical year is taken in the sponsored by the University
of California San Francisco, East Bay. Approximately seven months
are spent on the general surgery service at Highland and Alameda
County Hospitals and another four months of general surgery at Kaiser
Permanente Oakland or Walnut Creek.
These minor surgeries typically include biopsies, minor excisions
and cosmetic repair of head and neck lesions.
Residents are taught the evaluation and care of surgical patients
through a graded increase in responsibility. There is a large and
diverse patient population. There is an in-depth basic and clinical
science conference schedule. By the end of their internship year,
residents should be able to manage critically ill patients and should
have developed the technical skills necessary to begin their Otolaryngology
Head and Neck Surgery (OHNS) training.
The PGY-2 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 continues
with a multitude of educational opportunities.
Emphasis is placed on one-on-one proctorship with a staff attending
at this level of training. Five months are spent working closely
with each of our full-time Oakland OHNS staff. 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 - including appreciating cultural diversity,
physician patient interaction, strengthening interpersonal relationship
skills and discussing 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 the resident with staff supervision. These minor surgeries typically
include biopsies, minor excisions and cosmetic repair of head and
neck lesions. The resident can also electively rotate on an outpatient
fiberoptic bronchoscopy service weekly.
In the OR, the resident initially assists on major head and neck
cases. After observing actual, as well as video tapes of surgical
procedures and demonstrating surgical anatomy knowledge and satisfactory
technical skills in a soft tissue course and in the OPD minor surgery
clinic, the resident performs minor, and later, more complicated
procedures with direct staff supervision.
After didactic tutoring with lasers (CO2, KTP, Argon, YAG), the
resident can participate in laser surgeries. They assist on major
head and neck cancer, 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
year, the resident is competent performing a large number of surgical
cases 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
- I & D of cervicofacial infections
Residents benefit from a one month Audiology/Speech Therapy/Headache
Clinic rotation. Topics selected from an audiology reading list
are discussed. Speech pathologists from Kaiser Permanente give a
series of lectures on speech and language development, diseases,
and management. The diagnostic evaluation and rehabilitation of
speech patients are observed in the speech pathology department.
One-half day each week during this month, the resident is proctored
in our Headache Clinic. This subspecialty clinic, supervised by
our neurology staff physicians, specializes in the diagnosis and
treatment of patients referred for persistent or unusual headaches.
A one month Pathology Department rotation involves reviewing current
interesting head and neck pathology 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.
Since there is no Plastic Surgery Fellowship, our residents work
as first assistant on surgery on this service.
A one month rotation in Research is allotted. This is to identify
and begin developing research projects. This is protected time without
clinical responsibilities.
A one month rotation at the 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.
In the PGY-3 year, the resident has four rotations - at Kaiser Permanente
in Oakland, Hayward, Division of Research, and a resident chosen
elective. At Oakland, the resident spends five months on the clinical
service. Beginning this year, the residents have their own clinics
two to three half days per week with a staff physician assigned
for consultation. The PGY-3 has increased responsibility for patient
care in the OPD, hospital, and ER with appropriate staff back-up.
The resident spends approximately six to seven half days per week
in the OR with a full-time staff attending. During this year, they
will perform a large number of more complex procedures in head and
neck cancer, maxillofacial surgery, and plastic and reconstructive
surgery. The resident will typically assist on major cancer resections.
Maxillofacial, oculoplastic and plastic surgeons are available as
department consultants for improved quality of care and resident
teaching.
Having completed a temporal bone course with drilling dissections,
the resident begins to perform intermediate otologic surgery such
as tympanoplasties and simple mastoidectomies.
The resident will spend a three month block of time on research.
This is spent developing and completing projects generated in the
research time during the PGY-2 year. Progress updates to the involved
HNS and Divison of Research attending staff are expected during
this time.
A three month KPMC-Hayward rotation is included in this year. This
clinical rotation involves working as a resident with six full-time
Board Certified OHNS staff attendings. Areas of special clinical
interest include exposure to parathyroid surgery, L.A.U.P. procedures
(snoring laser surgery), facial cosmetic surgery, and hearing aid
dispensing.
A one month elective rotation allows the resident the discretion
to repeat any elective performed as a PGY-2, including the option
of an additional research month.
The PGY-4 year is a full clinical year devoted to strongly develop
surgical skills. The resident has three rotations - Kaiser Permanente
in Oakland, Redwood City, and San Francisco.
Six months are spent at Oakland. The resident has his or her own
OPD clinic panel with a readily available staff consultant. The
resident performs advanced head and neck cancer, maxillofacial,
plastic and reconstructive and otologic surgical procedures. The
PGY-4 serves as first assistant for most of these cases and primary
surgeon for some of them. The PGY-4 also has the opportunity to
rotate and act as primary surgeon with our maxillofacial, facial
plastic surgeons and Mohs' chemosurgeons. The PGY-4 proctors junior
residents in simpler procedures.
A three month rotation in Redwood City is contained in the PGY-4
year. As previously described, this rotation is weighed towards
a neurology, skull base and neuro-otologic surgical experience.
The PGY-4 spends a three month rotation in San Francisco. This
strong clinical experience entails working with four full-time Board
Certified HNS attending staff in both the OPD and OR. The resident
has a clinic three half days per week with seven half days per week
devoted to the OR. This rotation is an excellent exposure to general
otolaryngology and head and neck cancer.
The PGY-5 resident serves as a Chief Resident and rotates in Oakland
for six months and in Redwood City and San Francisco for three months
each. The goal of the final year of residency training is to complete
the development of the resident as an otolaryngologist-head and
neck surgeon. At each facility, the PGY-5 has a clinic three half
days a week with OHNS staff consultants running parallel clinics
and available for necessary consultation. The PGY-5 is the primary
surgeon on the more advanced and complex cases with an OHNS staff
available for direct and indirect supervision. The PGY-5 assists
more junior residents along with OHNS staff attending on cases that
require less skill. The Chief Resident is in charge of all consults
and hospitalized HNS patients and supervises junior residents in
the management of these patients. Full-time and courtesy OHNS staff
supervise the Chief Resident in these functions and are available
at all times for advice and consultation. The PGY-5 also has administrative
duties representing the OHNS residents on the hospital Residents'
Committee and the OHNS Training Program Evaluation Committee. The
Chief Resident is responsible for the resident call schedule and
the assignment of topics for the basic and clinical science study
course. The Chief Resident is the resident most responsible for
teaching of medical students.
The PGY-5 has time available to visit other Kaiser Permanente Medical
Centers or private institutions for clinical, surgical or educational
experiences of special interest. At the conclusion of the fifth
year, the PGY-5 is ready to assume responsibilities as a competent
otolaryngologist-head and neck surgeon with broad, well- rounded
clinical experience functioning in an independent manner.
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