685D - Advanced Clinical Otolaryngology

DESCRIPTION

The student receives instruction in a wide range of Otolaryngology and Head & Neck disorders, and actively participates in the clinic, hospital wards, operating room and conferences. Emphasis is placed on diagnostic skills and development of a broad differential diagnosis. Special examination techniques will be included (i.e., endoscopy, mirror examination).  

PREREQUISITES

UCI students must have successfully completed their basic science and clinical science curricula. Extramural students must be in the final year of undergraduate medical education. 

RESTRICTIONS

International students are not accepted on this rotation.

COURSE DIRECTOR

Douglas Trask, MD, PhD

WHAT STUDENTS SHOULD DO TO PREPARE

Read a basic Otolaryngology-Head and Neck textbook, ENT Secrets, and expand with KJ Lee.

INFORMATION FOR THE FIRST DAY

Who to Report to on First Day: Prior to your first day, the chief resident will send you an email detailing your schedule and OR/clinic assignments for the week. If you have not received this email by the afternoon before your first day, please contact the resident on-call by paging 714-506-6519 to find out where and when to report on your first Monday. You may also contact the academic office at (714) 456-8450 or the ENT office at (714) 456-5753.

Site: UCI Medical Center 

DURATION: two to four weeks 

Scheduling Coordinator: Scheduling Coordinator: UCI students please email comsched@uci.edu to make a scheduling appointment. Please read the following information carefully. Extramural students enrolled at a U.S. LCME medical school must use VSAS to apply. To apply please refer to the Visiting Students Learning Opportunities website.

Periods Available: Throughout the year.

NUMBER OF STUDENTS ALLOWED: one to four

COURSE RESOURCES

TEXTS AND READINGS: SUPPORTING AND REVIEW 

Answering clinical questions: During your rotation at UCI and other institutions, you will occasionally be asked to look up clinical questions related to diagnostic workup, anatomy, and surgical or medical treatment of disease processes. To set yourself up for success, it is important to be familiar with some of the resources commonly utilized by Otolaryngology residents and physicians. In the long run, knowing “how” to find the answer to the question can be more important than the answer to the question itself. Many resources can also be found online, often in media form (e.g., You Tube for sinus surgery videos). For almost all surgeries and protocols, start with Iowa protocols.

Included are some common resources: 

Standard ENT textbooks: These are exhaustive textbooks with detailed chapters of the basics. They are a good place to start, in order to develop a full understanding of the background of the clinical question. 

Cummings Otolaryngology (7th edition, 2020) 
Bailey’s Head and Neck Surgery: Otolaryngology (6th edition, 2023)  

Surgical Atlas: The most critical parts of any surgery are understanding anatomy, indications, key steps, and complications. Commonly used surgical atlases include: 

Atlas of Head and Neck Surgery by Cohen and Clayman 
Operative Otolaryngology by Myers and Snyderman 
Master Techniques in Otolaryngology-Head and Neck Surgery – different specialty areas 
Surgical Anatomy of the Head and Neck by Janfaza 
An Atlas of Head & Neck Surgery by Lore and Medina 

ENT Review books 

Once you have a full understanding of the background of the question, the review books help highlight the most important “clinical pearls” associated with the topic. However, without a broader understanding, it can be difficult to use these resources to fully answer a given question. 

Pasha’s Otolaryngology-Head and Neck Surgery: Clinical Reference Guide KJ Lee’s Essential Otolaryngology 

Literature Search: Once you have a good understanding of the background behind a question and the highlights associated with a topic, a literature search can help identify key points related to the clinical question. However, it is important to know that not every piece of published literature on a given topic is relevant to a surgical audience. Knowing the authors and their institutional affiliations, date of publication, and journal published are all key in determining the relevance of a given article. Several examples of established ENT journals are: 

JAMA Otolaryngology – Head & Neck Surgery Laryngoscope 
Otolaryngology – Head & Neck Surgery  
Head & Neck 
Annals of Otology, Rhinology and Laryngology International Forum of Allergy & Rhinology 
American Journal of Rhinology and Allergy 
Otology & Neurotology  
Journal of Voice 
Journal of Laryngology and Otology 

Often, high profile publications such as JAMA, NEJM, Cancer, and Journal of Clinical Oncology contain multidisciplinary articles about topics within Otolaryngology. Many other journals contain relevant literature to Otolaryngology as well, but it is always key to note the authors and affiliations.

Several review journals often invite “experts” to write reviews on topics as well, and these can be good supplements to answering your questions. These include: 

Otolaryngologic Clinics of North America 
Operative Techniques in Otolaryngology 
Facial Plastic Surgery Clinics of North America

ASSIGNMENTS AND GRADING

Educational Activities: The student will participate in daily rounds, group discussions, ground rounds and additional educational didactics. The sub-intern is also responsible for pre-rounding on all patients in whose operations they participated. 

Clinical Responsibilities of the Student: Pre-rounding, morning rounds, teaching conferences, patient care, case presentations, Grand Rounds, clinic rotation, participation in cases, ED consults, and floor procedures. 

Attending Rounds: During the rotation, there may be sessions where sub-interns will present inpatients whom they are following. Sub-interns are expected to present their patients in a concise but thorough format (5 minutes or less), and feedback will be given by faculty/residents regarding the presentation. Faculty in attendance will then ask the students and residents questions regarding the cases. Attending rounds are intended to be an opportunity to enhance learning in the group setting, and students are expected to fully participate. 

End-of-Rotation Presentation: The student is asked to deliver a 15-minute audiovisual presentation on an area in which they have conducted research, or on a patient or topic of interest, based on exposure during the rotation. Topics that include patient history, workup, disease pathophysiology, and treatment options have historically been more well-received than those that focus heavily on surgical techniques. The presentation should be discussed with and reviewed by a faculty member or the chief resident. All 4-week rotators are to present during the Grand Rounds time slot towards the end of the rotation. This can be scheduled prior to or during the first week of the rotation. 

Call Schedule of the Student: Please coordinate with the otolaryngology resident team regarding coverage of after-hour and weekend cases. 

Percentage of Time in Ambulatory Setting: Typically, 20-40 percent. 

Conference/Lecture/Small Group Sessions: The student will participate in group discussions, Grand Rounds and daily rounds. 

Subspecialty teaching conferences and Grand Rounds are Wednesday evenings from 4-6 p.m. in ENT at either City Tower office or via zoom. Verify the time and location with the resident team.

Weekly Thursday AM conference from 7-8, with subsequent clinic or OR. 

Facial Plastics Conference: 2nd Friday of the month, 7:30-10 a.m. after morning rounds. 

Content Theme Integration: 

Communication 
Decision Making 
Epidemiology
Ethics 
Pain Management

GRADING

Official Grading Policy: The student will receive a grade of Honors, Pass or Fail. The student's final grade will be submitted on the standard UCI form. The student will be evaluated by attendings and residents in the area of clinical performance, clinical skills, formal presentation, learning accomplishments, attendance, attitude and effort.