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Curriculum

Department of Otolaryngology Residency Training

In 2007, the University of Colorado Medical Center moved in its entirety to the Anschutz Medical Campus, located on the former Fitzsimons Army Base in Aurora Colorado. The School of Medicine (SOM), the University of Colorado Hospital (UCH), and The Children's Hospital (TCH) all moved to brand new facilities. The Veterans Affairs Medical Center (VAMC) is currently under construction to move in 2015. The campus has entirely new inpatient and outpatient facilities, faculty & staff offices, research laboratories, teaching facilities, and administrative space.

The Department has new University faculty offices, new program staff offices, a resident office, conference rooms and a dedicated otolaryngology library containing up to date journals in the field and computer access to the main library system. In addition to our new individual resources, a multi-departmental state-of-the-art dissection laboratory exists, which will allow temporal bone drilling, endoscopic and gross anatomy dissection courses to be taught to the residents. 

 

 

In addition to their own education, residents are partly responsible for educating medical students, as well as other students (e.g., dental, nursing, pediatric residents, physician assistant students) rotating through the various clinical services. This remains an important function of the residents, as these students participate in departmental conferences and grand rounds.

The residents develop teaching skills in a progressive fashion at all of the hospitals. As they progress to a more senior level, particularly at the University, they are in charge of a multi-resident team, with several students. They can have second through fourth year medical students, junior otolaryngology residents, dental residents and family practice residents to direct and teach. Their patient interactions responsibilities also increase with time at all the hospitals.

 

Block Diagram of Otolaryngology Educational Program

PGY-1

 

4 Months

4 Months

4 Months

Rotation

Anesthesia

ED

Plastics

Site

UCH

UCH

UCH

Inpt/Outpt

Inpt/Outpt

 

4 Months

3 Months

5 Months

Rotation

Oncology

Otolaryngology

Plastics
Surgery

Vascular Critical Care/ICU
Neurosurgery

Site

UCH

UCH

Denver
Health

VA

Inpt/Outpt

Inpt/Outpt

Inpt/Outpt

Inpt/Outpt

 

 

 

 

PGY-2

 

4 Months

4 Months

4 Months

Rotation

Otolaryngology

Otolaryngology

Otolaryngology

Site

UCH

Denver Health

TCH

Inpt/Outpt

Inpt/Outpt

Inpt/Outpt

Inpt/Outpt

 

 

 

 

PGY-3

 

 

 

 

4 Months

4 Months

4 Months

Rotation

Otolaryngology

Otolaryngology

Otolaryngology

Site

UCH

Research

VA

Inpt/Outpt

Inpt/Outpt

Clinical

Inpt/Outpt

 

 

 

 

PGY-4

 

8 Months

4 Months

 

Rotation

Otolaryngology

Otolaryngology

 

Site

UCH

TCH

 

Inpt/Outpt

Inpt/Outpt/Core Specialties

Inpt/Outpt

 

 

 

 

 

PGY-5

 

4 Months

4 Months

4 Months

Rotation

Otolaryngology

Otolaryngology

Otolaryngology

Site

UCH

Denver Health

VA Medical Center

Inpt/Outpt

Inpt/Outpt

Inpt/Outpt

Inpt/Outpt

 

 

Residents in this program rotate through otolaryngology services located at the University of Colorado Hospital, The Children's Hospital, Denver Health Medical Center, and the Veterans Affairs Medical Center. Each hospital has its own service chief who is responsible for the quality of care rendered and the educational experience at that particular institution.

University of Colorado Hospital (UCH)

It provides an outpatient clinic rotation in faculty supervised clinics, as well as inpatient and outpatient surgical procedures. As our primary teaching hospital, the UCH offers the greatest range of fellowship trained subspecialists promoting resident education in the evaluation, diagnosis and management of a very complicated patient base. The current clinics include several general ENT clinics and subspecialty clinics in the area of multidisciplinary Head and Neck, rhinology and sinus, laryngology, otology, facial plastics, allergy, vertigo, audiology and speech pathology. The UCH diverse subspecialty faculty and its role as the city's primary tertiary referral center provide a complicated and diverse clinical experience for the resident.

The Children’s Hospital (TCH)

The Children's Hospital rotation functions as a two-resident pediatrics otolaryngology team. This rotation provides the basics of pedicatric otolaryngology diagnosis and treatment, a strong component of our total residency program. This rotation is one of the more comprehensive pediatrics exposures in the country, including the surgical treatment of cleft lips and palates, rarely found in otolaryngology programs. In addition to daily general clinics, several multidisciplinary clinics (sinus, voice, airway, cleft lip/palate, and sleep) are held at various times during the month.

Denver Health Medical Center (DHMC)

Denver Health Medical Center serves the indigent population of the city and county of Denver. In addition to the usual medical and surgical otolaryngological diseases, a significant volume of head and neck trauma and infectious disease is seen here. There are specialized clinics that deal with specific problems including head and neck tumor clinic and multi-disciplinary otitis media clinic. There are no mid-level resident rotations here; therefore residents have a graduated experience and may, under the tutelage of the faculty and chief resident, advance rapidly to more senior level surgical cases as their skill permits.

Veterans Affairs Medical Center (VAMC)

The major objectives of the VAMC rotation are to develop patient management skills, to become knowledgable and comfortable with the multidisciplinary treatment protocols for head and neck cancer; and to cultivate any subspecialty interest within adult otolaryngology. Refining of skills with the operating microscope and various endoscopes is a primary focus. The residents manage the entire spectrum of inpatient and outpatient care with appropriate supervision from the attending staff.

 

 

The resident grand rounds presentations have been designed to present this learning experience. Residents are assigned half of their grand round topics and choose the other half. These are assigned and reviewed by the head of the curriculum committee, Dr. Vincent Eusterman. The residents are required to present three to four grand rounds a year. They are assigned topic areas felt to be their weaker areas for 1-2 of the presentations and are allowed to choose topics for the others in areas of their interest. The resident is assigned a faculty mentor for the topic. All presentations start with a case report example to relate the topic to patient care. Case are selected from their active services and are ones in which they have been directly involved in their care. Specific guidelines are given the residents about types, quality and quantity of references required. A bibliography is the expected last page of the talk. Classes are available for advanced training in medical literature search through the campus library staff, if the resident is interested or needing of the training.

The resident is expected to assimilate the information, with a heavier weight on the higher grade scientific evidence, and relate that to the patient scenario presented. They are also expected to describe how they will use this information in the future in their treatment of patients. The resident is assigned a faculty mentor to review the talk and offer advice about the key issues; however, the residents are required to research and prepare the talk independently. After the presentation, there is a short period of discussion in which the presenter is asked more in-depth questions by the faculty and resident audience, assuring that they have acquired a command of the subject. The learning is expected to be a progressive experience with more complicated patient care topics covered by more senior residents and later in each academic year. Residents are evaluated by the faculty and their peers for these talks and these scores are reviewed at their performance evaluations.

Residents are also required to present a ten-minute research presentation at the end of the year at resident research day, as well. At each hospital residents are usually required to present cases in which they are involved, together with summarized relevant literature at various teaching conferences such as Head and Neck Tumor Board, Quality Assurance and Children's Monday morning planning conference. Residents are also required to present critiques of articles at journal clubs, which occur approximately six times per year.

 

Conference Site Time Topic
Weekly Monday Morning -
Tumor Board		 UCH 7-8 AM Director of H&N Surgery
Dept. OTOL
Monthly Thursday Morning -
Quality Assurance Conference		 UCH 8-9 AM Morbidity / Mortality
Monthly Thursday Morning -
Resident Research Committee Conference		 UCH 6:30-7:00 AM Resident Research Project
Strategies & Progress
Weekly Monday Morning -
Tumor Board 		DH 7-8 AM Multidisciplinary Tumor
Board link to UCH
Weekly 4th Tuesday Morning -
"Trauma Conf		 DH 5-6 PM Multidisciplinary Trauma
Review with Plastic and
Oral-Maxillofacial
Surgery Depts
Monthly 1st Thursday Oto
HNS Journal Club		 DH 11-12 PM Review recent journal articles
Monthly 2nd Thursday
Radiology Conference		 DH 11-12 PM H/N Radiology Case Review
Monthly 3rd Thursday
Archives Oto Journal Club		 DH 11-12 PM Review recent journal articles
Monthly 4th Thursday
Pathology Conference		 DH 11-12 PM H/N Pathology Case Review

Core Themed Conferences

Sub-specialty trained faculty menbers are in charge of core blocks in their areas. They are required to present lectures or organize other presenters for their block time. Block time is allotted each year by the curriculum committee, based on program feedback and in-service scores. Typically these 4-6 week blocks include basic science topics and allied specialty topics pertinent to the area, e.g., audiology and vestibular physiology in the otology block

Journal Clubs

A rotating schedule of topics is covered. Conferences are supervised by a faculty member who, chooses articles and can assign specific residents to review to individual articles. They are responsible for facilitating the journal club presentations and discussions. All other faculty members are welcome to participate, as well.

Quality Assurance Conferences

Monthly quality assurance conference is used to discuss patient care issues in relationship to outcome measures. Residents are expected to research and understand the literature related to their individual complications and understand the impact.

Our quality assurance conference is one that provides experiential learning for system errors. Complications are presented at this conference by the resident surgeon who participated, with the attending surgeon present. If no resident was present the attending themselves presents the case. The resident is expected to review the literature about the complication and issues surrounding it to evaluate both their contribution as well as the system’s contribution to the complication and follow the Vanderbilt Matrix model for one to two cases a month.

Tumor Board Conferences

A multi-disciplinary tumor board occurs every Monday morning. This is a combined board for the University of Colorado Hospital, Denver Health Medical Center and Veterans Affairs Medical Center. Outside private otolaryngologists also bring cases to present. The residents present cases to the board, pathology and radiology are reviewed by the faculty from those areas, and treatment issues are discussed among the surgeons, radiation oncologists and medical oncologists. Additional dental prosthetics faculty and other faculty are present as needed.

 

 

The last two years the GME Department has set up a chief resident retreat for all of the senior residents which occur outside of the institution. It covers a variety of topics, but is designed to foster the professional characteristics for a successful chief year, such as leadership, communication with other services and ethics.

Residents are encouraged to participate in local, regional and national meetings and to present their work at these meetings. Local meetings include the Colorado Otolaryngology Society meetings and the annual Departmental Sponsored Mid Winter Otolaryngology Update Meeting, combined with the Colorado Audiology and Otology Conference. Most state meetings are held in Denver. National meetings permitted include the American Academy of Otolaryngology-Head and Neck Surgery annual meeting, the Midwinter Triological Society meeting, The Association for Research in Otolaryngology meeting and the Combined Otolaryngology Spring Meetings. One resident goes yearly to the annual AAOA meeting, supported by the society. The PGY-5 residents who are presenting research, are supported to attend the AAO-HNS meeting each year. Other residents are supported at National meetings if they are presenting papers. They are permitted to attend as part of their educational days at junior levels, but not necessarily funded by the Department. The Departmental sponsored meeting of the Western States Rhinology Course is partially sponsored for the residents by the meeting directors. Our residents participate in the following courses:

  • Temporal Bone Course – Colorado Neurological Institute
  • Otolaryngology & Neurosurgery Cadaver Lab – Anschutz Medical Campus
  • Sinus Dissection Course – Anschutz Medical Campus
  • The Ultimate Colorado Mid-Winter Otolaryngology Update Meeting
  • Western States Rhinology Course
  • American Academy of Otolaryngology-Head and Neck Surgeons Annual Meeting
  • Advanced Craniomaxillofacial Surgery: Mastery of Treatment Planning and Technique
  • Principles of Operative Treatment of Craniomaxillofacial Trauma and Reconstruction
  • Approaches to the Skull Base Course for Senior Neurotology Residents
  • Annual American Academy of Otolaryngic Allergy Resident Education Forum