Otolaryngology–Head and Neck Surgery Residency Milestones-Based Overall Educational Goals and Objectives

The residency program at Stony Brook Medicine in otolaryngology-head and neck surgery provides the entering physician-in-training with a comprehensive educational and practical experience in the ever-evolving specialty of otolaryngology-head and neck surgery.

It is the goal of our program to provide the resident with a thorough grounding in all aspects of our specialty, including experience in clinical practice, hands-on exposure to clinical and translational research, and preparation for life-long learning.

The resident will train in an environment of rich clinical experience and a climate of discovery and self-development that will proceed in a systematic manner over the five-year course of the program.

The program's overall goal is to train and graduate a competent resident who:

• Accurately stages tumor node metastasis (TNM) in a specific patient
• Makes correct diagnosis from clinical, radiologic, and pathologic information; knows histopathologic findings of common neoplastic processes
• Formulates appropriate treatment plan for a specific salivary gland cancer patient based on primary site, disease stage, and patient factors
• Completes procedure with oversight
• Recognizes and is able to treat and/or develop treatment plan for common complications

• Interprets appropriate lab, functional, and radiologic studies
• Makes correct diagnosis from clinical, radiologic, and pathologic information; knows histopathologic findings of common neoplastic processes
• Formulates appropriate treatment plan for a specific vocal cord lesion patient based on lesion and patient factors
• Performs microlaryngoscopy consistently with complete exposure of the anterior commissure
• Recognizes and is able to treat and/or develop treatment plan for common complications

• Interprets examination and advanced diagnostic testing
• Demonstrates thorough understanding of spectrum of sleep disorders in children and adults
• Can list and prioritize treatment options for the patient with SDB in complicated patient populations
• Performs T&A and palatopharyngoplasty on complex patients
• Recognizes and is able to treat and/or develop treatment plan for common and uncommon complications in the complex patient

• Interprets appropriate lab and radiologic studies; identifies and orders necessary adjunctive studies (i.e., angiography)
• Accurately diagnoses location and extent of specific facial trauma
• Develops appropriate treatment plan and performs ORIF for a facial fracture patient with combined mandible and midface fracture
• Performs uncomplicated mandibular ORIF
• Recognizes and is able to treat common complications

• Identifies nasal endoscopic pathologic findings in the previously operated patient; facile with interpretation/use of appropriate laboratory, pathologic and radiologic diagnostic studies
• Distinguishes the pathophysiologic and clinical presentations of the various subtypes of chronic rhinosinusitis
• Formulates appropriate treatment plan for patient with acute exacerbations of CRS or recurrent polypoid disease; tailors medical therapy to patient's symptoms level and disease presentation
• Completes ESS procedure with oversight
• Recognizes and is able to treat and/or develop treatment plan for significant complications

• Performs comprehensive dynamic nasal function analysis; identifies aesthetic/cosmetic abnormalities; correlates examination findings with underlying structural etiologies
• Identifies specific components of nasal pathophysiology in functional obstruction
• Formulates appropriate treatment plan for patient with fixed and/or dynamic nasal obstruction
• Resects or augments bony or cartilaginous framework, places and secure grafting material, and performs osteotomies
• Resects, recontours, and corrects septal abnormalities
• Recognizes and is able to treat and/or develop treatment plan for common complications

• Accurately interprets appropriate diagnostic studies; understands the indications for operative intervention; recognizes acute complications in the setting of COM
• Understands mechanisms underlying the development of intratemporal and intracranial complications of chronic ear disease
• Formulates appropriate treatment plan for care of a patient with complications of chronic ear disease
• Removes granulation tissue and/or cholesteatoma from the middle ear/mastoid; skeletonizes vertical segment of the facial nerve; performs tympanoplasty and/or ossiculoplasty
• Recognizes major complications

• Is a skilled pneumatic otoscopist in children of all ages; recognizes complications of acute OM, OM with effusion, and OE
• Diagnoses intra- and extra-cranial complications of ear infections
• Treats complications of ear infections
• Places tympanostomy tube safely in all patients with easy anatomy and in some patients with difficult anatomy
• Recognizes and is able to treat and/or develop treatment plan for common complications

• Knows tumor/node/metastasis (TNM) staging system and can stage specific patient
• Demonstrates thorough understanding of cervical nodal drainage pattern for all primary upper aerodigestive tract (UADT) cancer sites
• Formulates appropriate treatment plan for a specific cancer patient.
• Completes procedure with oversight
• Recognizes and able to treat and/or develop treatment plan for common complications

• Obtains detailed history and physical including detailed evaluation of surgical defect
• Chooses appropriate reconstruction method- based upon understanding of pedicled, axial, and random flap vascularity patterns
• Formulates appropriate reconstruction plan using local flap for patient with specific facial soft tissue defect
• Completes facial flap procedure with oversight
• Recognizes and able to treat and/or develop treatment plan for common complications

• Correlates anatomic knowledge with disease physical examination (PEx) and radiologic findings
• Understands molecular basis for UADT cancer; knows benign and malignant differential diagnoses of common site presentations
• Knows staging system for most common UADT cancers, and can accurately stage using available clinical and radiologic data
• Understands the prognostic indicators of tumor pathology, including molecular markers
• Describes treatment options based on primary site, disease stage, and patient factors

• Understands congenital variations of temporal bone and cochleovestibular anatomy
• Generates differential diagnosis for hearing loss in children, and identifies uncommon causes of hearing loss in adults
• Understands the natural history of pediatric hearing loss and uncommon causes of adult-onset hearing loss
• Considers unusual causes for hearing loss and orders/interprets appropriate advanced audiometric, laboratory, and imaging studies
• Describes indications/ contraindications and complications of the surgical aural rehabilitation techniques; tailors aural rehabilitation to patient-specific needs

• Demonstrates thorough knowledge of anatomy and physiology of voice and swallowing
• Demonstrates comprehensive understanding of most voice and swallowing disorders, including voice and swallowing manifestations of systemic diseases (i.e., autoimmune disorders, sarcoid, neuromuscular disorders)
• Articulates comprehensive understanding of risk factors and timeframe for malignant transformation of premalignant conditions (laryngopharyngeal reflux disease [LPRD], Barrett's, Dysplasia/Leukoplakia, recurrent respiratory papillomatosis [RRP])
• Correlates laboratory and radiologic work-up with clinical diagnosis
• Demonstrates understanding of treatment options and rationales, risks/benefits of each treatment option, and surveillance algorithms for malignant disease

• Demonstrates thorough understanding of anatomic impact of allergic inflammation on the nasal airway
• Distinguishes presentations of allergic and non-allergic rhinitis patients; demonstrates knowledge of cellular and molecular features of inhalant allergy
• Describes systems for AR subtype and severity (e.g., seasonal vs. perennial, intermittent vs. persistent, etc.) and incorporates knowledge of severity and natural history into patient management
• Combines clinical features and test results to correctly diagnose allergic disease
• Demonstrates a working knowledge of immunotherapy for allergic disease

• Skillfully identifies abnormal temporal bone anatomy
• Differentiates vestibulopathy from non-otologic causes of vertigo
• Describes mechanisms underlying central compensation for peripheral vestibular vestibulopathy
• Knows appropriate patient safety and comfort techniques in the skillful performance of the microscope examination of the ears including pneumatoscopy; identifies and describes spontaneous, positional, and positioning nystagmus; performs head thrust, head shake, and Romberg tests skillfully; orders and interprets appropriate lab, radiologic and adjunctive studies
• Knows the procedural interventions for medically refractory BPPV and Meniere's disease; lists the steps for performing intratympanic injections, endolymphatic sac decompression/shunt, and surgical labyrinthectomy

• Demonstrates thorough knowledge of thyroid/parathyroid anatomy and embryology
• Knows causes and differential diagnosis for malignant endocrinologic states
• Demonstrates knowledge of most common and disease progression presentations for malignant endocrinologic states; is able to correctly stage specific patient
• Assimilates workup findings to develop differential diagnosis and justify correct diagnosis
• Understands treatment rationale, risks and benefits of each treatment option, and surveillance algorithms for malignant disease

• Demonstrates a detailed understanding of surgically relevant anatomy including fascial planes
• Describes the cellular changes that occur within the face (i.e., changes in collagen, elastin, dermal thinning, fat atrophy)
• Demonstrates comprehensive knowledge of age related changes of the face
• Performs comprehensive history and physical of the scalp, face, and neck
• Plans and discusses a comprehensive rejuvenation program

• Demonstrates thorough knowledge of anatomy and head and neck embryology and histopathology of congenital head and neck anomalies
• Demonstrates full understanding of differences in how inflammatory, congenital, vascular, and neoplastic masses present and always makes correct diagnosis in typical cases
• Understands differences in the time course of disease progression between pediatric neck mass processes
• Orders proper diagnostic tests (radiologic and laboratory) based on working diagnosis; accurately interpret imaging studies in routine cases; assimilates workup findings to develop diagnosis and justify correct diagnosis
• Understands treatment rationale, risks and benefits of each treatment option

• Advocates for quality patient care and optimal patient care systems
• Analyzes M&M findings and provides feedback to improve patient safety

• Practices cost-effective care (e.g., managing length of stay, operative efficiency)
• Leads interdisciplinary team in patient care

(The ability to investigate and evaluate the care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning)

• Demonstrates consistent behavior of incorporating evidence- based information in common practice areas
• Organizes educational activities at the program level

• Analyzes and manages ethical issues in complicated and challenging situations
• Develops a mutually agreeable care plan in the context of conflicting physician and patient values and beliefs

• Develops working relationships across specialties and systems of care
• Organizes and facilitates family/healthcare team conferences

• Demonstrates a broad knowledge through clinical, surgical and didactic experiences in the medical and surgical care of patients with diseases and disorders that affect the ears, upper respiratory and alimentary systems, paranasal sinuses, pharynx, larynx, neck, and anterior and lateral skull bases.
• Demonstrates a thorough understanding of the basic medical sciences relevant to the head and neck; the upper respiratory and upper alimentary systems; the communication sciences, including the knowledge of audiology and speech pathology, and audiologic and speech rehabilitation; and the chemical senses and allergy, immunology, endocrinology, and neurology as they relate to the head and neck.
• Demonstrates a thorough understanding of the clinical aspects of the diagnosis and the medical and/or surgical therapy of diseases of the head and neck, including congenital and acquired deformities and defects, or of the ears, the upper respiratory and alimentary systems, the face, the facial skeleton, and related systems; head and neck oncology; and facial plastic and reconstructive surgery.
• Provides patient care that is compassionate, appropriate and effective for the treatment of otolaryngologic diseases. This includes gathering essential information, making decisions about diagnostic and therapeutic interventions, implementing a comprehensive care plan and performing preventive, preoperative and postoperative care.
• Develops the technical expertise required for performing procedures that are essential for the practice of otolaryngology–head & neck surgery.
• Demonstrates knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral sciences, as well as the application of this knowledge to patient care.
• Investigates and evaluates the care of patients, appraise and assimilate scientific evidence through continuous self-evaluation and lifelong learning improve patient care.
• Demonstrates an awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal healthcare.
• Describes the basic principles of scientific research, including how research is conducted, evaluated, explained to patients and subsequently applied to patient care.
• Demonstrates a commitment to their professional responsibilities, adherence to ethical responsibilities and sensitivity to diverse patient populations.
• Develops and demonstrates interpersonal and communication skills that result in effective exchange of information with team members, patients, families, and other health professionals.

The program offers progressive responsibility in medical and surgical care throughout the five years that residents are under the supervision of our division. The program is designed to be sequential, with ample opportunity for supervised learning and practice throughout the five years.

The five-year program is under the direct supervision of the program director, Melissa M. Mortensen, MD, who coordinates the learning experience. Each of the five program years, and each of the educational experiences, has competency- and milestones-based, level-specific goals and objectives.

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