Otolaryngology Sub-Internship Course Syllabus
UF syllabus policy: http://syllabus.ufl.edu/syllabus-policy/
Course name: Otolaryngology Sub-Internship
Course number: MDC7602
Credit hours: 4
Course web page:
CONTACT INFORMATION
COURSE INFORMATION
Course Description
This sub-internship will be a four-week experience during the Med 4 year. Students will be expected
to have successfully completed their Med 3 surgical and medical clerkships and be a member of the
Med 4 class in good standing. As most students will have had minimal to no formal clinical
experience in Otolaryngology, immersion through direct experiences in the discipline will be executed.
Otolaryngology is a highly subspecialized field- therefore, students will gain a graduated experience
over the month-long sub internship with directed supervision in the clinic, in patient wards and in the
operating room. In order to experience the full spectrum of Otolaryngology, the rotation will be divided
into 4 one-week rotations with an emphasis on a sub-discipline each week. Students will be expected
to attend and participate in all didactic activities including simulation as scheduled.
Students will participate in morning and afternoon rounds prior to and after attending their assigned
activity. Patients on the Otolaryngology service include medical/surgical floor, intermediate care, and
intensive care patients, thus exposing students to a wide breadth of inpatient care. Students will be
expected to round, present findings and assessments, and provide plans for inpatients admitted after
a surgical procedure in which they were directly involved. Students will work closely with the intern or
PGY-2 on service to learn care of the perioperative Otolaryngology patient.
As the Otolaryngology program utilizes a home call system, students will not take in house call.
However, they will be assigned 3-5 call nights. When “on call”, the student will be notified when a
patient consultation is required and the student will be expected to participate in activities including
evaluation, plan coordination, and treatment.
Course Objectives or Goals:
At the conclusion of the course, the student will have gained skills and knowledge to perform a head and neck exam using proper technique, assess otolaryngologic conditions, and formulate appropriate plans, thus successfully beginning his/her transition from medical student to resident.
Specific objectives include:
- To obtain a complete history for a patient with a otolaryngology pathology
- To demonstrate and perform a detailed head and neck exam with proper technique including otoscopy, oral cavity and oropharyngeal examination, anterior rhinoscopy, cervical lymph node and thyroid palpation and voice assessment
- To interpret appropriate studies including radiographic and procedural interventions after completing the history and physical
- To be able to discuss the potential risks, benefits and limitations of interventions including but not limited to audiograms, laryngoscopy and radiographic studies.
- To formulate a comprehensive differential diagnosis after performing the history and physical examination and interpreting the supplementary studies for various Otolaryngology conditions
- To recommend relevant orders and plans such as medications and surgery, including an understanding of risks, benefits, and potentials costs
- To provide complete written documentation in an organized manner from patient encounters in the consultation, inpatient, and outpatient settings
- To accurately and succinctly provide a verbal summary from a patient encounter to the senior resident and/or attending physician
- To recommend a specific plan of action to advance the patient’s condition and care
- To appropriately communicate transition of care concerns during patient handover including the present condition and findings, pending studies, potentially concerning symptoms, and the appropriate responsive action
- To function as a member of the Otolaryngology team, including interacting with other services during consultation requests and multidisciplinary conferences
- To recognize Otolaryngology emergencies and to initiate appropriate escalation of care
- To discuss the pathophysiology and recommended interventions including potential risks and alternatives to patients at an appropriate medical communication level
- To perform procedures expected of a PGY 1 resident under appropriate supervision
- To recognize opportunities for system improvement with emphasis on the patient care and the educational experience
Learning Activities
Educational activities will occur in multiple formats and arenas. In addition to patient care settings, students will be expected to attend didactic lectures, grand rounds, journal club, quality assurance conference, and visiting professor lectures. In settings of the “flipped” classroom, students will be assigned roles at a level of a PGY 1 resident. Didactic education will provide the foundation for the Otolaryngology fund of knowledge required to perform a history and physical of the Otolaryngology patient.
Sub-interns will participate in outpatient clinical encounters and inpatient consultations. It will be expected that the student perform a complete history and physical examination and identify and interpret existing laboratory and radiographic studies. The student will present these findings to a senior resident or attending including assessment, differential diagnosis and proposed plan. After discussion, the student may discuss the proposed course of action with the patient with use of the “teach back technique” encouraged to ensure proper patient comprehension.
Students will be expected to prepare for assigned surgical cases through a self-study review of anatomy and relevant patient history. Under appropriate supervision and with demonstration of an appropriate fund of knowledge, the student will engage in the surgical procedure including but not limited to obtaining biopsy, performing endoscopy and completing wound closure.
Students will round on post-operative inpatients with their team and assess patient progress, communicate findings and plans with the patient, as well as help coordinate consultations, ancillary studies and discharge planning in order to participate in the full breadth of care for the Otolaryngology patient.
As a member of the head and neck oncology team, the sub-intern will present a patient at the head and neck tumor board, which is a multidisciplinary forum geared to addressing the care of head and neck cancer patients. The presentation should include a succinct summary of findings, assessment and proposed plan of care. After consensus is obtained, the student will ensure that the appropriate studies and appointments are scheduled, and will participate in communication of the plan with the patient.
Students will be expected to present a specific Otolaryngology condition to the entire department. While not required, selection of a condition that was seen by the student while on service is recommended. Emphasis will be placed on presentation skills and review of the medical literature. Students will select a faculty mentor for this project who specializes in the treatment of the chosen pathology.
Core Competencies
The course objectives which are based on the thirteen Core Entrustable Professional Activities (EPAs) for Entering Residency will allow development of the six core competencies.
Patient Care:
Students will obtain the history and perform physical exams on patients seen in the clinic and in inpatient setting.
Students will learn how to incorporate and interpret study findings including imaging, biopsy and audiograms.
Students will develop procedural skills including discussing potential risks and recognition of complications.
Students will develop treatment plans and communicate these recommendations with the patient.
Students will interact with other departments and services to advance patient care.
Medical Knowledge:
Students will gain increased knowledge of the anatomy of the head and neck and its physiology. Students will gain skills in how to incorporate history, physical exam findings, testing into formulating a differential diagnosis.
Students will perform a comprehensive literature review of a specific Otolaryngology condition and present to a Department wide audience
Practice Based Learning:
To promote life-long learning skills, students will be expected to read about relevant topics based on patients seen in clinical encounters and for preparation for operative procedures.
Professionalism:
Students are expected to conduct themselves in a manner properly representing the Department and the College of medicine in direct patient interactions, in patient care conferences and outside of the hospital.
Interpersonal and Communication Skills:
As part of the inpatient team, students will be expected to independently evaluate patients and convey the findings, impression and possible plan to the team. Students will learn to recognize emergency conditions and initiate appropriate escalation of care. This will include direct communication with nursing and other staff. Students will develop rapport with the patient and their family and serve as an additional contact person for activities such as discharge planning. Similar functions will be performed in the outpatient clinical setting with emphasis on gaining the ability to explain medical conditions to the patients at a proper medical literacy level.
Systems Based practice:
As part of the inpatient team, students will coordinate care of their assigned patient including diagnostic testing and discharge planning. With the frequent alteration of communication ability in post-operative Otolaryngology patients, students will need to consider the new needs of their patients in their care plans.
Students will learn how to use the Electronic Medical Record and Physician Ordering System to appropriate document and prescribe therapy for the patient.
Students will contribute to the educational platform by assessing and providing feedback for future iterations of this rotation.
BOG Attestation Regarding Instructional Materials
Instructional materials for this course consist of materials reviewed, selected, and assigned by the instructor(s). The instructor(s) is only responsible for these instructional materials. Based on self-assessment of learning needs, students may identify other credible resources to augment the identification, analysis, and synthesis of relevant information.
Recommended Textbooks
- Otolaryngology-Head and Neck Surgery: Clinical Reference Guide, Pasha, Raza, Golub, Justin, Fifth edition. ISBN 13: 978-1944883393
- Cummings Otolaryngology: Head and Neck Surgery, Flint P et al, Sixth Edition, ISBN 13: 978-1455746965
Excused Absences
Absences are excused according to UF guidelines, including the following:
- Illness (including psychological)
- Family medical emergency
- Participation in the wedding of a first degree family member (travel should be scheduled to miss
the minimum amount of time; only 1 weekday should be missed) - Academic conference where a student is presenting their research
- Religious holidays
UF Attendance Policies: https://catalog.ufl.edu/UGRD/academic-regulations/attendance-policies
Students must contact the course director and copy the course manager to obtain permission for an excused absence. Once permission is obtained, students are responsible for notifying the Office of Medical Education of the dates for the approved absence.
ASSESSMENT
The Otolaryngology Milestones project which was a collaboration between the ACGME and the American Board of Otolaryngology will be used to assess the Sub Intern student. (J Grad Med Educ. 2014 Mar; 6(1 Suppl 1): 166–179.). The milestone measurements are periodically modified to adapt to the evolving medical educational environment.
The six core competencies are directly evaluate through this assessment. Linking the student’s performance to this nationally utilized system will help ensure that the educational training received at the University of Florida’s College of Medicine remains relevant, contemporary and transferable to other medical systems to which the student may matriculate. The milestones project involves grading on a Level 1 through 5 scale with the ability to select “half” levels”. It will be emphasized that Level 3 is generally achieved by PGY 3 year and that like the PGY 1 class, Levels 0, 1 and 1.5 are the expected range for the student.
The Oral presentation will be graded using the following rubric that is used in assessing Resident presentations.
Grading
Grading is A / B/ C/ D/ F. Final grades will be based on:
- 90% Daily assessment ability and preparedness as evaluated by the Milestones project
- 10% Oral Presentation to the Department
The course director is responsible for evaluating assessment performance.
POLICIES
Academic Honesty
All students should understand the Student Conduct Code and Student Honor Code and be familiar with what constitutes a violation. The Honor Code specifies a number of behaviors (e.g., cheating, plagiarism) that violate this code and possible sanctions. Students are obligated to report to the course director any violations of this code and any condition that facilitates academic misconduct. Consult the course director with any questions or concerns.
Student Conduct and Honor Codes: https://sccr.dso.ufl.edu/students/student-conduct-code Students are bound by the UF Honor Pledge: We, members of the UF community, pledge to hold ourselves and our peers to the highest standards of honor and integrity by abiding by the Honor Code.
For all assessments and work submitted for credit, the following pledge is either required or implied:
On my honor, I have neither given nor received unauthorized aid in doing this assignment.
Violations of the Student Conduct Code and Student Honor Code will lead to referral to the ASC.
Accommodations
The University of Florida is committed to providing academic accommodations for students with disabilities. Students requesting accommodations must first register with the Disability Resource Center (DRC) (352-392-8565 https://disability.ufl.edu/) by providing appropriate documentation. Once registered, students should present their accommodation letter to the ADA Representative, Mr. Jim Gorske, who will distribute the accommodation letter to appropriate course and/or clerkship directors, as needed, as well as the testing center. The University encourages students to register with the DRC as soon as they begin medical school or upon the verification of a disability.
Evaluations
All students are expected to complete online evaluation forms for courses and clerkships and to use professional judgment in written comments. Confidentiality is strictly maintained by de-identifying responses, both numerical and written. However, completion of evaluations is tracked. Students must complete at least 75% of the online evaluations for courses and clerkships. Failure to meet this goal in a timely manner will be noted as a concern for the Professionalism competency.
Electronic Communication
All electronic correspondence to students related to assessments, grades, student academic records, and FERPA-regulated matters must be sent only to or from a Gatorlink (“ufl.edu”) email address. FERPA, like HIPAA, has specific legal and regulatory restrictions, with violations leading to adverse consequences (see http://www.registrar.ufl.edu/ferpa.html). It is against UF policy to auto-forward Gatorlink email to an outside email address (see http://www.it.ufl.edu/policies/email/electronic-mail).
Student Mistreatment Reporting
An essential aspect of a conducive learning environment is the cultivation of professional and respectful interactions between faculty, staff, and students that avoids mistreatment of any kind. Mistreatment, either intentional or unintentional, occurs when behavior shows disrespect for the dignity of others and unreasonably interferes with the learning process. Examples of mistreatment include: sexual harassment; discrimination or harassment based on race, religion, ethnicity, gender, or sexual orientation; humiliation; psychological or physical punishment; and the use of grading and other forms of assessment in a punitive manner (see Mavis B, et al. Learning about medical student mistreatment from responses to the medical school graduation questionnaire. Acad Med. 2014 89:705 PMID 24667505). Mistreatment should be reported, including anonymously, at the Medical Student Portal under Resources (https://students.med.ufl.edu/about/student-mistreatment-report/).
Student Professionalism Lapse Reporting
Development of professionalism is a key outcome of the medical school curriculum and is evaluated as a core competency, as described above. Lapses should be reported at the Medical Student Portal under Resources (https://students.med.ufl.edu/about/student-professionalism-lapse-report/). Reports can be submitted anonymously and are kept confidential. Professionalism lapses by a student, faculty member, house staff, patient, or other staff should be reported through this mechanism.
College of Medicine Policies and Procedures Handbook
HEALTH AND WELLNESS
COM Office of Student Counseling and Development (http://counseling.med.ufl.edu/) provides information on counseling, self-assessment, wellness, student resources, and student advocacy. Especially helpful are many student resource links (http://counseling.med.ufl.edu/com-links/).
U Matter, We Care: If you or someone you know is in distress, please contact 352-392-1575 or umatter@ufl.edu or visit http://umatter.ufl.edu to refer or report a concern.
Counseling and Wellness Center: Visit http://www.counseling.ufl.edu/ or call 352-392-1575 for information on crisis services as well as non-crisis services.
Student Health Care Center: Call 352-392-1161 (24/7) to find care, or visit http://shcc.ufl.edu/.
UF Health Shands Emergency Room: For immediate medical care call 352-733-0111 or go to the emergency room at 1515 SW Archer Road, Gainesville, http://ufhealth.org/emergency-room.
UF Police Department: Visit http://police.ufl.edu/ or call 352-392-1111 (or 911 for emergencies).
SUPPORT
Library Support: Visit http://cms.uflib.ufl.edu/ask to access various ways to receive assistance with respect to using the libraries or finding resources.
E-learning Technical Support: Contact the UF Computing Help Desk at 352-392-4357 or via e-mail at helpdesk@ufl.edu.