Otolaryngology

Course #: 880J

Title:  Otolaryngology Overview

Selective Director(s):  Terry A. Day, M.D. and Judith M. Skoner, M.D.

Maximum Number of students per block: 3

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Know / demonstrate the essential components of a thorough head and neck history-
taking and physical examination
2. Understand and discuss the applied anatomy of the face, ear, nose/sinuses, mouth,
pharynx, larynx and neck
3. Gain exposure to patients with various common head and neck pathologies including
otitis media, vertigo, rhinitis, epistaxis, sinusitis, pharyngitis, tonsillitis, stridor,
dysphagia, dysphonia, facial trauma, and head & neck tumors/defects.
4. Recognize and describe symptoms suggestive of head and neck malignancies;
and recognize abnormal exam findings of the oral cavity and pharynx, including malignant lesions and lesions suspicious for malignancy.
5. Provide a differential diagnosis of a patient with a neck mass.
6. Describe the diagnostic workup of a patient with head and neck cancer.
7. Describe some options for reconstructing a variety of head and neck defects resulting
from trauma, congenital anomalies or cancer resections.
8. Describe the clinical aspects and develop differential diagnoses for hearing loss & vertigo; understand basic audiologic tests.
9. Describe common causes of hoarseness in adults and in children
10. List the differential diagnosis for stridor and be familiar with emergent and
long-term airway management techniques.
11. Understand basic speech and swallowing principles and evaluations.
12. Describe the work-up and treatments of common childhood ear, nose, and throat diseases
13. Describe some basic aesthetic principles of facial plastic & reconstructive surgery
14. List the common causes of rhinorrhea and nasal obstruction
15. Define acute and chronic rhinosinusitis, and describe the work-up and treatment options.
16. Understand indications for Otolaryngologic consultation
17. Observe various Oto-HNS surgical procedures, including endoscopic sinus surgery,
tonsillectomy, pressure equalization tube insertions, laryngoscopy and cancer
resections and reconstructive surgeries.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. PARTICIPATION IN OUTPATIENT CLINICS: students will evaluate new and follow-up patients in the various Oto-HNS clinics, and discuss findings/impressions/plans with the attending. Students are expected to be prepared for the clinic and be engaged in didactic instruction. The clinics will take place in Hollings Cancer Center, Rutledge Tower, the VA hospital (and possibly the East Cooper Medical Arts Bldg in Mt. Pleasant)
2. PARTICIPATION IN INPATIENT CARE: students will round daily with their designated team, interview/examine their patients, write daily progress notes for assigned patients, follow these patients perioperatively, and actively participate in discussions regarding decision-making and patient management. Students are expected to independently read about their patients’ diagnoses, treatments, etc. so that group discussions will be more meaningful.
Students are also expected to see/follow inpatient consultations with resident/attending supervision.
3. OPERATING ROOM PARTICIPATION: students will attend/observe/participate in various Oto-HNS inpatient and outpatient surgical procedures. They will review the upcoming cases for the week, determine the cases that they will attend, and prepare for the cases appropriately (pertinent anatomy, pathophysiology of the primary disease process, patient work-up, indications for that surgery, etc). The student should meet the patient preoperatively and review the chart for specifics of each case.
4. ATTENDANCE MULTIDISCIPLINARY H&N TUMOR BOARD: the student will attend the weekly head and neck tumor board conference which reviews new and follow-up head and neck cancer patients from a multidisciplinary view: case discussion, radiologic imaging, pathology, medical oncology and radiation oncology options, and surgical and reconstructive options.
5. INTRODUCTION TO AUDIOLOGY: during the rotation on Team A, the student will meet with the audiologist for a review of basic testing; they will observe an audiogram being performed and review the results, as well as learn the basics of tympanometry.
6. INTRODUCTION TO VOICE & SWALLOWING: the students will meet with members of the MUSC Evelyn Trammell Institute for Voice and Swallowing for an introduction to basic principles of diagnosis, evaluation and treatment for common voice and swallowing disorders
7. ATTENDANCE AT LECTURES: the students will attend the Monday evening 5-6:20 pm and Tuesday morning 7-8 am Oto-HNS educational lectures. In addition, the selective director will give an introductory lecture and review of the head and neck exam at the beginning of the 3-week selective.
8. COMPLETION OF INDEPENDENT READING: students are expected to read the provided basic Oto-HNS booklet, “Primary Care Otolaryngology” in full. There will be a quiz at the completion of the 3-week selective that will be derived from this reading. This is very basic, however, and the student is expected to refer to more detailed/comprehensive texts for specific assignments, patients and surgeries.
9. COMPLETION OF WEEKLY STUDENT PRESENTATIONS: at the end of each week, the students will present a prepared talk for the residents, other medical students on the rotation, the selective director and available attendings – this will be an Oto-HSN topic of the students’ choice, pertaining to the particular Oto-HNS subspecialty they were on that week, and is limited to a 10-minute oral (NO power-point/slides) presentation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 2 H&N cancer patients in clinic, and 2 inpatients with head & neck cancer
2. 2 Sinonasal patients (i.e.: sinusitis, allergic rhinitis, epistaxis)
3. 2 Otologic patients (i.e.: chronic ear infections, tinnitus, hearing loss, vertigo)
4. 2 Pediatric/airway/voice patients (i.e.: tonsillitis, OSA, stridor, ear infxns, dysphonia)
5. 1 Facial plastics patient (i.e.: congenital deformity, facial defect, aesthetic issues)
6. 2 General OtoHNS patients (i.e.: hoarseness, dysphagia, sleep apnea, thyroid)

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Performance in the clinics, hospital and O.R:
The student will be evaluated in regards to the following: professionalism,
team-work, interpersonal & communication skills with patients, motivation toward learning, history-taking, physical exam, knowledge base, differential dx, problem- solving, presentation skills, and procedural skills. Each attending and the chief resident on each team will be asked to complete a standardized evaluation form at the end of each rotation.
2. Presentations:
The students’ weekly 10-minute presentations will be evaluated by the residents, the
selective director(s) and available attendings; evaluation based on preparedness, content and oral presentation skills. Following the presentations, the group will review that prior
week’s experiences with the selective director(s) for informal discussion/teaching.
3. ‘Exit’ Quiz:
The student will complete a comprehensive quiz at the end of the 3-week selective; the
material for the quiz will come primarily from the provided booklet, “Primary Care Otolaryngology”, and ‘bonus’ questions will also be offered. The chief residents will
grade these standardized quizzes, and report results to selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive daily feedback from the residents and attendings (on rounds, in clinic, in the operating room). One of the selective directors will meet with each student at the end of their rotation to review their experience, discuss their evaluations, and complete a selective evaluation (to help us determine if the objectives of the course are being met).

Course #: 881J

Title: Head and Neck Surgery
        (Focus: Head & Neck Surgical Oncology & Reconstruction)

Selective Director(s):  Terry A. Day, M.D. and Judith M. Skoner, M.D.

Maximum Number of students per block: 2

SELECTIVE OVERVIEW:
Over the 3-weeks, the student will rotate on the OtoHNS oncology/recon team (Team C), with additional exposure to major head & neck reconstruction and facial plastics. The attending surgeons involved will primarily include: Dr. Terry Day, Dr. Boyd Gillespie, Dr. JD Osguthorpe, Dr. Joshua Hornig, Dr. Judith Skoner and Dr. Adam Ross (facial plastics). The student will also have exposure to a multidisciplinary atmosphere, with involvement of the speech & swallowing pathologists, maxillofacial prosthosdontist, OT/PT, Radiation-Onc and Medical Oncology, and H&N radiology, in order to get a well-rounded appreciation for our approach to the treatment of head and neck cancer patients.

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Demonstrate the essential components of a thorough head and neck history-taking and physical examination
2. Discuss the applied anatomy of the face, ear, nose/sinuses, mouth,pharynx, larynx and neck
3. Describe patients with various head and neck pathologies including head and neck cancers/tumors, stridor, dysphagia, dysphonia and head & neck defects.
4. Understand the risk factors for head and neck cancer
5. Recognize and describe symptoms suggestive of head and neck malignancies; and recognize abnormal exam findings of the oral cavity, pharynx and larynx, including malignant lesions and lesions suspicious for malignancy.
6. Provide a differential diagnosis of a patient with a neck mass.
7. Describe the diagnostic workup of a patient with head and neck cancer.
8. Describe some options for reconstructing a variety of head and neck defects resulting from trauma, congenital anomalies or cancer resections.
9. Describe the workup for a thyroid mass or “goiter”, and understand the indications for surgical intervention.
10. List the differential diagnosis and workup for parotid or submandibular ‘swelling’
11. Discuss the fundamental of emergent and long-term airway management techniques.
12. Understand basic speech and swallowing principles and evaluations.
13. Interpret basic head and neck imaging studies
14. Describe some basic aesthetic principles of facial plastic & reconstructive surgery
15. Understand and describe head and neck cancer staging for specific sites
16. Understand and describe various treatment options for head and neck cancers depending on type, site, stage.
17. Understand indications for OtoHNS consultation
18. Describe various Oto-HNS surgical procedures, including tracheostomy, neck dissections, various head & neck cancer resections and reconstructive surgeries including but not limited to skin grafts, local flaps, pedicled flaps and microvascular free flaps.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. PARTICIPATION IN OUTPATIENT CLINICS: students will evaluate new and follow-up patients in the various Oto-HNS clinics, and discuss findings/impressions/plans with the attending. Students are expected to be prepared for the clinic, interested and engaged in didactic instruction. The clinics will take place in Hollings Cancer Center, Rutledge Tower, and VA hospital.
2. PARTICIPATION IN INPATIENT CARE: students will round daily with their designated team, interview/examine their patients, write daily progress notes for assigned patients, follow these patients perioperatively, and actively participate in discussions regarding decision-making and patient management. Students are expected to independently read about their patients’ diagnoses, treatments, etc. so that group discussions will be more meaningful.
Students are also expected to see/follow inpatient consultations with resident/attending supervision.
3. OPERATING ROOM PARTICIPATION: students will attend/observe/participate in various Oto-HNS inpatient and outpatient surgical procedures. They will review the upcoming cases for the week, determine the cases that they will attend, and prepare for the cases appropriately (pertinent anatomy, pathophysiology of the primary disease process, patient work-up, indications for that surgery, etc). The student should meet the patient preoperatively and review the chart for specifics of each case.
4. ATTENDANCE AT MULTIDISCIPLINARY H&N TUMOR BOARD: the student will attend the weekly head and neck tumor board conference which reviews new and follow-up head and neck cancer patients from a multidisciplinary view: case discussion, radiologic imaging, pathology, medical oncology and radiation oncology options, and surgical and reconstructive options.
5. INTRODUCTION TO VOICE & SWALLOWING: the students will meet with members of the MUSC Evelyn Trammell Institute for Voice and Swallowing for an introduction to basic principles of diagnosis, evaluation and treatment for common voice and swallowing disorders, especially in relation to head and neck cancer patients.
6. ATTENDANCE AT LECTURES: the students will attend the Monday evening 5-6:20 pm and Tuesday morning 7-8 am Oto-HNS educational lectures. In addition, the selective director will give an introductory lecture and review of the head and neck exam at the beginning of the 3-week selective.
7. COMPLETION OF INDEPENDENT READING: students are expected to read the provided basic Oto-HNS booklet, “Primary Care Otolaryngology” in full. There will be a quiz at the completion of the 3-week selective that will be derived from this reading. This is very basic, however, and the student is expected to refer to more detailed/comprehensive texts for specific assignments, patients and surgeries. They will be informed of additional texts that they should read from during the rotation (ie: “Cancer of the Head & Neck”, by Meyers, Suen, Myers, Hanna; Bailey or Cummings OtoHNS texts, etc).
8 . COMPLETION OF WEEKLY STUDENT PRESENTATIONS: at the end of each week, the students will present a prepared talk for the residents, other medical students on the rotation, the selective director and available attendings – this will be an Oto-HSN topic of the students’ choice, pertaining to the particular Oto-HNS subspecialty they were on that week, and is limited to a 10-minute oral (NO power-point/slides) presentation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 2 oral cavity H&N cancer patients in clinic
2. 2 oropharyngeal H&N cancer patients in clinic
3. 1 laryngeal H&N cancer
4. 1 thyroid or salivary gland tumor
5. 2-4 inpatients on Team C (H&N team)
6. 1 ‘free flap’/ microvascular reconstruction
7. 1 facial plastics patient (i.e.: congenital deformity, facial defect)

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Performance in the clinics, hospital and O.R:
The student will be evaluated in regards to the following: attitude/interest/initiative, professionalism, team-work, interpersonal & communication skills with patients/MDs, motivation toward learning, history-taking, physical exam, knowledge base, differential dx, problem-solving, presentation skills and procedural skills. Each attending and the chief resident(s) on each team will be asked to complete a standardized evaluation form at the end of each rotation.
2. Presentations:
The students’ weekly 10-minute presentations will be evaluated by the residents, the
selective director(s) and available attendings; evaluation based on effort/ preparedness, content and oral presentation skills. Following the presentations, the group will review that prior week’s experiences with the selective director(s) for informal discussion/teaching.
3. ‘Exit’ Quiz:
The student will complete a comprehensive quiz at the end of the 3-week selective; the
material for the quiz will come from the provided booklet, “Primary Care Otolaryngology” and other assigned reading, from cases seen in clinic/hospital/ORs and from discussed topics; ‘bonus’ questions will also be offered. The chief residents will
grade these standardized quizzes, and report results to selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive daily feedback from the residents and attendings (on rounds, in clinic, in the operating room). One of the selective directors will meet with each student at the end of their rotation to review their experience, discuss their evaluations, and complete a selective evaluation (to help us determine if the objectives of the course are being met).

Course #: 882J

Title:  Head & Neck Surgery (Focus: Neurotology)

Selective Director(s):  Terry A. Day, M.D., Judith M. Skoner, M.D. and Ted Meyer, M.D.

Maximum Number of students per block: 1

SELECTIVE OVERVIEW:
Over the 3-weeks, the student will rotate primarily with our 2 Neurotologists, Dr. Paul Lambert (Chairman) and Dr. Ted Meyer (Director Cochlear Implant Division), and will also receive training in Audiology and Vestibulography/Balance Disorder testing.

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Know / demonstrate the essential components of a thorough head and neck history-
taking and physical examination
2. Understand and discuss the applied anatomy of the face, ear, nose/sinuses, mouth,
pharynx, larynx and neck
3. Describe patients with various head and neck pathologies including
otitis media, vertigo, tinnitus, as well as with skull base/brain tumors (ie: acoustic neuroma, meningioma)
4. Provide a differential diagnosis of a patient with a unilateral serous effusion.
6. Describe the diagnostic workup of a patient with unilateral tinnitus.
7. Describe some options for treating auricular deformities/atresia.
8. Describe the clinical aspects and develop differential diagnoses for hearing loss & vertigo; understand basic audiologic tests and balance testing.
9. Describe common causes of hearing loss in adults and in children, and the workup for these different age groups
10. Interpret basic temporal bone/brain imaging (CT/MRI) studies
10. Understand the principles of cochlear implantation and its indications
11. Describe the work-up and treatments of common childhood ear diseases
12. Understand indications for Otolaryngologic consultation
14. Describe various Oto-HNS surgical procedures, including pressure equalization tube insertions, middle ear surgery, mastoidectomy, cochlear implantation and skull base surgery.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. PARTICIPATION IN OUTPATIENT CLINICS: students will evaluate new and follow-up patients in the various Oto-HNS clinics, and discuss findings/impressions/plans with the attending. Students are expected to be prepared for the clinic and be engaged in didactic instruction. The clinics will take place in Rutledge Tower, the VA hospital and possibly the East Cooper Medical Arts Bldg in Mt. Pleasant
2. PARTICIPATION IN INPATIENT CARE: students will round daily with their designated team, interview/examine their patients, write daily progress notes for assigned patients, follow these patients perioperatively, and actively participate in discussions regarding decision-making and patient management. Students are expected to independently read about their patients’ diagnoses, treatments, etc. so that group discussions will be more meaningful.
Students are also expected to see/follow inpatient consultations with resident/attending supervision.
3. OPERATING ROOM PARTICIPATION: students will attend/observe/participate in various Oto-HNS inpatient and outpatient surgical procedures. They will review the upcoming cases for the week, determine the cases that they will attend, and prepare for the cases appropriately (pertinent anatomy, pathophysiology of the primary disease process, patient work-up, indications for that surgery, etc). The student should meet the patient preoperatively and review the chart for specifics of each case.
4. ATTENDANCE AT MULTIDISCIPLINARY H&N TUMOR BOARD: the student will attend the weekly head and neck tumor board conference which reviews new and follow-up head and neck cancer patients from a multidisciplinary view: case discussion, radiologic imaging, pathology, medical oncology and radiation oncology options, and surgical and reconstructive options.
5. ATTENDANCE AT AUDIOLOGY: the student will meet with the audiologists for a review of basic testing each week; they will observe audiograms being performed on patients and review the results, as well as learn the basics of tympanometry.
6. ATTENDANCE AT VESTIBULAR TESTING: the student will meet with Dr. Jack King and other audiologists who perform vestibulography / balance testing, to review the basic principles and interpretations of these tests. They will have to opportunity to watch these and to have these performed on themselves as well, for greater understanding of the patient’s experience.
7. ATTENDANCE AT LECTURES: the students will attend the Monday evening 5-6:20 pm and Tuesday morning 7-8 am Oto-HNS educational lectures. In addition, the selective director will give an introductory lecture and review of the head and neck exam at the beginning of the 3-week selective.
8 . COMPLETION OF INDEPENDENT READING: students are expected to read the provided basic Oto-HNS booklet, “Primary Care Otolaryngology” in full. There will be a quiz at the completionof the 3-week selective that will be derived in part from this reading. This is very basic, however, and the student is expected to refer to more detailed/comprehensive texts for specific assignments, patients and surgeries. The student will be informed of supplemental texts which they should refer to, and will be assigned reading.
9. COMPLETION OF WEEKLY STUDENT PRESENTATIONS: at the end of each week, the students will present a prepared talk for the residents, other medical students on the rotation, the selective director and available attendings – this will be an Oto-HSN topic of the students’ choice, pertaining to the particular Oto-HNS subspecialty they were on that week, and is limited to a 10-minute oral (NO power-point/slides) presentation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 2 chronic ear infections in adults
2. 2 chronic ear infections in children
3. 2 patients with vertigo/dizziness
4. 2 patients with hearing loss
5. 2 patients with dizziness
6. 1 patient with a ‘draining’ ear

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Performance in the clinics, hospital and O.R:
The student will be evaluated in regards to the following: attitude/interest/initiative, professionalism, team-work, interpersonal & communication skills with patients, motivation toward learning, history-taking, physical exam, knowledge base, differential dx, problem-solving, presentation skills, and procedural skills. Each attending and the chief resident on each team will be asked to complete a standardized evaluation form at the end of each rotation.
2. Presentations:
The students’ weekly 10-minute presentations will be evaluated by the residents, the
selective director(s) and available attendings; evaluation based on preparedness, content and oral presentation skills. Following the presentations, the group will review that prior
week’s experiences with the selective director(s) for informal discussion/teaching.
3. ‘Exit’ Quiz:
The student will complete a comprehensive quiz at the end of the 3-week selective; the
material for the quiz will come primarily from the provided booklet, “Primary Care Otolaryngology”, in addition to other assigned reading, and discussion topics; ‘bonus’ questions will also be offered. The chief residents will grade these standardized quizzes, and report results to selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive daily feedback from the residents and attendings (on rounds, in clinic, in the operating room). One of the selective directors will meet with each student at the end of their rotation to review their experience, discuss their evaluations, and complete a selective evaluation (to help us determine if the objectives of the course are being met).

Course #: 883J

Title:  Head & Neck Surgery (Focus: Pediatric Otolaryngology/Airway)

Selective Director(s):  Terry A. Day, M.D., Judith M. Skoner, M.D. and David White, M.D.

Maximum Number of students per block: 1

SELECTIVE OVERVIEW:
Over the 3-weeks, the student will rotate primarily with our Pediatric Otolaryngology-Head and Neck surgeons, Dr. David White and Dr. Lucinda H. Halstead. They will have extensive exposure to pediatric airway problems/treatment, as well as the most common pediatric OtoHNS pathologies.

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Know / demonstrate the essential components of a thorough head and neck history-
taking and physical examination
2. Understand and discuss the applied anatomy of the face, ear, nose/sinuses, mouth,
pharynx, larynx and neck and the unique qualities of the pediatric patient
3. Understand the embryologic considerations in Pediatric OtoHNS
3. Recognize pediatric patients with various common head and neck pathologies including otitis media, vertigo, rhinitis, epistaxis, sinusitis, pharyngitis, tonsillitis, stridor,
dysphonia, trauma, and head & neck tumors.
4. Recognize and describe symptoms suggestive of pediatric head and neck malignancies;
and recognize abnormal exam findings of the oral cavity and pharynx, including malignant lesions and lesions suspicious for malignancy.
5. Provide a differential diagnosis of a pediatric patient with a neck mass.
6. Describe the diagnostic workup of a pediatric patient with hearing loss.
7. Describe some options for reconstructing a variety of head and neck defects resulting
from trauma, congenital anomalies or tumor resections.
8. Describe the clinical aspects and develop differential diagnoses for congenital hearing loss; understand basic audiologic testing methods in the peds patient.
9. Describe common causes of hoarseness in children
10. List the differential diagnosis for stridor and be familiar with emergent and
long-term airway management techniques.
11. Understand basic speech and swallowing principles and evaluations.
12. Describe the work-up and treatments of common childhood ear, nose, and throat diseases
13. Describe some basic aesthetic principles of facial plastic & reconstructive surgery
14. List the common causes of unilateral rhinorrhea and nasal obstruction
15. Define acute and chronic rhinosinusitis, and describe the work-up and treatment options
in the pediatric patient.
16. Understand indications for Peds-Otolaryngologic consultation
17. Recognize various Oto-HNS surgical procedures, including tonsillectomy,
adenoidectomy, pressure equalization tube insertions, laryngoscopy/bronchoscopy, tracheostomy, airway management, and tumor/cyst excisions and reconstructive surgeries.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. PARTICIPATION IN OUTPATIENT CLINICS: students will evaluate new and follow-up patients in the various Oto-HNS clinics, and discuss findings/impressions/plans with the attending. Students are expected to be prepared for the clinic and be engaged in didactic instruction. The clinics will take place in Rutledge Tower, the East Cooper Medical Arts Bldg in Mt. Pleasant and a West Ashley clinic location.
2. PARTICIPATION IN INPATIENT CARE: students will round daily with their designated team, interview/examine their patients, write daily progress notes for assigned patients, follow these patients perioperatively, and actively participate in discussions regarding decision-making and patient management. Students are expected to independently read about their patients’ diagnoses, treatments, etc. so that group discussions will be more meaningful.
Students are also expected to see/follow inpatient consultations with resident/attending supervision.
3. OPERATING ROOM PARTICIPATION: students will attend/observe/participate in various Oto-HNS inpatient and outpatient surgical procedures. They will review the upcoming cases for the week, determine the cases that they will attend, and prepare for the cases appropriately (pertinent anatomy, pathophysiology of the primary disease process, patient work-up, indications for that surgery, etc). The student should meet the patient preoperatively and review the chart for specifics of each case.
4. INTRODUCTION TO AUDIOLOGY: during the rotation, the student will meet with the pediatric audiologista for a review of basic testing; they will observe audiograms being performed and review the results, as well as learn the basics of tympanometry.
5. INTRODUCTION TO VOICE & SWALLOWING: the students will meet with members of the MUSC Evelyn Trammell Institute for Voice and Swallowing for an introduction to basic principles of diagnosis, evaluation and treatment for common voice and swallowing disorders, in relation to the pediatric patient.
6. ATTENDANCE AT LECTURES: the students will attend the Monday evening 5-6:20 pm and Tuesday morning 7-8 am Oto-HNS educational lectures. In addition, the selective director will give an introductory lecture and review of the head and neck exam at the beginning of the 3-week selective.
8. COMPLEATION OF INDEPENDENT READING: students are expected to read the provided basic Oto-HNS booklet, “Primary Care Otolaryngology” in full. There will be a quiz at the completion of the 3-week selective that will be derived from this reading in addition to other assigned reading topics and discussions. This is very basic, however, and the student is expected to refer to more detailed/comprehensive texts for specific assignments, patients and surgeries.
9. COMPLETION OF WEEKLY STUDENT PRESENTATIONS: at the end of each week, the students will present a prepared talk for the residents, other medical students on the rotation, the selective director and available attendings – this will be an Oto-HSN topic of the students’ choice, pertaining to the particular Oto-HNS subspecialty they were on that week, and is limited to a 10-minute oral (NO power-point/slides) presentation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 4 airway/voice patients (ie: stridor, ‘noisy breathing’, hoarseness)
2. 2 Sinonasal patients (i.e.: sinusitis, allergic rhinitis, epistaxis)
3. 4 Otologic patients (i.e.: chronic ear infections, hearing loss, vertigo)
4. 4 tonsil/adenoid patients (i.e.: tonsillitis, OSA)

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Performance in the clinics, hospital and O.R:
The student will be evaluated in regards to the following: interest/attitude/initiative, professionalism, team-work, interpersonal & communication skills with patients, motivation toward learning, history-taking, physical exam, knowledge base, differential dx, problem-solving, presentation skills, and procedural skills. Each attending and the chief resident on each team will be asked to complete a standardized evaluation form at the end of each rotation.
2. Presentations:
The students’ weekly 10-minute presentations will be evaluated by the residents, the
selective director(s) and available attendings; evaluation based on preparedness, content and oral presentation skills. Following the presentations, the group will review that prior
week’s experiences with the selective director(s) for informal discussion/teaching.
3. ‘Exit’ Quiz:
The student will complete a comprehensive quiz at the end of the 3-week selective; the
material for the quiz will come primarily from the provided booklet, “Primary Care Otolaryngology”, other assigned reading topics, prior discussions; ‘bonus’ questions will also be offered. The chief residents will grade these standardized quizzes, and report results to selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive daily feedback from the residents and attendings (on rounds, in clinic, in the operating room). One of the selective directors will meet with each student at the end of their rotation to review their experience, discuss their evaluations, and complete a selective evaluation (to help us determine if the objectives of the course are being met).

Course #: 884J

Title:  Otolaryngology-Head & Neck Surgery (Focus in : Ooupatient/Clinic OtoHNS )

Selective Director(s):  Terry A. Day, M.D., Judith M. Skoner, M.D., KG Hoang, M.D. and Mark Hoy, M.D.

Maximum Number of students per block: 1

SELECTIVE OVERVIEW:
Over the 3-weeks, the student will rotate primarily through the various outpatient OtoHNS clinics, primarily at the East Cooper office, with no inpatient management/ O.R. (this would however, vary depending on the student’s level of interest, and could include exposure to surgeries if desired). This rotation would be particularly beneficial to those students interested in primary care, as a great deal of primary care complaints are related to the head and neck. The emphasis would be on developing excellent clinical head and neck history/exam skills, developing differential diagnoses, and understanding a wide variety of common Otolaryngologic problems and potential treatment approaches.

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Know / demonstrate the essential components of a thorough head and neck history-
taking and physical examination
2. Understand and discuss the applied anatomy of the face, ear, nose/sinuses, mouth,
pharynx, larynx and neck
3. Describe patients with various common head and neck pathologies including
otitis media, vertigo, rhinitis, epistaxis, sinusitis, pharyngitis, tonsillitis, stridor,
dysphagia, dysphonia, facial trauma, and head & neck tumors/defects.
4. Recognize and describe symptoms suggestive of head and neck malignancies;
and recognize abnormal exam findings of the oral cavity and pharynx, including malignant lesions and lesions suspicious for malignancy.
5. Provide a differential diagnosis of a patient with a neck mass.
6. Describe the diagnostic workup of a patient a neck mass.
7. Describe some options for reconstructing a variety of head and neck defects resulting
from trauma, congenital anomalies or cancer resections.
8. Describe the clinical aspects and develop differential diagnoses for hearing loss & vertigo; understand basic audiologic tests.
9. Describe common causes of hoarseness in adults and in children
10. List the differential diagnosis for stridor and be familiar with emergent and
long-term airway management techniques.
11. Understand basic speech and swallowing principles and evaluations.
12. Describe the work-up and treatments of common childhood ear, nose, and throat diseases
13. Describe some basic principles of head and neck reconstructive surgery
14. List the common causes of rhinorrhea and nasal obstruction
15. Define acute and chronic rhinosinusitis, and describe the work-up and treatment options.
16. Understand indications for Otolaryngologic consultation
17. Depending on student interest: Describe various Oto-HNS surgical procedures, including endoscopic sinus surgery, tonsillectomy, pressure equalization tube insertions, laryngoscopies.

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. PARTICIPATION IN OUTPATIENT CLINICS: students will evaluate new and follow-up patients in the various Oto-HNS clinics, and discuss findings/impressions/plans with the attending. Students are expected to be prepared for the clinic and be engaged in didactic instruction. The clinics will take place primarily at our office at the East Cooper Medical Arts Bldg in Mt. Pleasant, but also at Hollings Cancer Center, the VA and Rutledge Tower.
2. ATTENDANCE AT MULTIDISCIPLINARY H&N TUMOR BOARD: the student will attend the weekly head and neck tumor board conference at least once during the rotation; this board reviews new head and neck cancer patients from a multidisciplinary view: case discussion, radiologic imaging, pathology, medical oncology and radiation oncology options, and surgical and reconstructive options.
3. INTRODUCTION TO AUDIOLOGY: during the rotation, the student will meet with the
audiologists for a review of basic testing; they will observe an audiogram being performed and review the results, as well as learn the basics of tympanometry.
4. INTRODUCTION TO VOICE & SWALLOWING: the students will meet with members of the MUSC Evelyn Trammell Institute for Voice and Swallowing for an introduction to basic principles of diagnosis, evaluation and treatment for common voice and swallowing disorders
5. ATTENDANCE AT LECTURES: the students will attend the Monday evening 5-6:20 pm and Tuesday morning 7-8 am Oto-HNS educational lectures. In addition, one of the selective directors will give an introductory lecture and review of the head and neck exam at the beginning of the 3-week selective.
6. COMPLETION OF INDEPENDENT READING: students are expected to read the provided basic Oto-HNS booklet, “Primary Care Otolaryngology” in full. There will be a quiz at the completion of the 3-week selective that will be derived from this reading in addition to other assigned reading topics and prior discussions. This is very basic, however, and the student is expected to refer to more detailed/comprehensive texts for specific assignments/patients.
7. COMPLETION OF WEEKLY STUDENT PRESENTATIONS: at the end of each week, the students will present a prepared talk for the residents, other medical students on the rotation, the selective director and available attendings – this will be an Oto-HSN topic of the students’ choice, pertaining to the particular Oto-HNS subspecialty they were on that week, and is limited to a 10-minute oral (NO power-point/slides) presentation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 1 H&N cancer patients
2. 2 Sinonasal patients (i.e.: sinusitis, allergic rhinitis, epistaxis)
3. 2 Otologic patients (i.e.: chronic ear infections, tinnitus, hearing loss, vertigo)
4. 2 Pediatric patients (i.e.: tonsillitis, stridor, ear infxns, dysphonia)
5. 2 General OtoHNS patients (i.e.: hoarseness, dysphagia, sleep apnea, thyroid)

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Performance in the clinics, hospital and O.R:
The student will be evaluated in regards to the following: professionalism,
team-work, interpersonal & communication skills with patients, motivation toward learning, history-taking, physical exam, knowledge base, differential dx, problem- solving, presentation skills, and attitude/interest/initiative. Each attending with whom the student worked and the chief residents will be asked to complete a standardized evaluation form at the end of each rotation.
2. Presentations:
The students’ weekly 10-minute presentations will be evaluated by the residents, the
selective director(s) and available attendings; evaluation based on preparedness, content and oral presentation skills. Following the presentations, the group will review that prior
week’s experiences with the selective director(s) for informal discussion/teaching.
3. ‘Exit’ Quiz:
The student will complete a comprehensive quiz at the end of the 3-week selective; the
material for the quiz will come primarily from the provided booklet, “Primary Care Otolaryngology”, in addition to other assigned reading topics and prior discussions; ‘bonus’ questions will also be offered. The chief residents or selective director will grade these standardized quizzes.

Please outline when and how the learners will receive feedback on their performance:
Students will receive daily feedback from the residents and attendings (on rounds, in clinic, in the operating room). One of the selective directors will meet with each student at the end of their rotation to review their experience, discuss their evaluations, and complete a selective evaluation (to help us determine if the objectives of the course are being met).

Course #: 885J

Title:  Otolaryngology-Head & Neck Surgery (Focus in : Rhinology (Sinonasal) & OTO-HNS Allergy )

Selective Director(s):  Terry A. Day, M.D., Judith M. Skoner, M.D., and Rodney Schlosser, M.D.

Maximum Number of students per block: 1

SELECTIVE OVERVIEW:
Over the 3-week rotation, the student will work primarily with Dr. Rodney Schlosser for focused study in sinonasal conditions. The student will have access to other head & neck/ rhinology clinics as well as facial plastics clinic (for appreciation of both the aesthetic and functional components of nasal anatomy); they will also receive exposure to OtoHNS allergy testing and management.

LEARNING GOALS AND OBJECTIVES:
At the completion of this clinical rotation, students will be able to:

1. Know / demonstrate the essential components of a thorough head and neck history-
taking and physical examination
2. Understand and discuss the applied anatomy of the face, ear, nose/sinuses, mouth,
pharynx, larynx and neck
3. Describe patients with various common head and neck pathologies including
rhinitis, epistaxis, sinusitis, pharyngitis and sinonasal / anterior skull base tumors.4
4. Describe the symptoms suspicious for a CSF leak and the workup of such.
5. Describe the clinical aspects and develop differential diagnoses for nasal obstruction.
6. Recognize the signs and symptoms of environmental allergies and an approach to diagnosis and treatment
7. Understand the basic principles of skin-endpoint-titration allergy testing
8. Describe common causes of epistaxis in adults, adolescents and children
9. List the differential diagnosis for facial pain
10. Interpret basic imaging (ie: CT/MRI) studies of the face and sinuses / skull base
11. List the common causes of rhinorrhea and nasal obstruction
12. Define acute and chronic rhinosinusitis, and describe the work-up and treatment options.
13. Recognize and describe symptoms suggestive of head and neck malignancies;
and recognize abnormal exam findings of the sinonasal cavities, oral cavity and pharynx, including malignant lesions and lesions suspicious for malignancy.
14. Provide a differential diagnosis of a patient with a neck mass and middle ear effusion
15. Understand indications for Otolaryngologic consultation
16. Understand functional nasal anatomy and surgical interventions to correct abnormalities
17. Describe Oto-HNS surgical procedures, including endoscopic sinus surgery,
septoplasty, turbinate reductions, functional rhinoplasty and anterior skull base / tumor access (ie: pituitary tumor approach, etc)

TEACHING METHODOLOGIES AND ROTATION ACTIVITIES:
Students on this rotation will be expected to learn and achieve the educational goals and objectives through the following methodologies and activities:

1. PARTICIPATION IN OUTPATIENT CLINICS: students will evaluate new and follow-up patients in the Oto-HNS clinics, and discuss findings/impressions/plans with the attending(s). Students are expected to be prepared for the clinic and be engaged in didactic instruction. The clinics will take place in Hollings Cancer Center, Rutledge Tower and offices in the East Cooper Medical Arts Bldg in Mt. Pleasant.
2. PARTICIPATION IN INPATIENT CARE: students will round daily with their designated team, interview/examine their patients, write daily progress notes for assigned patients, follow these patients perioperatively, and actively participate in discussions regarding decision-making and patient management. Students are expected to independently read about their patients’ diagnoses, treatments, etc. so that group discussions will be more meaningful.
Students are also expected to see/follow inpatient consultations with resident/attending supervision.
3. OPERATING ROOM PARTICIPATION: students will attend/observe/participate in various Oto-HNS inpatient and outpatient surgical procedures. They will review the upcoming cases for the week, determine the cases that they will attend, and prepare for the cases appropriately (pertinent anatomy, CT findings, pathophysiology of the primary disease process, patient work-up, indications for that surgery, etc). The student should meet the patient preoperatively and review the chart for specifics of each case.
4. ATTENDANCE AT MULTIDISCIPLINARY H&N TUMOR BOARD: the student will attend the weekly head and neck tumor board conference at least once (more at the discretion of Dr. Schlosser); this board reviews new and follow-up head and neck cancer patients from a multidisciplinary view: case discussion, radiologic imaging, pathology, medical oncology and radiation oncology options, and surgical and reconstructive options.
5. INTRODUCTION TO ALLERGY: during the rotation, the student will meet with Jamie Woody, Physician Assistant, to review basic allergy testing indications, protocol and technique. The student will be able to observe testing and immunotherapy, as well as follow patients’ response to such.
6. ATTENDANCE AT LECTURES: the students will attend the Monday evening 5-6:20 pm and Tuesday morning 7-8 am Oto-HNS educational lectures. In addition, the selective director will give an introductory lecture and review of the head and neck exam at the beginning of the 3-week selective.
8. COMPLETION OF INDEPENDENT READING: students are expected to read the provided basic Oto-HNS booklet, “Primary Care Otolaryngology” in full. They are also expected to review head and neck anatomy. There will be a quiz at the completion of the 3-week selective that will be derived from this basic provided text, in addition to other assigned reading topics, imaging studies and prior discussions. The student is expected to refer to more detailed/comprehensive texts and journal articles for researching specific assignments, patient conditions and surgeries.
9. COMPLETION OF WEEKLY STUDENT PRESENTATIONS: at the end of each week, the students will present a prepared talk for the residents, other medical students on the rotation, the selective director and available attendings – this will be an Oto-HSN topic of the students’ choice, pertaining to the particular Oto-HNS subspecialty they were on that week, and is limited to a 10-minute oral (NO power-point/slides) presentation.

PATIENT ENCOUNTERS
Students on this rotation will be expected to work up and/or follow the following minimum number of patients with the specified conditions (i.e, 2 pediatric ear infections, 2 adult migraine headaches):

1. 6 acute or chronic sinusitis patients
2. 4 allergy patients
3. 1 allergy testing (OBSERVATION)
4. 1 patient with epistaxis
5. 1 patient with a pituitary / skull base tumor (current or past h/o)
6. 1 patient with chronic nasal obstruction and valve collapse

EVALUATION AND FEEDBACK:
Students on this rotation will be evaluated through the following methods, and designate by whom for each method:

1. Performance in the clinics, hospital and O.R:
The student will be evaluated in regards to the following: interest/ attitude/ initiative, professionalism, team-work, interpersonal & communication skills with patients/MDs, motivation toward learning, history-taking, physical exam, knowledge base, differential dx, problem-solving, presentation skills. Each attending and the chief resident on each team will be asked to complete a standardized evaluation form at the end of each rotation.
2. Presentations:
The students’ weekly 10-minute presentations will be evaluated by the residents, the
selective director(s) and available attendings; evaluation based on effort, preparedness, content and oral presentation skills. Following the presentations, the group will review that prior week’s experiences with the selective director(s) for informal discussion/teaching.
3. ‘Exit’ Quiz:
The student will complete a comprehensive quiz at the end of the 3-week selective; the
material for the quiz will come primarily from the provided booklet, “Primary Care Otolaryngology”, other assigned reading topics and prior discussions; ‘bonus’ questions will also be offered. The chief residents / PA will grade these standardized quizzes, and report results to selective director.

Please outline when and how the learners will receive feedback on their performance:
Students will receive daily feedback from the residents / PA and attendings (on rounds, in clinic, in the operating room). One of the selective directors will meet with each student at the end of their rotation to review their experience, discuss their evaluations, and complete a selective evaluation (to help us determine if the objectives of the course are being met).