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Policies & Procedures
Duty Hours
Duty hours at each affiliated hospital are dictated by the need for continuing patient care in line with the 80 hour work week standards. To provide 24-hour coverage while not overburdening each resident, a home based night call schedule is set up by the senior administrative resident and approved by the program director. Weekdays, call begins at 5:00 p.m. and ends at 7 a.m. Weekends (Saturday and Sunday) change over occurs at 7:00 a.m. On weekdays the hospital, including ER, consults, etc. is to be covered by residents assigned there from 7:00 a.m. to 5:00 p.m. The resident work hours will not exceed 80 hours per week average over a four-week period.
While on call, the resident covers all four affiliated hospitals. The PGY2 and PGY3 take home call; PGY4 -5 must be readily available by phone or beeper. There is also a staff physician who takes supervisory call and must be notified of all admissions, cases needing to go to the operating room, and any lingering unresolved questions. Residents at all levels spend on the average of at least one out of seven days without patient care responsibilities. On call rooms as well as provisions for meals and parking are available to the resident if needed. The work hours and call policy will be in accordance with ACGME policy without exception.
Supervision
The program policy is to provide appropriate supervision of residents in the operating room as well as in the clinics. The program director ensures that a full time or clinical faculty member is assigned to supervise residents during all operative procedures at all of the affiliated hospitals. These polices include:
- Norton and Kosair Children's Hospitals, the faculty is required to be in the operating room before any patient can undergo anesthesia.
- University of Louisville Hospital, the senior residents are permitted to operate independently on those cases for which he/she has been given prior written approval. For any of the other residents to operate, a staff physician must be present assisting the resident through all but the closure.
- Veterans Hospital, senior residents are allowed to operate independently and may assist junior residents in operative procedures.
However, an attending staff is still assigned to the operating room and is readily available on those cases as well. The staff physician must be able to be reached immediately by phone or beeper and to respond to the operating room rapidly as needed. They are not to be involved at other hospitals or with other patient care responsibilities, which would preclude their immediate response.
Likewise, a staff physician is assigned to all outpatient clinics held in the affiliated hospitals. The degree of supervision is left to the discretion of the staff member and is based on the level of clinical judgment of the resident or residents, which are being supervised. The policies for the clinics include:
Pediatric otolaryngology clinics at Kosair Children's Hospital, a junior level resident is assigned and the care is therefore personally supervised by a staff member all of the time.
Veterans Hospital and at University of Louisville Hospital, where a senior level resident is always present, care is personally supervised by a staff physician all of the time. Although personal supervision of care is provided, the resident is expected to still make the primary decisions regarding patient evaluation and management planning.
Resident Evaluation Criteria
Clinical Evaluation
Resident performance is evaluated on an ongoing basis in terms of knowledge, clinical judgment, technical skills and interpersonal skills and attitudes. Their progress is discussed regularly at monthly faculty meetings. Written evaluations are carried out semi-annually by each faculty member for each resident they have supervised during that time period. By direct observation of resident performance in the clinics, on the wards, in the operating room, at clinical and basic science conferences, at our annual mock oral exams as well as other didactic sessions, progress can be continually monitored and clinical competency can be accurately assessed. The program director meets semi-annually with each resident for a formal evaluation session in which the faculty's assessment of his or her knowledge, skills and professional growth is discussed. If there are specific problem areas, formal meetings are more frequent until the concerns are resolved.
National Examinations
Residents participate in two national standardized exams each year, the home study course and the annual in-service examination of the American Academy of Otolaryngology-Head and Neck Surgery. Each year the results are evaluated and the curriculum content of the program is assessed in terms of areas of strengths and weaknesses. Residents are expected to score the minimal passing standards (mean) in accordance with the ABO guidelines for the corresponding year in residency and a minimum score of the 85 percentile on the home study course. Individual residents are also counseled if there are any glaring weaknesses and guidance if given as to how to address these weaknesses. The performance of program graduates on the American Board of Otolaryngology is also monitored.
Mock Orals
Mock Orals are scheduled for all residents in March. On that day, exams will begin at 8:30 continuing until 12:00. Each faculty member will meet with resident asking a question from his or her specialization. The evaluation form follows this discussion.
Faculty Evaluation
The program director as well as the residents participates in faculty evaluations annually. The faculty is evaluated on their clinical knowledge, teaching ability and commitment, and scholarly contributions. Resident written evaluations of the faculty are strictly anonymous to ensure candor.
Self Evaluation
The direction of the overall program goals and objectives as well as the needs of the residents and the teaching responsibilities of the faculty are under continuous scrutiny of the Division Director and discussed monthly at faculty meetings. We constantly strive to maintain the balance between service and education both as a faculty and as a program. Formal self-evaluation is carried out each year; a resident curriculum evaluation and planning session and a faculty strategic planning retreat. The resident curriculum planning session involves assessing the strengths and weaknesses of curriculum content, including resident rotations, formal didactic sessions and courses attended. Each are evaluated in terms of quality and importance in accomplishing program goals and objectives. The program director and at least one other faculty member meets with all residents for this session. Results are then communicated to other faculty members by a written summary. Based on the results as well as faculty input the next academic year is planned. The Special Requirements for Residency Education are reviewed to ensure all requirements are met in designing the curriculum and resident rotations. The faculty strategic planning retreat is a half-day session in which the program mission statement and goals and objectives are assessed in terms of strengths, weaknesses, opportunities and obstacles. The areas assessed include administration, teaching, clinical service and research. Based on the discussions we develop a one- year, three-year, five-year and long term program plan. We also assess what we have accomplished from our previous year's plan, and make any appropriate modifications. This is an important part of our self-assessment and ensures that we always have a vision for our future.
Research expectations, abstracts, and support
Research
All residents are expected to participate in clinical research activities with a faculty member. Consult the following list of research topics for the appropriate faculty member to match with your interests. Clinical activities and an active monthly journal club are viewed as important learning and research opportunities. Each year, all residents rotating on the clinical rotations are expected to develop a clinical research project in conjunction with a faculty mentor. A research plan including a time table, method for data retrieval, and if necessary completion of Institutional Human Studies review are completed. The resident is expected at regular intervals to report project progress, findings, or difficulties to their respective faculty mentors. Interdisciplinary research activity is encouraged and past activity has involved cooperation with general surgery, neurosurgery, plastic surgery, medical oncology, radiation oncology, radiology, pediatrics, audiology and speech pathology. Once data collection is complete on projects, data management is the responsibility of the resident. Statistical software capabilities are extensive and support/consultations can be made on a case by case basis. Residents are expected to present their research at the divisions yearly Resident Research Day.
In addition, residents are encouraged to present a local, regional, and national meetings; the residents' ability to attend meetings to present their research is financially subsidized by the division of Otolaryngology through internal and occasionally extramural funding. The residents are encouraged to culminate their yearly research activity with the preparation of a manuscript to be submitted to a professional journal.
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