Purpose: The fundamental purpose of the Boston University Otolaryngology Residency Training Program is to educate and train physicians to function independently as specialists in the field of otolaryngology – head and neck surgery.

Because this specialty provides comprehensive medical and surgical care of patients with diseases and disorders of the head and neck that affect the ears, the facial skeleton, the respiratory and upper alimentary systems and structures, specialists in this discipline must have core knowledge, skills and understanding of the basic medical sciences relevant to the head and neck, the respiratory and upper alimentary systems the communication sciences including audiology and speech – language pathology, the chemical senses of smell and taste, as well as allergy, endocrinology and neurology as they relate to the head and neck. The specialist in Otolaryngology must be proficient in the diagnosis and in the medical and surgical therapy, reconstruction or prevention of disease, neoplasm, deformity, disorder, and injury of the head and neck. 

To this end, seven basic experiences are provided; it is the responsibility of the trainee to take full advantage of these opportunities:

1. Independent reading

2. Clinical training: clinic, operating room and ward

3. Conferences

4. Didactic courses

5. Teaching medical students and other house officers

6. Research

7. Evaluation

INDEPENDENT READING

*       Each resident will purchase and read one of the multi-volume core textbooks of otolaryngology. Myerhoff and Rice, Bailey, or Ballanger, (see below) is our current recommendation. This should be assimilated by the completion of the second year. The following is the faculty consensus opinion for excellent text books and journals related to Otolaryngology – Head & Neck Surgery.

A. ESSENTIAL:

Basic text (initial survey reading for new ORL residents & for medical students/rotating residents): KARMODY, C. -or DeWEISE and SAUNDERS

Core text for ORL residents: MYERHOFFand RICE, or BAILEY, HEAD & NECK SURGERY-OTOLARYNGOLOGY, or BALLENGER, 13th Ed – Diseases of the Nose, Throat, Ear, H&N.

Anatomy text: HOLLINGHEAD or PAFF

Surgical atlas: NAUMAN, Head and Neck Surgery, 4 vol; or MONTGOMERY, W. Surgery of the Upper Resipiratory System, Vol 1& 2

Pathology text: BATSAKIS

B. STRONGLY RECOMMENDED, BASIC

Head and neck text: THAWLEY, S. & PANJE, W. / MEYERS, E. & SUEN, J.

Plastic text: McGREGOR, I. A. – Fundamental Techniques of Plastic Surgery 7th ed. – Churchill Livingstone,1980.

Maxillofacial trauma text – ARYAN, S. -

Pediatric otolaryngology text: BLUESTONE, C. & STOOL, S. -

Otology text: SCHUKNECHT, H. Pathology of the Ear, SHAMBAUGH& GLASSCOCK: Surgery of the Ear

Otology atlas: .Atlas of Otolaryngoic Surgery, Goycoolea, PAPARELLA & Nissea

Audiology text: KATZ, J.

Vestibular physiology/diagnosis text: BALOH – Neurotolgy

C. STRONGLY RECOMMENDED, ADVANCED:

Lasers: DAVIS, Lasers in Otolaryngology Head & Neck Surgery, WB Saunders, 1990

Endoscopic sinus surgery: RICE & SCHAEFER, Raven Press.

Base of skull surgery: FISCH, H. -

Plastic surgery atlas: SHEEN, J. – Aesthetic Rhinoplasty

Plastic surgery text: McCARTHY, J. – Plastic Surgery, lst 5 volumes – W. B. Saunders Co,1990

Phonosurgery: FORD & BLESS, Phonsurgery, Raven Press 1991

Problems/complications in ORL: CONLEY, J. -

AFIP Fasicles – American Registry of Pathology – Armed Forces Institute of Pathology – Room 1077 – Washington, D. C. 20306-6000

Physiological acoustics: Jahn, and Santos-Sacchi, – Physiology of the Ear -

Therapy in ORL: GATES, G. -

Writing/communications: LUCENTE, F. -

History of otolaryngology: GARRISON

D. RECOMMENDED JOURNALS/PERIODICALS:

The Laryngoscope

The Annals of Otology, Rhinology and Laryngology

The Archives of Otolaryngolog

Otolaryngology – Head and Neck Surgery

Year Book of Otolaryngology – Head and Neck Surgery

Otolaryngologic Clinics of North America

V. AAO-HNS SIPacs and Monografs and Video tapes – cf. AAO-HNS 1990-91 Complete Directory for Continuing Education in Otolaryngology- Head and Neck Surgery – AAO-HNS Foundation, Inc. – Department of Continuing Education, Alexandria, VA 22314

*       Each resident will read about the diseases of patients under his care (Case oriented reading).

*       Each resident will know the anatomy and physiology of the head and neck before being permitted to operate on living patients. The H&N anatomy course every Fall will help to correlate reading.

*       Each resident must read about the surgery in which he intends to participate and possess a well thought out plan before entering the operating room. Residents who fail to prepare intellectually for surgery cannot be awarded the opportunity to develop their technical skills.

*       All residents participate in the AAO Home Study Course and all take the Annual Otolaryngology Examination. Results from these experiences are utilized as one of the parameters for determining advancement and/or continued participation in the residency program.

*       Each resident is strongly advised to become familiar with the current contents of the specialty journals, thereby benefiting from the experiences of others. “Journal Club” meeting are held throughout the year.

*       All Residents should become members of the American Academy of Otolaryngology- Head & Neck Surgery. The Academy offers many important services to everyone in the Specialty.

CLINICAL TRAINING: CLINICS, “IN HOUSE”, OPERATING ROOMS

CONDUCT: Residents must conduct themselves in a professional manner at all times. They must be properly attired, considerate and punctual. Residents must explain their status as a trainee to the patient. The patient has the right to refuse treatment by a resident (or anyone) but a good communicator can help the patient understand the advantages of receiving dual care. Patient confidence is essential to a satisfactory outcome, and that confidence is directly linked to the patient’s belief that the those caring for him are competent, caring and concerned about the patient.

Rules and regulations, as described in the House Staff Manuals of the hospitals to which they are assigned, must be known and followed.

*       Responsibility for the full and complete care of the patients who are admitted to the service must be assumed by every resident. Patients seen in consultations and as outpatients must be followed, laboratory data must be checked, and appropriate return visits must be arranged.

*       Private and indigent patients are to be treated with like respect and dignity. All deserve the highest standard of care and consideration, and nothing less is expected or tolerated.

*       Nurses, secretaries, technicians and other ancillary care providers must be treated with respect and in a professional manner at all times. Only through harmonious cooperation of the entire health care delivery team does the patient receive optimal care, which is always our overriding goal.

The MEDICAL RECORD.

The medical record communicates data needed by all members of the health care team, charting the course of the present and future care. Records must also satisfy requirements of the Joint Commission on Accreditation of Healthcare Organizations and Hospital by-laws.

The medical record has legal status and may become a legal document. What is not written in the medical record is presumed legally not to have occurred. “Reality is not what happened or what you say happened; reality is what is in the medical record.”

GUIDELINES for record keeping:

*       All entries should be neat, legible and written in ink.

*       All entries must be signed. Sign, first and last name, include MD and date All entries by students or MD surrogates must be countersigned and dated. All signatures must be legible or a printed version of name appended.

*       All entries must be dated. Undated entries are presumed in law to have NOT occurred.

*       Only standard abbreviations may be used; avoid dittos and initials.

*       State only objective facts; do not assign or imply fault. Impressions and opinions should be avoided; if they must be recorded, they must be clearly labeled as such and backed by statements of relevant facts. An example would be a disease that has been ruled out -and why.

*       Never erase or alter a record. Corrections or additions should be added to the record in regular sequence, with reference to the previous entry which is being corrected. Always explain any instances in which the notes of others (nurses, students, etc.) do not agree with those of the physician. Where corrections must be made directly, only one line should be drawn through the incorrect entry and the time, date and initials of the person making the correction must be recorded.      

*       Document the following:

Missed appointments and other indicators of patient non-compliance

Requests for referral or consultation

All telephone calls

All prescriptions including verbal orders

Verbal instructions

Distribution of educational literature

IN HOUSE PATIENTS (ON ORL SERVICE):

The Chief Resident must make an Admission note on every patient

1. The history and physical examination is to be complete on the day of admission and will include rectal, breast and pelvic exam in adult patients or documentation of why they were not done.

2. See every patient at least twice each day.

3. Daily progress notes on every patient should include notation of :

*       Hospital day or post- op day:

*       General condition, vital signs, intake/output

*       New or ongoing problem

*       Physical findings, when pertinent:

*       HEENT and airway condition

*       Respiratory

*       Cardio Vascular

*       GI and Renal

*       Wounds

*       Drains and drainage (describe)

*       Lab data: new and significant

*       X-Ray findings: new

*       Procedures: including dressing change, pack removal, including count

*       Impression of status

*       Signature by a MD. The Chief Resident must sign all notes relating to unusual circumstances, including transfers, complications and incidents.

Patients with only medical care (no surgery) must have a progress note that outlines the plan for care.

CONSENT: Informed consent must be obtained and documented prior to any invasive procedure. Consent, to be legal, must obtained before the patient is sedated. Before signing, patients must fully informed of the planned procedure, its indications and alternatives and the risks, including the risks of anesthesia; patients should acknowledge in writing that they have had opportunity to ask questions, that all questions have been answered and that they understand the information they have been provided. Some members of the teaching staff will reserve for themselves the discussion of these factors. Do not provide possibly contradictory information that will confuse the patient. If uncertain about this, ask the Attending before becoming involved.

Informed consent also must be obtained prior to involvement of the patient in any form of research that requires patient identification, including research that uses “excess” body tissue and / or fluids.

PRE-OP NOTE is an important medical-legal document; it also clarifies one’s thinking by showing, in writing, that all factors regarding the planned surgery, its indications, the patient’s condition, and the prevention of avoidable complications have been considered, and that an informed consent has been obtained.

PRE-OP NOTE FORMAT: by the resident “surgeon”

*       Diagnosis:

*       Planned Procedure:

*       Status: Chest & CXR, Heart & EKG (If cardiac problem).

*       Lab: CBC with diff., UA, PT & PTT, electrolytes?, ABGs?

*       Bleeding time, if required

*       A statement that the procedure planned, alternatives (list), and risks, including death, bleeding, infection, convulsion, stroke, and those risks specific to the procedure (i.e.: facial nerve injury, deafness, vertigo, pneumothorax, etc.) have been discussed with parents / patients, who understand, agree to surgery, and have signed the consent form.

BRIEF OP NOTE FORMAT: prior to patient leaving the OR, describe:

*       Procedure (Use standard terminology, including CPT code)

*       Surgeons

*       Anesthesia

*       Findings: include diagram

*       Diagnosis

*       Drains, packs & other foreign bodies intentionally left in patient, and any other circumstances that may need postoperative attention

*       Blood loss and fluid replaced:

*       Complications:

*       Post-op condition:

Note: at some institutions, a check – list operative report form, containing this information, is appended to the record before the patient leaves the OR suite; in such instances, the brief op note form need only note the procedure and the post op condition.

POST-OP NOTES FORMAT: same as progress notes format

FINAL DOCUMENTAION (operation reports, discharge summaries):

Introduction:

Omitted diagnoses or procedures, non-standard terminology, and incomplete documentation may cause coding errors, incorrect assignment of the DRG, and loss of revenue. Standardized terminology is essential for retrospective chart research. Documentation is so important that many institutions will suspend the privileges of those who ignore it.

Dictate the discharge summary listing all relevant diagnoses and procedures before or within 24 hours following the patient’s discharge. Completion of all records is required before the completion of each rotation. The resident is responsible for completing any deficits which appear following their departure and will be called back to do so.

Use Hospital approved and specific medical terms. Abbreviations are unacceptable in the Discharge Summary (principal diagnosis and secondary diagnoses).

Provide COMPLETE and CONCISE information including:

*       All relevant diagnoses affecting the hospitalization and length of stay.

*       All complications arising during the patient’s stay.

*       All diagnostic, therapeutic and surgical procedures.

*       All future care plans

Definitions; The following definitions are based upon the Uniform Hospital Discharge Data Set (UHDDS) guidelines:

Principal Diagnosis: The condition established, after study, to be chiefly responsible for the major portion of the patient’s care while in the Hospital. It may or may not be the diagnosis responsible for the patient’s admission. The principal diagnosis is the major factor in determining DRG classification ( and re-imbursement). Designate the principal diagnosis with an “X”. Use standard terminology.

Secondary Diagnoses: All conditions that coexist at the time of admission, or that develop subsequently, which affect the treatment received and/or the length of stay. “Status post” (old) diagnoses that have no bearing on the hospital stay are excluded.

Complication: All conditions that develop after the admission which affect the treatment received and or the length of stay.

Co-morbidity: A significant condition which existed prior to admission which affects the treatment received and the length of stay.

Principal Procedure: The procedure performed for definitive treatment or one that was necessary to resolve a complication.

Secondary Procedures: Other therapeutic and diagnostic procedures performed during the patient’s stay.

The Principal Diagnosis

A. Always record a diagnosis, and not an operative procedure, as the reason for admission.

Example:

Principal dx: nasal obstruction from nasal polyps       (correct)

Principal dx: admitted for nasal polypectomy       (incorrect)

B. Do not use diagnoses that generally are not a reason for admission to the acute care setting.

Example:

Principal dx: cirrhosis of the liver       (correct)

Principal dx: chronic alcoholism       (incorrect)

C. Do not record the symptoms as the principal diagnosis if the underlying disease has been established.

Example:

Principal dx: Polyp, benign, left true vocal cord (correct)

Principal dx: Hoarseness       (incorrect)

D. If a condition has been ruled out, list the definitive principal diagnosis wherever possible. You may list the ruled-out diagnosis as a secondary diagnosis:

Example:

Principal dx: Polyp, benign, left true vocal cord (correct)

Principal dx: ruled out laryngeal carcinoma (incorrect)      

E. “Status post” conditions should be included only when they are treated during current admission.

Example: status post glottic carcinoma (l993)

Stage all cancers according to AJC Manual for Staging. Otherwise diagnosis is incomplete.

Complications and Co-morbidities

All relevant secondary diagnoses, complications and co-morbidities must be included in the documentation since they may effect the DRG coding of the primary diagnosis.

Example:

laryngectomy with chondritis, and post -op wound dehiscence

laryngectomy, without wound dehiscence

Use of Specific Terminology

It is important to be as specific as possible when recording the principal diagnosis and all secondary Dx. The following are examples where specification makes a difference as to code and DRG assignment.

ACUTE/CHRONIC

-acute

-chronic

-acute and chronic

COMPLICATIONS

-cause

FRACTURE

-closed or open

-anatomical site

INJURY

-period of unconsciousness

NEOPLASMS

-primary site

-still present or resected

-metastatic from…………. to …………

PROCEDURES

-endoscopic approach

-cancelled

-aborted

-biopsies, open/needle

Discharge Summary content

Format varies with different institutions. Obtain a copy of the format specific to the hospital to which you are assigned and follow it.

Begin all dictation by stating your name and the name of the patient. Exercise brevity while not sacrificing any information. The discharge summary should include:

Identifying information: Patient name, medical record number, service, admission date, discharge date, name of the person dictating and the name of the attending physician.

Reason for Admission: Why was the patient admitted?

Significant Findings: What did H&P and initial testing indicate? Impressions?

Hospital Course: What happened while the patient was here? What was the response to treatment?

Discharge Diagnosis: Condition established, after study, to be responsible for this stay.

Secondary Diagnoses/Complications: Did the patient have any other active problems? Were there any complications during this stay?

Procedures Performed: List all therapeutic procedures including operations, XRT and chemotherapy and all major diagnostic procedures that were done.

Condition on Discharge: Was the patient improved? ambulatory? Still have pain, fever, other unresolved problems?

Instructions to Patient:

*       Medications – List discharge medications, including dosages

*       Diet Restrictions – Anything the patient should not eat?

*       Physical Activity – Physical limitations?

*       Wound care

*       Whom to call in case of emergency: phone# and beeper #

*       Disposition: Where did the patient go? home? Nursing Home? VNA notified or requested?      

*       Follow-Up: Does the patient have an appointment? When and with whom?       Future care plans.      

*       Referring Physician: Did another physician refer this patient ?

*       List Physicians or Clinics that should get a copy of summary. Has patient agreed to release of information?

Operative Report Guidelines

Operative procedure must be reported immediately following the surgery; this should include:

*       Identifying Information: Include patient name, medical record number, date of surgery, surgeon’s name, surgical assistant’s name.

*       Anesthesia Information: Name of anesthesiologist and type of anesthesia used.

*       Preoperative Diagnosis: Be as precise as possible, use terminology established for ICD coding.

*       Title of Operation: Use terminology established for CPT coding. This training program and the American Board of Otolaryngology both require reports of resident operative experience, and these reports must use standard terminology and code.

*       Indications for the procedure.

*       Description of Findings. Include anatomic maps whenever possible

*       Description of the Technical Procedure Employed. Include anatomic maps whenever possible

*       Specimens Removed and Sent to Pathology:

*       Drains, packs and other foreign bodies intentionally left in the patient

*       Post-operative Diagnosis: List postoperative diagnosis following operation (state pathology pending, if necessary), using terminology established for ICD coding.

*       Post operative status

*       Complications

*       Post operative care plans

NB: The BU Program requires documentation of resident operative experience at the end of each rotation (q 3 months); the American Board of Otolaryngology H&N Surgery requires yearly documentation. Both use the same terminology & CPT codes (included). Without this documentation, you cannot become certified.

CLINIC:

Start on time

Clinic note and Consult format:

*       Date:

*       I.D.: Age, sex, race

*       Problem: Positive and Negative symptoms

*       Findings: (Exam):

*       Impression:

*       Disposition: plans, actions, suggestions

*       Signature: must be identifiable (include printed version if necessary) and include title (MD). All notes by medical students or other physician surrogates must be countersigned. All clinic/consult notes must be signed by a OTO 2 or higher resident; an Attending must sign all clinic/consult notes when payment by third parties is expected.

*       Draw diagrams of physical findings where applicable

*       Contact (phone) the referring physician whenever possible.

All Workmen’s Compensation hearing loss patients must include:

Date and time of last noise exposure

Hearing loss: onset, duration and laterality

Tinnitis: onset and duration

Vertigo: onset and duration

Family deafness Yes or No

Ear infection, pain, otorrhea: Yes or No

Ear surgery , Yes or No, when and what

Head or Ear trauma: Yes or No, when and what

Serious illness and systemic disease or surgery

Malaria or TB and treatment when and what

Systemic antibiotics.

CONSULTS:

Seen the same day, ASAP, without fail, and write a note at that time, following format of “Clinic notes” above.

Attending staff must discuss and sign consult notes.

Personally contact the referring resident with your findings, impression and suggestions.

Suggest further work-up of other problems, i.e.: infants at high risk for hearing loss, neck masses, etc.

When appropriate, provide a short “thumbnail” teaching talk to referring residents on the problem or a related topic.

If applicable, suggest other available ORL services.

All consult sheets must have the patients full name, hospital number and date of consultation and the name of physician requesting.

SURGERY

The resident “surgeon” must have examined the patient preoperatively and have entered the findings and conclusions in the patient’s chart before surgery.

Discuss the surgical procedure with the responsible staff person in advance. Since procedures are done in a variety of ways by different staff, a preliminary discussion will avoid misunderstandings and clashes in the operating room.

The responsible staff person ( the “attending” physician) must be present in the OR prior to the start of surgery unless an emergency exists that requires immediate intervention.

The resident must be in the operating room before the scheduled time and have checked patient, chart, needed XRays, lighting, equipment and instruments (does the laser work?). Check positioning of the patient. Catheterize, insert rectal probes prn.

Performing any portion of a surgical procedure is at the discretion of the attending. These privileges are directly proportional to the resident’s preparation, abilities, experience, and general performance.

At conclusion of the operation, stay with patient until the patient is in the recovery room.

Operation reports must be completed before leaving the OR suite.

ON CALL RESPONSIBILITIES:

All services must have resident coverage 24 hours per day, every day, unless all residents are otherwise assigned (for instance while taking the annual examination or attending Wednesday didatic sessions).

In general, the residents will respond to the initial request for service and will provide the service when it is routine and / or requires immediate attention.

A staff physician, at all times, is responsible for the patient and for the services provided by the resident to the patient; to this end, the staff physician must be informed of the residents activities and must guide them as necessary. Any doubt as to the need for guidance or for stat informing should be resolved by discussion with the staff physician.

Call is “home call”.  The “on call” Resident must always be available.

Problems on the service should be discussed with the chief resident who will decide if the attending physician should be called. Any question as to need to call the attending should be resolved by calling the attending.

The staff physician on call must be notified of all admissions.

The staff physician on call must be notified of the need for any unscheduled surgery, must concur, and must be present in the OR prior to its start unless urgency makes this impossible.

ETHICAL ISSUES

*       Seek guidance

*       The Program Administrator and other Faculty are always available for discussion.

*       The House Officers Manuals cover most situations.

CHIEF RESIDENT RESPONSIBILITIES

*       The Chief Resident at each hospital is the most senior otolaryngology resident assigned to the hospital.

*       In consultation with the attending staff, the Chief resident plans, supervises and provides appropriate care for all patients on the service. Visiting staff assigned to assist the resident should be given opportunity, well ahead of time, to discuss the case.

*       Supervises other residents and students in the clinic in providing appropriate evaluation and treatment for all patients.

*       Arranges the call schedule.

*       Personally provides, or arranges with another Chief Resident for, continuous coverage of all cases and problems on the service. The Chief Resident rounds daily, including weekends and holidays, on all patients on the service.

CONFERENCES & COURSES

Conferences and courses provide a forum for the synthesis of the independent reading and the clinical experiences of the resident. By discussing specific cases with the more experienced staff of our various institutions, the resident gradually develops judgment and medical acumen. Residents must attend the following conferences and courses:

*       Basic Science Course: Wednesday afternoons in the Fall.

*       Introductory Course (Summer “Crash Course”) OTO 1 only

*       Wednesday didactics: Laser lab, Allergy lab, Broncho-esophagology, Plastic Techniques, and all major Otolaryngology-Head and Neck topics

*       Intra hospital courses at the hospital to which the resident is assigned: Tumor Conference, Diagnostic Radiology, Pathology -

*       Attendance is recorded. Failure to attend without adequate explanation will result in appropriate disciplinary measures.

Adequate explanation includes:

a. Personal emergencies or illness or excused absence (vacation)

b. Emergency patient care

Moonlighting is not permitted.

TEACHING

Everyone, the teacher most of all, benefits from teaching. Medical students, nurses, resident peers, patients and even professors may learn from you.

RESEARCH

Each resident will fulfill the research rotation in a satisfactory manner.

Well before the beginning of the research rotation (which occurs during OTO 2) the resident should confer with the Director of Research regarding a project. Before the start of the research rotation, the resident must have defined a question to be examined and a clear path as to how to proceed, ie., a written protocol, and approval from all involved committees. Be aware that prior to their initiation, most projects must be reviewed by one or more Institutional Review Committees; all projects that involve animals or identifiable human subjects require clearance by appropriate “rights” committees, a process of many, many months duration. Start early!

A project report must be submitted to the Program Advisory Committee when the project is completed.

Publication of the results of the research in a refereed journal is encouraged but not required. However, publication of at least one paper in an acceptable journal is required for successful completion of the residency training.

Prior to submission for meeting presentation or for publication of any subject that reflects the Training Program, whether related to the research rotation or not, the staff responsible and the Program Director must review all papers, their supporting raw data and or case reports.

EVALUATION

Evaluation is essential to the learning process; it is most effective when it is timely and related to an event and when it includes positive as well as corrective feedback.

Observation & feedback: The high faculty to resident ratio in this program provides for close supervision and timely feedback. Residents should take advantage of this opportunity to test their understanding of the problems at hand and should be receptive to whatever criticisms the faculty offer as a means of educational advancement.

Evaluation of Residents: At the completion of each service rotation, the service chief, using personal observations and those of the staff and senior residents, evaluates and scores the effectiveness of the resident according to a standard list of criteria; this evaluation is discussed with the resident, signed by the service chief and the resident and forwarded to the Program Director. At this discussion the resident must provide a list, using standard terminology and CPT codes, of the operative experience during the rotation.

Formal testing: At the completion of the numerous “mini – courses” given throughout the year, all residents are tested on the course contents. All residents must take the “Annual Otolaryngology Examination” given each spring and are expected to achieve a score at or above the national median for their peer group. Residents must take the Home Study course and the grades are monitored.

Comprehensive evaluation of each resident is performed every 6 months.  The resident meets with the Program Director and Departmental Chair to review faculty evaluations, case write-ups, in-service scores, and research.  The purpose is to discuss the progress of each resident. It considers the comments of faculty who are currently working with the resident as well as the results of the formal testings and any other documents that may relate to the resident. At least twice yearly, and at other times when appropriate, the program chairman discusses with the resident the Committee discussions and any other matters related to the educational process, or any matter of concern to the resident. All documents so generated are open to review by the resident.

Evaluation of Faculty:

To insure the goals of the program, the program director supervises the conduct of faculty during Grand Rounds, clinics, OR and wards, makes periodic visits to affiliate institutions, converses informally with the residents and further requires that the residents yearly & anonymously, following their own methodology, evaluate and score the faculty according to a standard set of criteria.

Evaluation of the Program

A Program Advisory Committee, composed of all faculty members and the chief administrative resident and chaired by the program director meets quarterly to evaluate the program and to advise the program director as to the conduct and course of the Training Program. At this time the individual performance of each resident is discussed as are other matters related to the conduct of the program including the scope and quality of the educational effort and its compliance with the General and Specific Requirements of the Accreditation Council for Graduate Medical Education (ACGME). In its evaluations, the committee also reviews the results of the end of service evaluations, the “mini course” tests, the annual Otolaryngology Examinations, the Board Examinations and all current information regarding the program. The annual reports to the Dean of the School of Medicine summarize all departmental activities, and include a detailed description of teaching activities, publications, research and funding, etc. The Graduate Medical Review committee of Boston University Hospital and of the affiliate institutions and of the ACGME periodically review the program.

The program director and chairman, and indeed, all faculty, keep their office doors “open” to the residents for discussion of any matter of concern.

RESIDENT PROMOTION

Progression of the resident through the training program is dependent upon satisfactory performance by the resident.

DISCIPLINE

The purpose of the Otolaryngology Residency Training Program is to educate and train physicians to function independently as specialists in the field of otolaryngology – head and neck surgery, and we want the resident to succeed in this effort. To insure this success for all residents, the faculty will employ all reasonable and necessary methods, including discussion, counsel, warning, censure, and disciplinary action. Discipline is protected by due cause. This means that arbitrary and capricious actions are not permitted.

Disciplinary action may include but is not limited to:

*       Probation

*       Suspension of privileges

*       Extension of the required residency training period without pay

*       Suspension from the residency program

*       Non-reappointment

NON REAPPOINTMENT

Non reappointment may occur as a disciplinary action or from inability of the resident, as determined by the Program Director with advice from the Program Advisory Committee, to assimilate the knowledge or to learn and perform the skills necessary for the satisfactory practice of the specialty of Otolaryngology – Head and Neck Surgery.

EXTENDED TRAINING

Extended training may be required if the Program Director and the Program Advisory Committee believe that extended training is needed to qualify the resident for the satisfactory practice of the specialty of Otolaryngology – Head and Neck Surgery and that the resident will benefit sufficiently from such extended training. Usually there is no funding available for financial support during extended training. The ACGME must approve any extension of training.

GRIEVANCE: Boston Medical Center Grievance Committee is available.

VACATION, SICK AND EDUCATIONAL LEAVE:

BACKGROUND: A clearly stated and scrupulously observed vacation/leave policy is essential so that requests can be accommodated as equitably as possible within the context of making certain that there is continuity of coverage for all clinical services. This policy will work well only if it is fully understood and strictly observed by all.

VACATION is defined as any time off taken for personal reasons other than illness. The Chief Administrative resident coordinates vacation scheduling according to the following policy:

*       Each resident is eligible for three weeks of vacation each academic year.

*       Sick leave is granted as necessary. Generally, institutions continue salary support for no more than 15 days during any year.

*       If the amount of sick leave significantly interferes with the residents educational progress, the period of training may need to be extended.

*       The needs of the residents and of the clinical services must both be accommodated.

*       Vacations may not be taken during the last two weeks of June or in month of July. Absence not authorized by the Program Director during these times will have to be “made up” before the training period will be considered to be completed and certified.

*       No more than one resident may be away from any one hospital service at a given time.

*       No vacation may be taken during the Children’s Hospital rotation.

*       Vacations are to be taken in week long (7 day) blocks unless exceptional circumstances occur. Manipulations of the policy, such as one day mini-vacations designed to create long weekends, are not likely to be approved. If approved, all time away will count as vacation time.

*       Final approval of any request must include: (l) clearance regarding scheduling conflicts by the Department Secretary, and (2) approval by the service chief involved.

*       Unauthorized absence from any service will be regarded as such and appropriate compensation adjustments will be made.

*       Unused vacation time cannot be carried over into a subsequent academic year.

*       Exceptions to these policy guidelines can be made for compelling reasons.

SALARY

Salary is determined by the pay scale for the resident’s PGY level.