Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
Monroe Carell Jr. Children's Hospital at Vanderbilt
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Home / Health Professionals / Otolaryngology Education and Training / Description of the Program and Outcome Expectations
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Description of the Program and Outcome Expectations

The Pediatric Otolaryngology Fellowship Program faculty is charged with the responsibility of producing capable pediatric otolaryngologists who will excel in patient care, surgical technique and research endeavors contributing to the specialty. The one-year program is designed to acquire and establish diagnostic and technical expertise in the field of pediatric otolaryngology through a graduated experience that will allow the fellow to develop expertise in diagnosis, treatment planning, medical, surgical and rehabilitative issues.

The fellowship curriculum is based on a core curriculum learned in the otolaryngology residency. The fellows must have completed an ACGME-accredited otolaryngology head and neck surgery residency. Candidates are selected into the program based on demonstration of excellence in patient care, commitment to research and exhibition of the clinical competencies established by the ACGME.

We have always emphasized a multi-disciplinary approach in the diagnosis and treatment of the pediatric otolaryngology patient. This approach incorporates a core curriculum in pediatric otolaryngology with supplementation of multiple surgical and non-surgical specialties that play a role in their care. We emphasize in our training understanding of these multiple disciplines and how they interact with one other in a complex system. Knowledge of these multiple systems and disciplines will increase efficiency and overall improved patient care.

We strive to design a program that allows the fellow to gain insight into each discipline to improve interaction as part of this multi-disciplinary team, but also to help innovate patient care. The specialty of pediatric otolaryngology is quite diverse. It draws on the expertise of many other fields including speech therapy, audiology, head and neck surgery, skull base surgery, plastic and reconstructive surgery, neuroradiology, interventional radiology, pathology, genetics and radiation oncology.

The comprehensive training program for pediatric otolaryngology fellowship must incorporate topics from all these specialties. The curriculum addresses this need by providing both didactic and hands-on experience in all specialties. Our institution affords abundant opportunities in that all facets of the disciplines involved in patient care are well represented. The fellowship provides fundamental educational building blocks on which to add and refine subsequent knowledge and skills.

The one-year pediatric otolaryngology program is organized on a weekly calendar for the fellow. The calendar will allow the fellow to spend equal time between each faculty member and follow patients from the clinic to the operating room and back. The goals and objectives of each calendar portion provide fundamental teaching that will be used throughout the fellowship and subsequent pediatric otolaryngology career. Multiple conferences and multi-disciplinary clinics provide an active forum for the fellow to learn the important components of patient care. The curriculum develops expertise in complex pediatric otolaryngology, diagnosis and surgical treatment. Fellows will be expected to develop expertise in complex medical and surgical decision-making as they mature through the program.

Pediatric Otolaryngology

During the pediatric otolaryngology fellowship training, the fellow spends the entire year on the pediatric otolaryngology service. This rotation develops clinical skills, taking a history and performing a physical examination of the head and neck and neurologic examination, as well as determining the diagnosis and treatment of common pathologic conditions. Special attention is focused on becoming an effective member of the pediatric otolaryngology team who will integrate with clinic staff, OR staff, speech therapy, audiology and multiple other ancillary services. All fellows participate in outpatient clinical activities, gain significant experience in examination techniques and develop diagnostic abilities in pediatric otolaryngology.

This experience will allow the fellow to learn and develop basic diagnostic and decision-making skills, working closely with the faculty in the clinic and in the OR. These skills will be used throughout the fellowship to establish and refine a pediatric otolaryngology differential diagnosis.

Exposure and experience with the following surgical procedures, introduced in a graduated fasion, is required from the pediatric otolaryngology fellows:

  • Middle ear surgery
  • Tympanoplasty
  • Tympanomastoidectomy
  • Cochlear implants
  • Direct laryngoscopy/bronchoscopy (with and without removal of tissue or foreign bodies)
  • Endoscopic and open airway reconstruction
  • Pediatric sinus surgery
  • Correction of velopharyngeal insufficiency
  • Cleft lip and palate repair
  • Treatment of congenital head and neck masses (intralesional and resection)

The output of the Pediatric Otolaryngology Fellowship Program is a physician capable of serving as an independent subspecialist in the practice of pediatric head and neck surgery. Therefore each fellow upon completion of the program must demonstrate the ability to care for patients with and provide consultation on pediatric ENT disorders to colleagues without the need for oversight and modification of their work by faculty. During the Fellowship program, faculty will encourage assumption of independence as expeditiously as the fellow's increasing knowledge, experience and professional maturity permit, in keeping with both safe patient care and sound educational principles.

The attending physician never relinquishes responsibility for the patient. However, the amount of freedom to make and implement decisions and the amount and timing of faculty supervision will change depending on an individual fellow's demonstrated performance  judged by ongoing faculty performance review.

Attending physicians serve as a resource for fellows and are available (by phone, paging device or in person) to fellows for guidance or assumption of care as needed. Teaching rounds occur daily, Monday to Friday, for patients on the pediatric ENT/Consult service. On weekends, all patients are seen daily. Consults are seen as indicated.

A typical care team consists of a supervising attending, a first year pediatric ENT fellow, and often medical residents and students. In this team, there is a hierarchy of increasing authority and responsibility as experience is gained. For example, the pediatric ENT fellow has more authority and responsibility than general medicine residents. Judgments on delegation of responsibility are made by the attending based on his or her direct observation and knowledge of each fellow's skills and ability. The degree of supervision may vary with the clinical circumstances and the fellow's developmental stage.

About two to five new consultations are performed daily. Follow-up rounds are made on active patients previously evaluated. Fellows on the service are given a primary role in the performance of new consultations. Recognizing the educational mission of this fellowship, fellows will not be unduly burdened with a large volume of new consultations. They will be provided with sufficient time to fully evaluate their patients and read about the problems their patients' conditions pose, as well as those seen primarily by others on the service. New consultations and follow-ups are presented on daily attending rounds, providing a format for in-depth discussion of clinical presentation, pathophysiology and management. All major clinical decisions are discussed and all plans reviewed with an attending.

To ensure appropriate fellow instruction and supervision, the expectation of the fellow's role on the pediatric ENT service is as follows:

1.  Fellow functions as an integral member of care team.

2.  Fellow sees patient initially.

a.  Performs complete history and physical examinations on all new inpatients and/or outpatients for whom they have primary responsibility.

b.  Examines all data related to the management of patients they have evaluated.

c.  Synthesizes all available information to generate differential diagnoses and subsequent diagnostic and therapeutic plans.

d.  Communicates the synthesis of the above information in both an oral and written format to their supervising faculty member.

e.  Follows up on all tests and procedures ordered for patients under their care.

3. After all new patients are presented in detail to one of the clinic faculty, he or she then examines the patient, followed by extensive discussion of differential diagnosis proposed approaches.

4. All patients seen in follow-up are also discussed in detail with and examined by the faculty member, including review of laboratory findings, and X-rays (brought to the clinic as indicated).

5. All records in a particular clinic session are reviewed and a faculty note is written by the attending assigned to supervise the clinic.

Research requirements

The fellow will be responsible for obtaining up-to-date IRB training and responsible conduct of research. The faculty will help the fellow identify a critical gap in the pediatric ENT literature and request a hypothesis-driven research project. The faculty member will assist the fellow in a formal literature search, create a data retrieval form (if a retrospective study) and design any prospective component of the study. Together the fellow and faculty member will write the IRB protocol and obtain approval. The fellow's faculty-supervised data analysis will hopefully lead to a research presentation at a national meeting. Writing of the manuscript will be the responsibility of the fellow, with faculty guidance.

Last Edited: July 25, 2018
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