ROTATION SUMMARY PEDIATRIC ENT

Size: px

Start display at page:

Download "ROTATION SUMMARY PEDIATRIC ENT"

Dale Webster
7 years ago
Views:

1 ROTATION SUMMARY PEDIATRIC ENT Rotation Contacts and Scheduling Details Rotation Director: Anna Messner, M.D. Positions Available: This rotation can be performed in 2 week blocks or over a 4 week period in conjunction with another 2 week rotation. The rotation accommodates 1 pediatric resident per period. The rotation is offered yearround. Introduction The Pediatric ENT rotation exposes residents to a wide range of ENT issues including otitis media, hearing loss, airway concerns, tonsillar and adenoid hypertrophy and its sequelae. The rotation involves daily clinic with an occasional opportunity for operating room experiences if future career plans would benefit from advanced training in more specialized areas. Residents play a hands-on role in the clinic by performing the initial history and physical, presenting to an Attending, suggesting a differential diagnosis and plan. At the conclusion of the rotation, the resident will have a better fund of knowledge of common Pediatric ENT conditions and be able to diagnose and manage simple ENT issues and make appropriate referrals for those more complicated. Residents will strengthen their physical exam skills of the head and neck, particularly otoscopy skills. Participants will develop an understanding of the etiology, natural course, and treatment options for children with otitis media, sleep apnea, and hearing loss. Weekly Schedule Time Monday Tuesday Wednesday Thursday Friday Morning Report Morning Report Morning Report Morning Report Grand Rounds CLINIC CLINIC CLINIC CLINIC (8:00-9:00) CLINIC Conference Conference Conference Conference Conference CLINIC CLINIC CLINIC CLINIC CLINIC Rotation Specifics Orientation Residents will obtain the schedule for the rotation from Anna Messner prior to the start. On the first day of clinic, residents will receive a brief orientation to the clinic structure from the NP or Dr. Chang. Clinic Overview Provide a general description of how clinic is structured, including but not limited to: Clinic staff consists of Nurse Practitioners, Residents and Attendings. Residents are encouraged to pick-up the next patient to be seen. History and physical exam should be focused on the head and neck. Residents may see follow-up or new patient visits. Pagers The resident is expected to carry his pager during business hours during the rotation. Call Schedule There are no call requirements for this rotation. The resident should provide Dr. Messner with a list of call and continuity clinic responsibilities at the onset of the rotation. Resident Roles and Responsibilities Performs the primary patient care role including taking the initial history and performing the physical exam

2 Communicates with referring physician when appropriate Dictates clinic visit in timely fashion. Independently studies clinical material related to patients seen in clinic Takes initiative to improve physical exam skills Evaluation and Feedback The Pediatric ENT Rotation will perform a Medhub group rotation evaluation. Residents will be asked to evaluate each Faculty Member. Daily feedback on physical findings, assessment and plan will occur through clinical interactions.

3 Competency-based Goals and Objectives Goal 1. Sinusitis. Diagnose and manage patients with sinusitis, and refer when appropriate. Diagnose acute sinusitis accurately, using information from the history and physical exam. Explain the role of radiologic tests in diagnosing sinusitis, including cost factors and limitations of each study (radiographs and computed tomography). Discuss the major microbes involved in sinusitis and indications for antibiotics. List options for antibiotic treatment. Prescribe adjunctive pharmacotherapy for sinusitis as needed (e.g. nasal drops or sprays, antihistamines). Explain the pathophysiology, epidemiology and management of sinusitis, especially viral rhinosinusitis. Recognize the complications of sinusitis (e.g. Pott s puffy tumor, meningitis, chronic or recurrent sinusitis) List reasons to refer patients with sinusitis to specialist and possible therapeutic interventions (e.g. endoscopic surgery). Describe characteristics that help differentiate allergic, viral and bacterial sinusitis as well as acute and chronic sinusitis. Explain conditions that mimic sinusitis and how to sort through the differential diagnosis. Describe the signs and symptoms of acute and chronic adenoiditis and how it relates to sinusitis. Goal 2. Tonsillar and Adenoidal Hypertrophy. Screen, diagnose and manage patients with symptoms secondary to tonsillar and adenoidal hypertrophy, and refer when appropriate.

4 Counsel parents about the pathophysiology of conditions associated with tonsillar and adenoidal hypertrophy Explain to parents the reasons for referral to otolaryngology and general issues related to surgical intervention. Describe the use of diagnostic tests for assessing tonsils and adenoids (e.g. airway films, sleep studies). Take a sleep history with focused questions that assist in the diagnosis of sleep apnea. Understand indications for tonsillectomy and/or adenoidectomy. Goal 3. Maintenance of Airway Patency and Oxygenation. Recognize and manage upper airway obstruction. Identify conditions that result in upper airway obstruction. Discuss routine care of a tracheostomy and describe how to recognize tracheostomy obstruction. Lecture from ENT NPs Goal 4. Cleft Lip and Palate. Collaborate as a team member in the management of patient with cleft lip and palate. Collaborate with the CFA team in the care of the patient with cleft lip and palate. Describe how to identify a submucous cleft palate Anticipate speech complications associated with cleft palate repair in the case of oronasal fistula and velopharyngeal incompetence. Goal 5. Allergic Rhinitis. Diagnose and manage patients with allergic rhinitis. Identify the signs and symptoms of allergic rhinitis. Compare pharmacologic options for treatment of allergic and nonallergic

5 rhinitis Goal 6. Prevention, Counseling and Screening (Audiology). Understand the pediatrician s role in screening, counseling and preventing hearing dysfunction and hearing loss. Counsel patients and families about preventing noise exposure and hearing loss in the well child/adolescent setting (e.g. avoiding music and sounds that lead to high frequency hearing loss, wearing ear protectors for noisy tasks.) Request and assess audiologic diagnostic studies that are appropriate to a child s age and developmental level. 1. Auditory brainstem response 2. Complete threshold auditory brainstem response 3. Behavioral audiologic assessment 4. Otoacoustic emission testing 5. Pure tone audiometry 6. Tympanometry Describe general principles about interventions for hearing-impaired children (speech training, sign language, amplification devices, communication boards, cochlear implants). Interpret an audiometric report on tests performed by an audiologist. - Interpret the audiogram. - Interpret the tympanogram. - Understand the scale for speech comprehension. - Identify significant abnormalities and the appropriate next step in the evaluation process. Goal 7. Normal v. Abnormal (Audiology). Differentiate normal from pathologic conditions.

6 Differentiate the child who is likely to have normal hearing from the child who requires further testing. Demonstrate a general understanding of normal ear anatomy and hearing physiology as they relate to common causes of hearing loss in children. Recognize differences between different types of hearing loss, including: - Permanent hearing loss - Temporary/treatable hearing loss - Sensorineural v conductive. Goal 8. Ear conditions. Diagnose normal versus abnormal ear conditions and make appropriate treatment plans. Demonstrate mastery of pneumatic otoscopy. Differentiate the following conditions based on appropriate history and physical exam: - acute otitis media - serous otitis media - retracted tympanic membrane - perforated tympanic membrane - tympanosclerosis - cholesteatoma Describe appropriate treatment in acute versus chronic otitis media. Understand indications for referral to otolaryngology for further management of ear disease. Explain basic approach to tympanostomy tubes: indications, surgical procedure, expected outcomes, and complications. PBLI = practice based learning and improvement ICS = interpersonal and communication skills P= professionalism = medical knowledge = patient care = systems based practice

Hearing Screening Coding Fact Sheet for Primary Care Pediatricians

Hearing Screening Coding Fact Sheet for Primary Care Pediatricians While coding for hearing screening is relatively straightforward, ensuring that appropriate payment is received for such services is a