The fellows are assigned to Texas Children’s Hospital for the duration of their 12-month fellowship. The program director meets with the fellows on the first day of their rotation for several hours to review the goals and objectives of the fellowship year.
The overall goal of this educational program is to provide an environment that encourages self-directed learning and scholarly activities.
Each graduate will achieve the following:
- A knowledge base as defined by the structured curriculum.
- Refined operative skills especially in the area of aerodigestive endoscopy, head and neck tumors and chronic ear disease.
- Increase mastery of principles and procedures in the pediatric otolaryngology scope of practice which have been introduced in the general otolaryngology residency.
- Skill in communicating with patients and families.
- The ability to interact with other physicians and health care team members so as to plan and implement individual patient care through collaborative decision making
- The ability to critically evaluate the literature and research to determine its validity and appropriateness in the care of the pediatric otolaryngology patient.
- The ability to care for children and display an understanding of the ethical, social, legal, and economic issues involved in this care.
- The ability to educate various groups of healthcare providers in the care of infants and children. Exposure to clinical research.
Specific Expectations and Performance Objectives
Under supervision from faculty, fellows are expected to participate in and/or develop specific knowledge and procedural capabilities (initial competence) in the following areas of inpatient and outpatient care at Texas Children's Hospital.
Outpatient Clinical Experience
- Appropriate diagnosis and treatment of AOM, OME and OE
- Develop logical approach to assess H&N mass
- Perform flexible laryngoscopy in patient with hoarseness
- Assess patients with symptoms of sinusitis and outline maximal medical management; understand role of surgical management
- Assess severity of adenotonsillar diagnosis and determine indication for appropriate surgical intervention
- Long-term follow-up and management of tracheostomy of infants and children
- Indications for tracheotomy decannulation
- Assess speech disorders
- Assess swallowing disorders
- Hearing loss work-up and understanding of multidisciplinary nature of this evaluation
Inpatient Clinical Experience
- Recognize complications of OM and sinusitis as well as the timing of appropriate interventions
- Develop an orderly approach to the work-up of the patient with respiratory distress and stridor
- Master the interpretations of sinus CT scans and diagnostic imaging techniques
- Indications for pediatric tracheotomy
- Understand the evaluation of pediatric swallowing dysfunction
Emergency Room Encounters
- Evaluate emergency management of respiratory distress
- Evaluation and management of AOM and its complications
- Assessment of patient with foreign body / caustic ingestion
- Evaluation and Management of complicated neck abscess
Surgical Experience
- Recognize the role of preoperative consultation with appropriate services
- Understand the global assessment of pediatric surgical patients (preoperative and perioperative)
- Conduct appropriate preoperative discussions, counseling and perioperative with family and patients
- Promote communication between Otolaryngology and other surgical services
Operative Goals for the PGY-6
- Complex pediatric otolaryngologic cases (with faculty supervision)
- Peripharyngeal space tumor (42699)
- Excision angiofibroma (42880)
- Excision nasal dermoid (30125)
- Laryngo-tracheal resection with repair (31780, 31582)
- Thyroglossal duct cyst – multiply recurrent cases (60281)
- Cochlear implantation (69930)
- Complex neck mass
- Choanal atresia repair (30540)
Moderately complex procedures that are fundamentally different when performed on the pediatric rather than on the adult patients.
- Head and neck
- Superficial and total parotidectomy (42415, 42420)
- Otology
- Tympanoplasty II-IV (with ossicular reconstruction) (69632-69633)
- Tympanoplasty with mastoidectomy (69635-69642)
- Middle ear exploration (69440)
- General
- Endoscopic sinus surgery – all sinuses (31254-31288)
- Tracheostomy
Procedures, including endoscopy, involving premature infants and low birthweight newborns.
- All otolaryngologic procedures, particularly
- Tracheostomy (< 2yrs)
- Direct laryngoscopy and bronchoscopy, all types
Learn to teach basic pediatric otolaryngology procedures to the OTO Levels 1 and 2 residents.
- Thyroglossal duct cyst (primary cases) (60280-60281)
- Tympanoplasty I (69620-69631)
- Direct laryngoscopy, operative, with excision of tumor and/or stripping of vocal folds or epiglottis (laser or conventional) (31540-31541)
- Esophagoscopy - with foreign body removal (43215)
- Bronchoscopy-with foreign body removal (31635)
- Tonsillectomy and adenoidectomy (42820)
- Myringotomy and tube (69436)
- “Organization of the Reading Service”
Learn to teach basic pediatric otolaryngology procedures to the OTO Levels 1 and 2 residents.
- Thyroglossal duct cyst (primary cases) (60280-60281)
- Tympanoplasty I (69620-69631)
- Direct laryngoscopy, operative, with excision of tumor and/or stripping of vocal folds or epiglottis (laser or conventional) (31540-31541)
- Esophagoscopy - with foreign body removal (43215)
- Bronchoscopy-with foreign body removal (31635)
- Tonsillectomy and adenoidectomy (42820)
- Myringotomy and tube (69436)
- “Organization of the Reading Service”
Didactic Program
We have a robust didactic program to complement the clinical experience of the fellowship:
Fellows participate and facilitate the following monthly Conferences:
- Complex Airway
- ENT- Neuroradiology Conference
- Cochlear Implant/Otology
- Quality Improvement
Other conferences include:
- Combined ENT-Pulmonary Conference
- Journal Club
- Pediatric Otolaryngology Lecture Series
- Topics including Head and Neck, Vascular Anomalies, Sleep Medicine and Sleep Surgery
Additionally, there are a number of patient care meetings that fellows can attend
- Aerodigestive
- Patients under consideration for airway reconstruction are presented here
- Cochlear Implant Outcomes and Planning
- Thyroid
- Tumor Rounds
- Vascular Anomalies
- Special Sessions
- Airway Simulation Session
- Teaching Residents in the OR by Dr. Anna Messner
- Mock Oral Boards
As a part of the Bobby R. Alford Department of Otolaryngology, fellows have access to the weekly Departmental Grand Rounds with topics across the varying subspecialties of Otolaryngology.
Baylor College of Medicine and Texas Children’s Hospital offer a variety of lectures and programs on topics such as Career Development, Quality Improvement, Diversity, Inclusion and Health Equity, Work-Life Balance just to name a few.
Rotations
The fellow will participate in the after-hours emergency room consult call schedule for one week every month. During this call period, call begins at 5 p.m. and ends at 7 a.m. There is no in-house call. The pediatric otolaryngology fellow is not expected to remain in the hospital on call except as patient care dictates. A general otolaryngology fellow is always on “first call” and the pediatric otolaryngology fellow functions in a supervisory role on call to that resident. While the pediatric fellow has call responsibilities, a faculty member will be on call for consultation and for all cases requiring surgery. This on call experience is intended to give the fellow to the typical duties associated with pediatric otolaryngology, while providing support and guidance for the more complicated and demanding patients.
As on weekday call, there is always a supervising faculty member on call. The fellows will alternate weeks of consult call (“on-service”) and non-consult clinical duties (“off-service”). Each fellow takes on-service weekend call every other weekend. Call begins at 5 p.m. on Friday and ends 7 a.m. Monday. The fellow who will be responsible for consults the following week will be responsible for weekend rounding with the general otolaryngology residents (PGY-2 or PGY-3). The fellow covering weekend rounds will assist with any highly specialized pediatric otolaryngology weekend consultations or surgeries that occur on their call weekend in conjunction with the on-call faculty.
As for weekday night call, the fellow is not expected to remain in the hospital on call; also, a general otolaryngology resident is always on “first call” with the pediatric otolaryngology fellow functioning in a supervisory role. The purpose of this call is to assist the weekend otolaryngology call team with the specialized pediatric otolaryngology cases, particularly emergency airway cases. Historically this call is non-taxing and, in addition to rounding, rarely requires more than one or two short trips to the hospital on a given weekend.
The ER Call Schedules will be available one week or more in advance and are made for one month at a time. Weekend call schedules are compiled and provided for six months at a time. The fellow will have input into weeks and weekends on call.
When the fellow is not covering hospital rounding duties on the weekend, he/she should not participate in clinical activities as this fulfills the required time off for the fellow from clinical duties.
Training Site
Our program is affiliated with Texas Children’s Hospital, the largest children’s hospital in the United States.
Texas Children’s Hospital has three campuses that fellows can participate in educational activities:
- Texas Medical Center Main Campus
- West Campus
- Woodlands
There are a number of resources that fellows can take advantage of at Texas Children’s Hospital and Baylor College of Medicine
- Learning Resource Center
- Surgical Research Unit
- Access to Research assistants, statisticians and data specialists
- Temporal Bone Lab
- Uber Safe Home Program for transportation if trainees are fatigue
- Employee Assistant Program
- Operating Room Lounges with access to snacks and beverages
- Electronic Library with access to major textbooks in Pediatric Otolaryngology, Airway, Head and Neck, Otology, Microtia and Cochlear Implants