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
- 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)
- Tympanoplasty II-IV (with ossicular reconstruction) (69632-69633)
- Tympanoplasty with mastoidectomy (69635-69642)
- Middle ear exploration (69440)
- Endoscopic sinus surgery – all sinuses (31254-31288)
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”