The surgery subspecialties rotation is a preceptorial rotation lasting 1 block and typically completed during the 3 rd year of training. The rotation occurs at Memorial Hospital, in the surgical subspecialist’s office and in other locations included in the surgical subspecialist’s usual practice. Surgical subspecialties included in this rotation include otolaryngology and ophthalmology. The teaching of these specialties in the program includes this rotation as well as experiences in the Family Medicine Center, the noon conference series and on other rotations (see other curricula).
Goals
- At the completion of this rotation, the resident will have an understanding of the practice of surgery subspecialties in a community setting, which will facilitate appropriate referral practices in the future.
- At the completion of this rotation, the resident will have knowledge and skills in the areas of otolaryngology and ophthalmology pertinent to the practice of family medicine.
Objectives
At the completion of this rotation, the resident will have demonstrated to the satisfaction of the surgery subspecialty preceptors:
–medical knowledge in otolaryngology, urology and ophthalmology pertinent to the practice of family medicine, including the appropriate evaluation and treatment of (MK):
Otolaryngology
Auditory canal obstruction, recalcitrant/recurrent otitis media, epistaxis, chronic rhinitis and sinusitis, head and neck cancers, recurrent tonsillitis, tinnitus, hearing loss and tympanic membrane perforations,
Opthalmology
Lacrimal duct obstruction, diabetic retinopathy, cataract, acute eye injury, red eye, glaucoma, diseases of the eyelid, refractive errors, strabismus and amblyopia, presbyopia and inflammatory eye conditions.
- the ability to perform an appropriate history and physical examination on the surgical subspecialty patient and to present these findings to another physician in an appropriate manner (PC).
- the ability to interpret appropriate data related to the surgical subspecialty patient and arrive at reasonable diagnostic and management decisions, weighing alternatives, benefits and risks of diagnostic and therapeutic options, and co-managing patients appropriately with other specialists (PC).
- the ability to make appropriate decisions to assure high-quality care in a cost-effective manner ( SBP ).
- communication and interpersonal skills which facilitate positive and therapeutic relationships (ICS).
- the ability to work cooperatively with other health professionals as part of a healthcare team (ICS).
- compassion, respect, and integrity; responsiveness to the needs of patients and society that supersedes self-interest; accountability to patients, society and the profession; a commitment to excellence and on-going professional development (P).
- a commitment to ethical principles pertaining to the provision or withholding of clinical care, confidentiality of patient information, informed consent and business practices (P).
- sensitivity and responsiveness to a patient’s culture, age, gender and disabilities (P).
There are no specific procedural requirements for this rotation. However, there is a separate Procedures Curriculum, and residents may gain experience meeting these requirements during this rotation. Procedures typically performed by residents on this rotation with the surgical subspecialists include (PC): evaluation of audiometric and tympanography studies, cerumen and foreign body removal, nasal cautery and packing, bladder catheterization, circumcision, prostate examination, semen analysis, vasectomy, eye examination with fluorescein, measurement of intraocular pressure, ophthalmoscopy and slip-lamp examination.
Implementation
This is a preceptorial rotation, so the resident is assigned to a particular surgical subspecialist or surgery subspecialties group for each of the three surgical subspecialties. The resident will accompany the surgical subspecialist during his/her professional activities in Memorial Hospital, in the surgical subspecialist’s office and in other locations involved in the preceptor’s usual practice. Approximately 80-90% of the time spent on this rotation will be in the outpatient setting. In the course of seeing patients, the surgical subspecialist will provide experiential learning, role-modeling and one-on-one teaching to the resident. At the discretion of the preceptor, the resident may be assigned to research specific topics in otolaryngology, urology or ophthalmology.
The resident is responsible for contacting the surgical subspecialists prior to the start of the rotation to arrange a schedule for the rotation. The resident must continue to meet usual residency obligations to his/her Family Medicine Center population including attending scheduled clinics, caring for continuity patients admitted to Memorial Hospital and rounding in the nursing home. The resident is expected to attend noon conferences and abide by duty-hour restrictions in keeping with usual program policies. Upon completion of the rotation, the resident must complete and return the evaluation form provided by the program.
Evaluation
The surgery subspecialties preceptors will complete an evaluation form at the end of the rotation. Residents will specifically be evaluated on the following ACGME Milestones:
- MK-1: Demonstrates medical knowledge of sufficient breadth and depth to practice family medicine.
- PROF-2: Demonstrates professional conduct and accountability.
- PROF-3: Demonstrates humanism and cultural proficiency.
- PBLI-2: Demonstrates self-directed learning.
- C-2: Communicates effectively with patients, families, and the public.
- C-3: Develops relationships and effectively communicates with physicians, other health professionals, and health care teams.
