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Course Overview (Clerkship Years 3 & 4)
The one-week Otolaryngology block is part of the Anesthesia / Ophthalmology / Otolaryngology rotation (4 weeks total). The Otolaryngology portion takes place at the otolaryngology clinics at the University Health Network, Sunnybrook Health Sciences Centre, St. Michael’s Hospital, and Sinai Health System. This year, some students will be completing their week rotation in a community site such as Michael Garron Hospital, North York General Hospital, Humber River Regional Hospital, Markham-Stouffville Hospital, William Osler Hospital (Etobicoke Site), or The Scarborough Hospital. Each hospital develops and distributes a site-specific schedule of teaching sessions and clinical experience in the outpatient clinics. The remainder of the time will be spent on the wards, in the operating room, on seminars and self-directed learning with otoscopy and nasal packing simulators and online cases. The rotation includes a series of online seminars, covering common and important topics in otolaryngology including hearing loss, vertigo, epistaxis, rhinosinusitis, emergencies, and head and neck malignancies. Students are also given a paediatrics otolaryngology seminar, an Otosim seminar, and an audiology lecture at the Hospital for Sick Children.
In clinic, students will be responsible for taking complete otolaryngologic histories and performing relevant head and neck examinations on patients, as well as formulating differential diagnoses and plans of management which will be presented to preceptors.
Attendance in the operating room is available to students and may be arranged at their Academy with the site director at the beginning of their rotation.
Students are not expected to take call, but may do so if interested. Call may be arranged with the otolaryngology residents at each hospital/Academy.
Evaluations are based on performance on a written mastery exercise in multiple-choice question format (80%) and preceptor evaluations (20%). The written mastery exercise is given on the final day of the combined four-week Otolaryngology / Ophthalmology / Anesthesia block. The written exam is one hour in duration and is separate from the Ophthalmology and Anesthesia mastery exercises. In order to obtain Credit in the Otolaryngology course, students must receive a grade greater than 60% on both the written mastery exercise and preceptor evaluation.
Students must also receive a satisfactory Professionalism evaluation (Credit/No Credit) and complete all Case Log requirements (Credit/No Credit) in order to pass the Otolaryngology clerkship.
For details, including grading regulations, see the course website on the U of T Quercus (https://q.utoronto.ca/ – registered users only), and the program policies related to examination and assessment (http://www.md.utoronto.ca/policies).
GOALS: By the end of the Otolaryngology clerkship rotation, the clinical clerk will demonstrate the foundation of knowledge of medical conditions involving the ears, nose, neck, and upper aerodigestive tract necessary for the practice of otolaryngology from the perspective of the primary care physician. In addition, the clinical clerk will demonstrate the skills necessary to perform a thorough head and neck examination.
The Otolarygology clerkship course follows the CanMEDS Guidelines through both didactic and clinical teaching. The course also provides an opportunity to develop Collaborator and Manager skills through interprofessional collaboration with nursing, audiology, and speech-language pathology services.
A. GENERAL COMPETENCIES
By the end of the Otolaryngology clerkship, the clinical clerk will be able to:
[Medical Expert/ Skilled Clinical Decision Maker]
- Demonstrate the ability to evaluate and manage common ear, nose and throat problems presenting to the primary care physician
- Demonstrate the ability to rapidly recognize airway and head and neck oncologic emergencies that require immediate referral to an otolaryngologist
- Demonstrate a focused history and physical examination for patients presenting with common ear, nose and throat symptoms.
- Develop plans for investigations (diagnostic imaging and audiometry) and interpret those investigations.
- Develop a differential diagnosis and management plan.
- Communicate effectively and empathetically with patients and their families.
- Demonstrate thorough and clear documentation and charting, with concise recording of pertinent positive and negative findings.
- Demonstrate the ability to council and educate patients and families.
- Demonstrate the ability to present a patient case in a clear, concise and complete manner.
- Establish and maintain effective working relationships with colleagues and other health care professionals commonly treating otolaryngology patients (nursing, audiology, speech language pathology).
- Demonstrate knowledge of community resources available to the otolaryngologist.
- Demonstrate appropriate and cost-effective use of investigations and treatments.
- Develop organizational skills and efficiency in managing patients and maintaining patient flow.
- Develop an understanding of the factors contributing to resource issues in the otolaryngology clinic.
[Health Advocate/Community Resources]
- Demonstrate an awareness of the underlying psychosocial and socioeconomic problems that contribute to otolaryngologic problems.
- Identify opportunities for primary and secondary prevention strategies (smoking cessation, alcohol intake, etc.).
- Access and critically appraise the literature relevant to otolaryngology.
- Understand the many unique learning and teaching opportunities available in otolaryngology.
- Recognize and accept his or her limitations and know when to ask for help.
- Protect information provided by or about patients, keeping it confidential, and divulge it only with the patient's permission except when otherwise required by law.
- Be reliable and responsible in fulfilling obligations.
- Recognize situations where common medical errors may occur in the otolaryngology clinic.
B. EDUCATIONAL CORE OBJECTIVES
By the end of the Otolaryngology Clerkship rotation, the student should be able to demonstrate basic proficiency in the following skills.
Clinical Examination Skills:
- Head and neck examination
- Thyroid examination
- Oral examination
- Cranial nerve examination
- Balance testing
- Nasal packing (simulation)
II. Problem based
By the end of the Otolaryngology Clerkship rotation, the student should understand the following concepts and/or be able to demonstrate an approach to patients presenting to the Emergency Department (based on real or simulated encounters) with the following problems or conditions:
- Hearing Loss
- Nasal Obstruction
- Neck Mass
Recommended Readings (Textbook):
Toronto Notes, Comprehensive Medical Reference and Review for MCQE 1 and USMLE 2 Otolaryngology – Head & Neck Surgery Chapter
I suggest you review the physical exam videos before starting your rotation: http://otolaryngology.utoronto.ca/ascm-ii-resources
- www.entcanada.org and follow the link for “Undergraduate Education.”
- Download the LearnENT app from the App store for Iphone users.
Comprehensive Research Experience for Medical Students (CREMS)
The University of Toronto has the most extensive biomedical and health research resources in Canada and among the best in the world. Medical students are encouraged to explore their interest in research through opportunities organized within the UME program and through other initiatives offered by individual Departments and Hospital Research Institutes affiliated with the University. The majority of such opportunities are offered during the summer, when Preclerkship students in particular are able to devote large blocks of time to research projects.
COMPREHENSIVE RESEARCH EXPERIENCE FOR MEDICAL STUDENTS (CREMS)
CREMS is an umbrella program that allows interested medical students to gain extracurricular research experience in various structured sub-programs without interrupting their medical studies. CREMS aims to provide participating students with an opportunity to:
- Explore their research interests
- Gain valuable hands-on research experience
- Prepare for a clinical career with a good research foundation and understanding of biomedical research
- Consider a career as a clinician-scientist
For a complete description, please see: http://md.utoronto.ca/research
Students participating in any of the CREMS programs undertake an original research project under the supervision of a member from the University of Toronto Faculty of Medicine. The research may be in the basic, clinical, applied biomedical, or epidemiological sciences, or in social sciences/humanities related to medicine or medical practice. Projects are diverse and may involve laboratory experiments, prospective, or retrospective clinical or social studies. All potential supervisors and research projects must be approved by the CREMS Director and Advisory Committee prior to commencement of the particular CREMS program of choice.
The CREMS programs are not part of the required medical curriculum. Students participating in the CREMS programs do so in addition to the regular official curriculum and electives as set forth by the Faculty of Medicine. Moreover, students must be in good academic standing (i.e. have passing grades in all courses) both to participate and continue in any of the CREMS programs. Failure to satisfy administrative requirements of the CREMS program may also lead to dismissal from this extra-curricular activity.
For all CREMS programs, participating students are expected to present their work at the Medical Students Research Day held in late winter/early spring of the following year.
The various CREMS programs are described below:
1. CREMS Research Scholar Program
The Research Scholar program is a 20-month longitudinal program that begins in January of first year of medical school with a modest commitment of time (up to ten hours per week) for the rest of the first year. It extends as a full-time block throughout the summer between first and second year, continues during second year (again up to ten hours per week), and then concludes with a second full-time block in the summer between second and third year. A stipend of $15,000 for the entire program is provided. The CREMS Research Scholar program accommodates up to 30 students at one time. Supervisors must be full or associate members of the University of Toronto School of Graduate Studies. Please check the website for deadlines and information on the application process: https://md.utoronto.ca/research
2. CREMS Summer Program
This is a 10-to-12-week full-time program that can be completed either during the summer between first and second year or during the summer between second and third year. Students may seek out a mentor independently or select from a list of potential mentors provided by the CREMS program. The chosen supervisor does not need to be affiliated with a University of Toronto graduate program. Students are selected through a competitive application process, and each receives a stipend of $5,500. Please check the website for deadlines and information on the application process: http://md.utoronto.ca/summer-research-programs
3. MAA International Health-Related Scholarships (in partnership with CREMS)
This international health program is a 10-to-12-week summer experience that enables students to conduct research in a developing country. There are usually eight to ten positions available for the summer. The scholarship are offered by the Medical Alumni Association (MAA) and are intended to cover return airfare and a modest stipend. There are two options:
- The supervisor is a U of T faculty member who has an ongoing global health project. or
- The project can be self-initiated, provided that the student is able to secure both a U of T faculty supervisor and an in-country supervisor.
The quality of proposed projects is adjudicated by a CREMS program committee, and the top-ranked projects will be supported. Please check the website for deadlines and information on the application process: http://md.utoronto.ca/medical-alumni-association-crems-programs
4. MAA Scholarships in Humanities and Social Sciences (in partnership with CREMS)
This program provides a 10-to-12-week summer opportunity for two students to pursue research interests in the humanities or social sciences related to medicine. Preference will be given to one project related to the history of medicine. Supervisors do not have to be from the Faculty of Medicine but must be from the University of Toronto. A stipend of $5500 is provided. Please check the website for deadlines and information on the application process: http://md.utoronto.ca/medical-alumni-association-crems-programs
OTHER EXTRA-CURRICULAR RESEARCH OPPORTUNITIES
In addition to research under the umbrella of the CREMS programs, students may participate in other research opportunities made available by individual University Departments and Institutes or by hospitals. These include pure research programs as well as combined research/clinical experiences such as the Department of Paediatrics “PeRCS” (Pediatric Research and Clinical Summer) program. Please note that the application procedures, funding practices, expected time commitment, and eligibility restrictions are at the discretion of the sponsoring Department or institution.