Curriculum and Academics
The Bay Area Residents’ Research Symposium (BARRS)
Residents are expected to participate in the Annual Bay Area Residents’ Research Symposium. It is a unique program intended for presenting resident research. BARRS includes HNS residency programs from all over California, and our residents have won numerous awards for their research presentations. For more information, visit our Research page.
Head and Neck Oncology Multidisciplinary Tumor Board
The Multidisciplinary Tumor Board is extremely high volume and reviews almost every head and neck cancer diagnosed in Kaiser Permanente Northern California. The conference averages approximately 20 cases per week, and covers a wide breadth of pathologies. The conference is held via WebEx to bring together expertise from across the entire region, from Sacramento to Santa Clara. The panel consists of head and neck surgeons, radiologists, radiation and medical oncologists, pathologists, social workers, nutritionists and allied specialists.
Journal Club is a monthly dinner meeting attended by Kaiser Permanente Otolaryngology faculty from Oakland and other sites and all residents to review selected journal articles. This is an important meeting for developing social interactions between residents and staff and keeping up to date on recent literature.
Temporal Bone Dissection Course
Our temporal bone laboratory is utilized to teach an annual dissection course. This in-house course is mainly directed at the PGY2 and PGY3 residents, but all residents can participate. Over a three-month period weekly anatomy lectures given by Kaiser faculty from various locations in Northern California and visiting professors from University of California Davis are followed by supervised resident temporal bone drilling.
Head and Neck Anatomy Course
A series of resident-performed, staff-supervised cadaver dissections held on a weekly basis for three months. Topics include laryngeal anatomy and emergent airway techniques, external approaches to the sinuses, neck dissection, lateral temporal bone dissection, and soft tissue dissection.
A recently established multi-institute one-day program is offered by the University of California, Davis and is supported by the program. PGY1 and PGY2 residents participate in this ENT emergencies simulation bootcamp.
Once a year, we invite a prominent Otolaryngologist to our medical center for a day-long conference. Usually the morning is spent discussing interesting and complex patient cases presented by residents and the afternoon is filled with a series of didactic lectures given by the professor.
Regional & National Otolaryngology-Head and Neck Surgery Courses
Our residents frequently participate in national or regional courses. During their training, our residents receive attend:
- UCSF Otolaryngology Update
- Vanderbilt Temporal Bone Dissection Course (attended by chief residents)
- Stanford Otology Update
- Loma Linda Laryngology Course
- Western States Rhinology Course
Thursday Education Block
The backbone of our didactic program is our weekly Thursday morning educational block. The curriculum is sub-specialty based and includes team-based learning, traditional lecture format, hands-on-learning, case-based learning, reversed classroom, landmark article review and debate format. The didactic program also includes monthly neuroradiology conference led by our attending neuroradiologists, and head and neck pathology review led by our attending pathologists.
Curriculum blocks include:
- Sleep Surgery/Sleep Medicine
- Laryngology (includes Speech Language Pathology lectures)
- Otology and Neuro-otology (includes Audiology lectures and Temporal bone histopathology sessions)
- Head and Neck Oncology (includes Speech Language Pathology lectures)
- Pediatric Otolaryngology
- Facial Plastics and Trauma (includes facial plating course)
- Rhinology and Skull Base Surgery (includes Allergy lectures)
Resident Rotation Schedule
The first year is spent in the General Surgery Residency Training Program sponsored by the University of California San Francisco, East Bay. In accordance with the ACGME guidelines for the PGY1 residents’ educational experience, the year includes five clinical rotations in Otolaryngology. There are four required rotations in emergency medicine, critical care (ICU or trauma service), anesthesia and neurosurgery. Finally, there is one clinical rotation from the following possibilities: general surgery, thoracic surgery, vascular surgery, pediatric surgery, plastic surgery, or surgical oncology. Minor surgeries typically include biopsies, minor excisions and cosmetic repair of head and neck lesions.
Residents are taught the evaluation and care of surgical patients through a graded increase in responsibility. There is a large and diverse patient population. There is an in-depth basic and clinical science conference schedule. By the end of their internship year, residents should be able to manage critically ill patients and should have developed the technical skills necessary to begin their full-time Head and Neck Surgery training.
The PGY2 year is the first full introductory year to otolaryngology. This year is designed to build a strong foundation in both the basic science and clinical practice of our specialty. Our program supports/participates in the UC Davis ENT Emergencies Simulation Boot Camp and our residents are expected to participate as either a PGY1 or 2.
Emphasis is placed on one-on-one proctorship with a staff attending at this level of training. Nine months are spent working closely with each of our full-time Oakland HNS staff. During each rotation, the resident works exclusively with the supervising attending both in the clinic and the operating room.
In the Outpatient Department (OPD), the resident learns to take a careful head and neck history and acquires skills in performing examinations. Physical findings and diagnoses are discussed. The rationale for management plans are emphasized so the resident understands the need for appropriate diagnostic tests, medications, cost-effective medical decisions and surgical interventions. The art of medicine is also emphasized – including appreciating cultural diversity, physician patient interaction, strengthening interpersonal relationship skills and discussing ethical issues.
A wide variety of OPD procedures are performed under direct supervision. A minor surgery clinic for patients referred from the dermatology, general surgery, medicine, and plastic surgery departments is managed by the resident with staff supervision. These minor surgeries typically include biopsies, minor excisions and cosmetic repair of head and neck lesions.
In the OR, the resident initially assists on major head and neck cases. After observing and assisting in surgical procedures and demonstrating surgical anatomy knowledge and satisfactory technical skills in a soft tissue course and in the OPD minor surgery clinic, the resident performs minor, and later, more complicated procedures with direct staff supervision.
After didactic tutoring with lasers (CO2, KTP, Argon, YAG), the resident can participate in laser surgeries. They assist on major head and neck cancer, plastic and reconstructive surgical cases, and observe advanced otologic procedures until satisfactory completion of a temporal bone anatomy dissection course. By the end of the year, the resident is competent performing a large number of surgical cases such as:
- Type 1 myringoplasties
- Rigid/flexible endoscopies
- Complex lacerations
- Septoplasties/Primary FESS procedures
- Mandible fractures
- I & D of cervicofacial infections
Residents benefit from a one month Audiology/Speech Therapy rotation. Topics selected from an audiology reading list are discussed. Speech pathologists from Kaiser Permanente give a series of lectures on speech and language development, diseases, and management. The diagnostic evaluation and rehabilitation of speech patients are observed in the speech pathology department.
A one month rotation in Research is allotted. This is to identify and begin developing research projects. This is protected time without clinical responsibilities.
A one month rotation at the San Francisco Allergy Service teaches basic allergy and immunology. It includes a lecture series and provides experience in the diagnosis and management of allergic diseases under direct staff supervision.
In the PGY3 year, the resident has three clinical rotations at Kaiser Permanente in Oakland (four months), Hayward (three months) and San Francisco (three months). At Oakland, the resident is assigned to work with an individual faculty attending each month. Beginning this year, the residents also have their own clinics one to two half days per week with a staff physician assigned for consultation. The PGY3 has increased responsibility for patient care in the OPD, hospital, and ER with appropriate staff back-up.
The resident spends approximately three to four half days per week in the OR with a full-time staff attending. During this year, they will perform a large number of more complex procedures in head and neck cancer, maxillofacial surgery, and plastic and reconstructive surgery. The resident will typically assist on major cancer resections. Maxillofacial, oculoplastic and plastic surgeons are available as department consultants for improved quality of care and resident teaching.
A three month KPMC-San Leandro/Fremont rotation is included in this year. This clinical rotation involves working as a resident with six full-time Board Certified HNS staff attendings. Areas of special clinical interest include exposure to parathyroid surgery, TNE (transnasal esophagoscopy), facial cosmetic surgery and hearing aid dispensing.
A three-month KPMC-San Francisco rotation is a part of this year. This clinical rotation has a resident working with eight full-time board-certified HNS staff attendings. Areas of special interest include general otolaryngology, cosmetic surgery, advanced sinus surgery and laryngology.
Our program supports/participates in the Stanford Soft Tissue Course and our residents are expected to participate as either a PGY2 or 3. Having also completed our Temporal Bone Anatomy course with drilling dissections as a PGY2 or 3, the resident begins to perform intermediate otologic surgery such as tympanoplasties with ossiculoplasties and simple mastoidectomies.
The resident will spend one month on Research. This is spent developing and completing projects generated in the research time during the PGY2 year. Progress updates to the involved HNS attending staff and our Research Coordinator/APD Dr. Wang are expected during this time.
A one month Pathology/Elective rotation allows the resident the discretion to spend part-time reviewing head and neck pathology supported by our pathology attending staff while spending a portion of the month as an elective to rotate on or look at potential fellowship opportunities.
The PGY4 year is a full clinical year devoted to strongly develop surgical skills. The resident has three rotations – Kaiser Permanente in Oakland and Redwood City and a research block. Late in the PGY4 year our residents attend the Seattle Science Foundation Otology/Rhinology Dissection Course to prepare for the advanced surgical procedures they will undertake during their chief resident year.
Seven months are spent at Oakland. The resident has his or her own OPD clinic panel with a readily available staff consultant. The resident performs advanced head and neck cancer, maxillofacial, plastic and reconstructive and otologic surgical procedures. The PGY4 serves as primary surgeon for most of these cases and assistant surgeon for some of them. The PGY4 also has the opportunity to rotate and act as primary surgeon with our maxillofacial and facial plastic surgeons and Mohs’ chemosurgeons. The PGY4 proctors junior residents in simpler procedures.
A three month rotation in Redwood City is contained in the PGY4 year. As previously described, this rotation is weighed towards a general otology, rhinology, skull base and neuro-otologic surgical experience.
Finally, the PGY4 has a two-month Research rotation. This block time is given for completion of research projects begun earlier during residency and to identify a project to complete during the last year of residency.
The PGY5 resident serves as a Chief Resident and rotates in Oakland for nine months and in Redwood City for three months. The goal of the final year of residency training is to complete the development of the resident as an otolaryngologist-head and neck surgeon. At each facility the PGY5 has a clinic three half days a week with HNS staff consultants running parallel clinics and available for necessary consultation. The PGY5 is the primary surgeon on the more advanced and complex cases with an HNS staff available for direct and indirect supervision. The PGY5 assists more junior residents along with HNS staff attending on cases that require less skill. The Chief Resident is in charge of all consults and hospitalized HNS patients and supervises junior residents in the management of these patients. Full-time HNS staff supervise the Chief Resident in these functions and are available at all times for advice and consultation. The PGY5 also has administrative duties arranging resident coverage for surgical cases, preparing the resident call schedule, supervising daily clinical rounds and assisting in organizing the didactic schedules especially the Grand Rounds presentations. The Chief Resident is the resident most responsible for teaching of medical students and junior residents.
Our residents perform > 90% of the surgical procedures done by our department. They have experience performing the key and essential elements of an extensive assortment of surgeries under the supervision of our attending surgeons. The PGY5 resident will complete his/her training with a very diverse surgical experience and with an operative log account well above the national average for otolaryngology training programs. Recent graduates have finished with an average of a +3200 surgical caseload experience. At the conclusion of the fifth year, the PGY5 is ready to assume responsibilities as a competent otolaryngologist-head and neck surgeon with broad, well- rounded clinical experience functioning in an independent manner.