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return to: Medical Student Instruction

CLINICAL OTOLARYNGOLOGY – 068-003 – PATIENT EXPERIENCES CHECKLIST

 Word document - may download and print separately: Student Checklist

Completion of the items on this form is required.  You will not receive a grade until it is completed and returned. The completed form is due when you take your final examination.  Failure to complete the minimum required items will result in an incomplete grade for the course.  You must have your resident co-sign the checklist; uncosigned checklists will result in an incomplete grade for the course..

 

Guidelines for completion of this checklist:

SECTION A: During your rotation, we would like for you to have some experience with the most common types of clinical situations that an otolaryngologist would encounter.  In a 2 week rotation, it is difficult to have all of these experiences with an actual patient.  There are patient-based clinical scenarios that are available online (COOL cases) that are designed to supplement and reinforce the clinical experience that you will have on the clerkship rotation.  There are currently 29 COOL cases available.  At the minimum, you are required to complete the 12 COOL cases that are listed below in section A1.  You may complete the other COOL cases that are listed in section A2 for your own education if you desire. 

As you do encounter patients on the rotation, either in the clinics, in surgery, or on call, you will be asked to document the level of clinical participation that you had with that patient.  Additional clinical scenarios that you may encounter are listed in section A2.  At the minimum, you must have had some clinical participation with an actual patient for eight of the following patient scenarios that are listed in either section A1 or A2.  You may use the same patient to fulfill several items. 

Full participation will include complete history and physical exam, diagnosis development, and thorough clinical reasoning which support management: formulation or review of treatment plan, appropriate use of diagnostic or monitoring tests, schedule for follow-up, appropriate counseling and/or patient education, appropriate medication review and prescription.

Partial participation includes completion of history and physical, but not developing a diagnosis and treatment plan.

Observe level means observing history and/or physical exam, but not participating in care.

SECTION B:  During your rotation, we require that you observe and/or perform the 3 procedures listed in section B.  At the minimum, you must have at least observed in person or seen a portion of the procedure in a COOL case for all three of the listed procedures.

SECTION C:  During your rotation, you must complete the call requirement.  At the minimum, you must complete one evening call from 5 pm to 8am Monday through Friday, OR one weekend shift from 9am to 9 pm Saturday or Sunday.

SECTION D:  During your rotation, you must complete a short, 3-5 minute oral presentation on a clinical topic of your choice.  This presentation will be given to your team at a mutually agreed upon time.  At the minimum, you must complete this oral presentation to your team.

A. PATIENT CARE

1. REQUIRED patient experiences

Epistaxis

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Nasal Obstruction

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Rhinosinusitis

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Allergic Rhinitis

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Otitis Media

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Sensorineural Hearing Loss (2008)

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Tinnitus

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Hoarseness

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Adult Neck Mass

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Dysphagia

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Oral Cavity Lesions             

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Sleep Medicine for the General Practitioner             

□ FULL

□ PART

□ OBS

□ COOL

date:_____

2. Additional patient experiences

Cholesteatoma (Otoscopy)

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Ear Canal Obstruction

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Management of Positional Vertigo

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Otalgia

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Sudden Sensorineural Hearing Loss (2009)

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Pediatric Stridor

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Pediatric Neck Mass

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Non-melanomatous Cutaneous Malignancies

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Hoarseness/Laryngeal Neoplasms

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Salivary Disease

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Pharyngitis

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Nasal Trauma

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Chronic Cough

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Reflux

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Management of the Thyroid Nodule

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Facial Soft Tissue Trauma

□ FULL

□ PART

□ OBS

□ COOL

date:_____

B. COMMON PROCEDURES

Flexible Laryngoscopy

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Audiogram Evaluation

□ FULL

□ PART

□ OBS

□ COOL

date:_____

Ear Microscope Exam

□ FULL

□ PART

□ OBS

□ COOL

date:_____

C. ORAL PRESENTATION

            Date of presentation: ___________

D.  COMPLETION OF CALL

            Date of call: ___________

I certify that these checklist items have been completed with honest and integrity.

_____________________________________

STUDENT SIGNATURE

_____________________________________

RESIDENT SIGNATURE

 

 

 

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