Goals and objectives
The goal of this block is to give medical students a more in-depth exposure to otolaryngology. Our department recognizes that there are fourth year students who are interested in joining the field of otolaryngology and also those who plan to pursue other specialties but wish to further their basic understanding of our field through more depth of study. The department welcomes both types of students, and the faculty will do its utmost to maximize their educational experience as it is relevant to the students’ career goals.

Fourth-year medical students will gain further experience in the field while also integrating with and participating in the team approach to patient care. Basic expectations for fourth-year students are the following:

• Punctual attendance at morning and evening rounds with the resident team and active participation in the care of in-patients.
• Active evaluation of patients in the in-patient and out-patient setting, under supervision of residents and faculty.
• Increased exposure to a variety of ENT cases in the operating room and assist when appropriate, commensurate with the performance level of a fourth-year medical student sub-intern.

Participation, expectations of performance, and grading
Our department uses the ACGME Residency Review Committee Guidelines for General Competencies in Medical Education as a basis for student evaluations. Since the clinical rotation is a part of developing clinical competency and in transitioning to residency training, we have incorporated these competencies in assessing performance (listed below, quoted from the ACGME1):

• Patient care that is compassionate, appropriate, and effective for the treatment of health programs and the promotion of health
• Medical knowledge about established and evolving biomedical, clinical, and cognate sciences, as well as the application of this knowledge to patient care
• Practice-based learning and improvement that involves the investigation and evaluation of care for their patients, the appraisal and assimilation of scientific evidence, and improvements in patient care
• Interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and other health professionals
• Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to patients of diverse backgrounds
• Systems-based practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care

We realize that not every fourth-year student has had the same clinical exposure to otolaryngology and, therefore, do not expect him or her to be expert in our field. However, both residents and attendings will expect each student to demonstrate a willingness to learn, to be involved in patient care, and to show an increased knowledge of otolaryngology at the completion of the rotation.

Therefore, our expectations of the fourth-year medical student include:

Clinic
Participate in clinic by, initially, shadowing a senior resident and then by seeing uncomplicated patients on his or her own. The medical student will present his or her findings to an otolaryngology resident and then, together, to the clinic attending. (The residents/attendings will indicate to the medical student if he or she is to present to the attendings directly.)

Operative experience
In order to gain optimal experience in the operating room, the fourth year student is expected to read the patient’s chart prior to the day of surgery. The fourth-year student is also expected to have reviewed and be able to demonstrate knowledge of the pertinent anatomy for a given procedure. The student should also follow his or her surgical patients during their hospital stay in order to better understand patient care and disease processes.

Resident conference presentations
During the rotation, each fourth year medical student is expected to present an otolaryngology topic in morning conference. Ideally, the topic will be directly related to a patient case in which the student is involved while on service.