THE CHINESE UNIVERSITY OF HONG KONG

FACULTY OF MEDICINE

DEPARTMENT OF OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY (ENT)

GUIDELINES FOR THE UNDERGRADUATE TEACHING PROGRAMME (6 YEAR CURRICULUM)

FOR 6th YEAR MEDICAL STUDENTS

2017/2018

INDEX Page (A) Clinical Attachment 3-7 (B) Academic Requirements 7-10 (C) Video Library 10 (D) Recommended Reading 10-11 (E) Teaching Staff 11 (F) Attachment Timetables 12-14 (G) Form 15

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(A) Clinical Attachment Objectives of the module (a) Nose 1. To be able to take a history of nasal symptoms and to be able to interpret

and understand nasal symptomatology. 2. To be able to examine the structure and function of the nose. To be

familiar with the normal appearances and variations of the nose. 3. To be able to assess the patency of the nasal airway. To be able to

recognize a deviated septum, allergic rhinitis, a nasal polyp, a foreign body and tumours of the nose and sinuses.

4. To know how to investigate and diagnose rhinitis, sinusitis and

rhinosinusitis including the orbital and cranial complications of sinusitis. 5. To understand the pathophysiology of epistaxis. To know the

management of all degrees of severity of epistaxis. 6. To recognize the importance of epistaxis as a sign of local nasal,

nasopharyngeal or general disease and to appreciate the importance of excluding and/or diagnosing nasopharyngeal carcinoma as a cause of epistaxis. Early referral of epistaxis is emphasised.

(b) Ear 1. To be able to take a complete otological history including a history for

hearing loss, vertigo, ear pain and ear infections. 2. To be able to perform an otological examination and to be familiar with

the clinical presentation of conditions in point 1. 3. To be familiar with the appearance of the normal tympanic membrane. 4. To be familiar with the common investigations for hearing loss and ear

disease. 5. To be able to perform, interpret and understand tuning fork tests and

free-field speech threshold tests. 6. To observe the performance of audiological tests and to understand and

interpret the findings. To be able to understand an audiogram. 7. To be aware of the availability and value of specific vestibular tests. 8. To be able to recognize fluid in the middle ear, granulations in the ear

canal, tympanic membrane perforations and a cholesteatoma. 9. To be aware of the signs of acute mastoiditis.

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10. To know the complications of various forms of otitis media and their

mode of presentation. 11. To know the causes of a facial nerve palsy and be able to localize the site

of a facial nerve lesion. 12. To be able to carry out clinical testing on a child with hearing loss. 13. To be aware of the treatment and rehabilitation of a patient with hearing

loss. 14. To understand the various techniques used to clean the external ear

canal. (c) Throat 1. To be able to take a history of mouth and pharynx symptoms. To be able

to perform an examination of the mouth and pharynx and to be able to interpret the findings.

2. To be aware of the routine and specialised methods used to examine the

nasopharynx, hypopharynx, larynx, tracheobronchial tree and oesophagus.

3. To be competent in diagnosing facial fractures. 4. To recognize the prevalence of nasopharyngeal carcinoma in the

Southern Chinese community and to acquire a detailed knowledge of the modes of presentation, methods of diagnosis and of the importance of early recognition of this condition.

5. To be aware of the importance of hoarseness as a symptom and the

necessity for early referral and diagnosis. 6. To know the causes of hoarseness and its management. 7. To be aware of the causes, diagnosis and management of stridor in

children and adults. 8. To be competent in the examination of the neck. 9. To be aware of the methods employed in the investigation of a lump in

the neck. 10. To know the causes and investigation of dysphagia. 11. To be aware of the methods of rehabilitation after laryngectomy.

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(d) Audiology

1. To understand the scope of practice in audiology.

2. To understand the anatomy and physiology of the auditory system.

3. To understand the basic terminologies in audiology.

4. To understand the basics of different audiological evaluation procedures, behavioural and electrophysiological, and their applications.

5. To be able to interpret the severity, type, and site of lesion of a

patient’s hearing disorder from the audiological evaluation results, and to predict the impact on the patient’s communication ability.

6. To understand the re/habilitation options for infants, children and

adults with different hearing disorders.

7. To understand the evaluation and management basics of balance system disorders.

(e) Speech Therapy 1. To be aware of the scope of service of speech therapy 2. To be aware of the clinical signs of patients with speech, language,

hearing, voice, dysfluency and swallowing difficulties. 3. To understand the general assessment of and treatment approaches for

patients with communication and swallowing problems. 4. To understand the basic terminologies in speech therapy including

aphasia, dysarthria, apraxia and dysphagia. 5. To be aware of the joint clinics, such as VFSS, FEEST and Cleft Clinic,

involving speech therapists and other professionals in the overall management of patients.

6. To know the mechanism of the various speech rehabilitation methods

after total laryngectomy.

Medical Year 6 2 Weeks Module in Otorhinolaryngology, Head and Neck Surgery Teaching and Attachment Timetables (see later) Moderator - Professor A C Vlantis

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Note

(a) Students are to meet on Monday morning at 8:00am in Integrated Ward at the start of the first week.

(b) One student is to be designated as the ‘group leader’ and leave a contact page or

mobile phone number with the nursing staff in the ENT Treatment Room.

(c) If two tutorials follow each other with no break, please do not be late for the second tutorial. Apologize to the first tutor, excuse yourselves and complete the first tutorial at another time.

(d) Students should prepare for and participate in tutorials.

(e) Try to base tutorials on clinical (ward) patients.

(f) Case allocation in the wards must be in strict sequence and all patients must be

allocated.

(g) No student may be excused as an "Assistant Intern" during their module unless to work in the ENT Department.

(h) Students may only be excused from attendance under exceptional circumstances.

(i) The Department of Otorhinolaryngology, Head and Neck Surgery holds its own

final end of year examination, the ENT OSVE (objective structured video examination), and so there will be no ENT in the final Surgery Examination at the end of Medical Year 6.

Out patient attendance Each student should attend the out patient clinic sessions during their attachment according to their timetable. There are general ENT clinics and specialist ENT clinics. Usually only one student can be accommodated in a consultation room at any one time. Attendance of the specialist clinics should be on the basis of the medical student having or showing a special interest in that particular subspecialty of Otorhinolaryngology, Head and Neck Surgery and the student should arrange in advance to attend the specialist clinics. Once again, only one student can be accommodated at a time. This will mean that while some medical students are attending a specialist clinic, other medical students from the group will be busy with other activities related to the ENT attachment. When the group as a whole is involved in a tutorial, the whole group should attend the tutorial.

OT Video Clips Viewing

There are two sessions of video shows of surgeries in the two-week module to enable students see clearly how the selected surgeries are performed without restriction of limited space of the operation theatre. A few questions in the summative ENT

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Objective Structures Video Examination will be based on the surgeries shown in the video sessions. Voluntary operating theatre attendance A voluntary operating theatre attendance session is available for students who want to get more exposure to live surgeries. Both general anaesthetic and local anaesthetic ENT operating theatres at the PWH, AHNH and UCH are available for students to attend during their attachment. A maximum of two medical students should attend a surgery at any one time. It is not practical for more than two medical students to be inside the same operating theatre at the same time. Interested students should refer to the operation lists and register with the surgeon-in-charge beforehand. (B) Academic Requirements The clinical attachment assessment will count for 35% of the overall final year mark in Otorhinolaryngology, Head and Neck Surgery (ENT-H&N Surgery) and the end of the academic year summative ENT OSVE examination will count for 65% of the overall final year mark in ENT. 1. The ENT-H&N Surgery Objective Structured Video Examination OSVE* – 65% of the

final year mark The Department of Otorhinolaryngology, Head and Neck Surgery will hold its own ENT final summative assessment. This will take the form of a written ‘Objective Structured Video Examination’ (OSVE). The examination will take place once, at the end of the academic year. The result of the exam, in combination with the clinical attachment assessment, will constitute the final assessment mark for Otorhinolaryngology, Head and Neck Surgery. 2. The clinical case scenario presentation – 5% of the final year mark As a group, you will be expected to produce and present two clinical case scenarios at the end of the second week. Each group is sub-divided into two smaller sub-groups, either A and B or C and D. Each smaller sub-group comprises 4 to 5 students. Each sub-group must devise an original clinical case scenario, a question and 5 answers, one of which must be correct and 4 incorrect. Each of the 5 answers must be accompanied by an explanation. Explain why the correct answer is correct and why each of the 4 incorrect answers are incorrect. The topic of the clinical scenario for each sub-group is as follows: GROUP AND CLINICAL SCENARIO TOPIC 1KL. Hearing loss- childhood (SNHL & otitis media with effusion) 1OP. Hearing loss – adult (Presbycusis, sudden SNHL, conductive HL) 2KL. Hearing aids (including BAHA and cochlear implant) 2OP. Otalgia (Otitis externa, acute otitis media, referred) 3KL. Otorrhoea (chronic otitis media – attico-antral disease) 3OP. Complications of middle ear infections 4KL. Facial nerve palsy 4OP. Disorders of balance – otological causes (vertigo) 1KL. Tinnitus

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NOSE AND PARANASAL SINUSES 1OP. Allergic rhinitis 2KL. Vasomotor rhinitis 2OP. Nasal polyps 3KL. The common cold (viral rhinitis) 3OP. Epistaxis 4KL. Acute sinusitis 4OP. Chronic sinusitis THE THROAT 1MN. Stridor 1QR. Sore throat & tonsillitis 2MN. Dysphagia 2QR. Infections of salivary glands 3MN. Snoring 3QR. Sleep apnoea 4MN. Foreign bodies HEAD AND NECK NEOPLASIA 4QR. Neck lumps – non-metastatic adult conditions 1MN. Neck lumps – metastatic adult conditions 1QR. Cancer of the larynx 2MN. Cancer of the oral cavity 2QR. Cancer of the oropharynx 3MN. Cancer of the hypopharynx 3QR. Cancer of the nasopharynx 4MN. Cancer of the nose and paranasal sinuses 4QR. Cancer of the salivary glands The case scenario can deal with one or more aspects of the topic, for instance a differential diagnosis, a management option, outcomes of treatment, prognosis, a complication and so on. You can attach a clinical photo of the patient, lesion, radiology result, and audiogram and so on if this will add to the scenario. For example: Topic - dysphonia Scenario: An adult has been hoarse for 3 weeks. Question: What is the management? Answers: a) wait and see, b) EUA, c) antibiotics, d) IDL, e) reassure. Please see the attached form (Form 1) as a guide for the scenario. Please prepare the clinical scenario as a Power Point presentation with a maximum of 10 slides. Your case scenario should be presented to the group on the second (last) Friday of your attachment as a Power Point presentation. 3. Telecast teaching - 10% of the final year mark You will each be expected to clerk / take a history and perform an examination on an out-patient and present your findings to the rest of your group during the telecasting clinical teaching session. Five students should clerk and present cases in the first week and the other 5 students of the group in the second week of your attachment. The 5 students who will clerk and present the cases should excuse themselves from the journal club meeting in time to clerk the cases, as the telecasting clinical presentations will begin at 10H30 in the LKS ENT outpatient clinic.

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4. Clinical ENT examination – 10% of the final year mark During the second week of your attachment, you will be expected to perform a basic ENT examination on a patient / mock patient. A simple examination of the ears, nose, mouth, oropharynx and neck will be assessed and count for a maximum of 10% of the final year mark in ENT. 5. Overall performance - 10% of the final year mark Attendance at and participation in academic meetings, ward rounds, ward work, outpatient clinics, operating theatre sessions, clinical case telecast presentation and the clinical scenario will be assessed by at least 4 members of the ENT-H&N Surgery Department and averaged to give a mark for overall performance / attitude / involvement /contribution that will count for a maximum of 10% of the final year mark in ENT. The grade, subdivisions and standard used for a student’s overall course assessment:

Grade & Subdivisions Standard

A A-

Excellent Very Good

B+ B B-

Good

C+ C C-

Fair

D+ D

Pass

F Fail

Note In case of failure, the student may be allowed to repeat the module at the discretion of the Chairman or Head of Academic Divisions of Otorhinolaryngology – Head and Neck Surgery (ENT-H&N Surgery). A pass in ENT-H&N Surgery is mandatory before a student can sit the final Surgery Examination. If both ENT-H&N Surgery and Ophthalmology are failed, the student will be deemed to have failed Surgery. There will be no specific questions on ENT-H&N Surgery in the final year Surgery Examination. Should students encounter any problems relating to the ENT-H&N Surgery Module, they are encouraged to approach any staff member, or the Chairman or Head of Academic Divisions of the department, to discuss and resolve the difficulty during their allocated time of attachment. Students will be given two opportunities to provide feedback on the ENT module. At the end of the 2 week clinical attachment students will be asked to complete a course evaluation form giving feedback on the module for analysis by the Office of Educational Services of CUHK, and at the end of the OSVE examination the students will be asked to complete a student feedback

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questionnaire for analysis by the Department of Otorhinolaryngology, Head and Neck Surgery, both in an attempt to continue to improve the overall quality of the ENT module. The 6 students who attain the highest assessments in Otorhinolaryngology, Head and Neck Surgery will be interviewed to determine which student will be awarded the Alan Gibb Prize in Ear, Nose and Throat Surgery.

* The ENT-H&N Surgery written OSVE examination will be on Tuesday morning, 27 February 2018.

(C) Video Library

1. Acute otitis media - An epic battle lost and won 2. An Endoscopic View of the Ear 3. Dynamic documentation of laryngeal disease 4. Examination of ENT system – Kings General Hospital 5. Examination of the nose and throat 6. Examination of the ear, nose and throat 7. Examination techniques of Mucous Membrane 8. GP Refresher’s Course 9. The Hong Kong vascularised temporalis fascia flap 10. Laryngitis, Croup & Epiglottitis 11. The normal nasopharynx 12. NPC, the approach to diagnosis 13. Surgical Treatment of deafness 14. Speech after total laryngectomy in Cantonese patients 15. Audiology

(D) Recommended Reading 1. Ear, Nose and Throat and Head and Neck Surgery 2nd Edition R S Dhillon & C A East Churchill Livingstone, 1999, ISBN 0-443-05955-1 2. A Short textbook : Ear, Nose and Throat

Pracy Siegler Stell 3. Clinical ENT. An Illustrated Textbook Gerald M. O'Donoghue, Grant J. Bates, Anthony A. Narula Oxford University Press, 1992, ISBN 0-19-261667-6 3. Clinical Otorhinolaryngology Adrian Drake-Lee Churchill Livingstone, 1996, ISBN 0-443-04965-3

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These 4 websites provide succinct and extensive materials on Otorhinolaryngology-Head and

Neck Surgery

http://www.martindalecenter.com/MedicalAudio.html http://www.utmb.edu/otoref/default.asp http://www.emedicine.com/ent/index.shtml

http://www.entdev.uct.ac.za/guides/open-access-atlas-of-otolaryngology-head-neck-operative-surgery/

(E) Teaching Staff Academic Staff

Professor C A van Hasselt Professor Michael Tong Professor A C Vlantis Professor Kathy Lee Professor Jason Chan Dr Jacky Lam Dr Kammy Yeung

Honorary Clinical Staff /Adjunct Tutors

Dr C L Sham Dr Li Hok Nam

Dr John Woo Dr Alice Siu

Dr Victor Abdullah Dr Ryan Cho

Dr Gordon Soo Dr Chang Wai Tsz

Dr Peter Ku Dr Jackie Cheung

Dr Henry Lam Dr Kelvin Chow

Dr S K Ng Dr John Lee

Dr Willis Tsang Dr Zenon Yeung

Dr Wendy Kwan Dr Jacky Lo

Dr John Sung Dr Eric Lau

Dr H Q Wong Dr Iris Leung

Dr Osan Ho Dr Jacqueline Chan

Dr Frederick Wong Dr Kary Lui

Dr Eddy Wong Dr Ronald Lai

Dr Jennifer Chow Dr Zion To

Dr Samuel Chow Dr Calvin Lai

Dr Eric Tang Mr Terence Wong

Dr Nelson Lai Ms Becky Chan

Dr Natalie Leung

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ORL, H&N Surgery - Daily Routine

Moderator - Professor A C Vlantis

Monday Tuesday Wednesday Thursday Friday

AM 8:00 Ward Round

8:30 Operating Theatre (GA)

8:45 ENT OPD (LA OT)

9:30 ENT OPD

8:00 Ward Round

9:30 ENT OPD

9:30 H&N Meeting

10:00 NPC Clinic

11:00 H&N Clinic

8:30 Grand Ward Round

9:00 X-ray meeting (4th week)

9:15 Academic Meeting /

Journal Club

10:15 M&M meeting (1st week)

10:30 ENT OPD

10:30 Dysphagia Clinic

(2nd

& 4th week)

10:30 Facial Plastic Clinic

(3rd

week)

10:30 MS Telecast Teaching

8:00 Ward Round

8:30 Operating Theatre (GA)

8:45 ENT OPD (LA OT)

9:30 ENT OPD

8:00 Ward Round

9:30 ENT OPD

9:30 Rhinology & Allergy

Clinic

PM

13:00 Operating Theatre (GA)

14:00 ENT OPD (LA OT)

14:15 ENT OPD

17:00 Ward Round

14:15 ENT OPD

17:00 Ward Round

14:15 ENT OPD

14:15 Chronic Ear Clinic

14:15 Voice Clinic (3rd

week)

14:15 Paediatrics Clinic

(3rd

week)

17:00 Ward Round

13:00 Operating Theatre (GA)

14:00 ENT OPD (LA OT)

14:15 H&N Clinic

14:15 Thyroid Clinic

(1st & 3

rd week)

17:00 Ward Round

14:15 ENT OPD

17:00 Ward Round

Note : All students should report to Integrated Ward on Monday at 8:00am All students must attend one Wednesday grand round at 8:30am during the two weeks

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Attachment Timetable

WEEK 1 Mon Tue Wed Thu Fri

0800-0830

Prof A C Vlantis Introduction & Revision of Examination Techniques

Ward Round (PWH) Ward Round (PWH)

0830-0900 Dr Gordon Soo / Dr Peter Ku / Dr Frederick

Wong / Dr Jennifer Chow The Scope of Functional Facial Plastic

Surgery

0900-0930 Prof Jason Chan

Oral Cavity and Oropharyngeal Carcinoma

0930-0945

ENT Journal Club Meeting

0945-1000

MS to clerk patients for telecast

teaching

1000-1030

Viewing OT video clips

Prof C A van Hasselt

Nasopharyngeal Carcinoma Q&A for OT video clips

1030-1100 MS Telecast Teaching

1100-1200 Tutorials (TKOH) Rhinitis, Sinusitis, Rhinosinusitis Location: ENT Office, 1/F, KEC

Admin Bldg., TKOH

1200-1230

1230-1300

1300-1400

1400-1430 Dr Jackie Cheung / Dr Li Hok Nam

/ Dr Natalie Leung ENT Infections

(Quinsy, Supraglottitis, Neck Abscess)

Dr Winnie Kan / Dr Li Hok Nam / Dr Natalie Leung

ENT Infections (Quinsy, Supraglottitis, Neck Abscess)

Dr Jacky Lam Emergencies in ENT

1430-1500

Tutorials (TKOH): Facial Nerve Palsy and Sudden

Sensorinerual Hearing Loss; Stridor and Airway Management

1500-1530

1530-1600

1600-1630 Prof Kathy Lee / Mr Thomas

Law / Speech Therapist Speech Therapy: Scope of Services

Audiologist Basic Understanding of Audiological

Tests 1630-1700

1700-1730

draft

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WEEK 2 Mon Tue Wed Thu Fri

0800-0830 Ward Round (PWH) Ward Round (PWH) Grand Round (PWH) Ward Round (PWH) Ward Round (PWH)

Voluntary OT attendance PWH / AHNH / UCH

GA: 0830

PWH/AHNH/UCH

#LA: 0845 PWH/AHNH/UCH

Clerking cases for bedside

teaching

Dr C L Sham Common Sinonasal Operation

0930-0945

ENT Journal Club 0945-1000 MS to clerk

patients for telecast teaching 1000-1030

1030-1130 Prof Michael Tong Bedside teaching

(need to clerk cases beforehand) Tutorials (AHNH)

Ear Wax, Otitis Externa and Otalgia; The Vertiginous Patients: Approach to

Management

MS Telecast Teaching

Prof A C Vlantis Neck Swellings: Approach to

Management; Scenario Presentation 1130-1230

1230-1300 Dr Henry Lam (AHNH) SOM, AOM, CSOM and Complications

1300-1330

1330-1400

1400-1430

Viewing OT video clips

SOPD Clinic Group A: AHNH

Group B: PWH

Dr S K Ng / Dr Eddy Wong

Hoarseness and Carcinoma of Larynx 1430-1500

Dr H Q Wong Free topic

1500-1530 Dr S K Ng / Dr Eddy Wong

Hoarseness and Carcinoma of Larynx

1530-1600

Dr John Woo Epistaxis

Q&A for OT video clips

1600-1630

Dr Samuel Chow / Dr Eric Lau Assessment of ENT Examination Skills

1630-1700

1700-1730

Remarks: Only 1-2 spaces are available for each elective clinic, please register with the surgeon-in-charge beforehand Only 1-2 spaces are available for each OT in the “Voluntary OT Attendance” session, please register with the surgeon-in-charge beforehand.

e 15

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ENT Clinical scenario Answer a feedback

Answer b feedback

Answer c feedback

Question

Answers Answer d feedback

Answer e feedback

a. …………………………………………………………….

b. …………………………………………………………….

c. …………………………………………………………….

d. …………………………………………………………….

e. …………………………………………………………….

Form 1