The Otolaryngology Milestone Project: A Joint Initiative of

The Otolaryngology Milestone Project
A Joint Initiative of
The Accreditation Council for Graduate Medical Education
and
The American Board of Otolaryngology
October 2013
The Otolaryngology Milestone Project
The milestones are designed only for use in evaluation of resident physicians in the context of their participation
in ACGME-accredited residency or fellowship programs. The milestones provide a framework for the assessment
of the development of the resident physician in key dimensions of the elements of physician competency in a
specialty or subspecialty. They neither represent the entirety of the dimensions of the six domains of physician
competency, nor are they designed to be relevant in any other context.
i
Otolaryngology Milestones
Chair: Terry Tsue, MD, FACS
Working Group Advisory Group

Nasir I. Bhatti, MD Timothy Brigham, MDiv, PhD
Anthony E. Brissett, MD, FACS Brian Burkey, MD
Brian Burkey, MD Sukgi S. Choi, MD
Laura Edgar, EdD, CAE Michael Cunningham, MD, FACS
Pamela Derstine, PhD, MHPE Ellen S. Deutsch, MD
Noel Jabbour, MD Marvin P. Fried, MD, FACS
Abraham Jacob, MD Sonya Malekzadeh, MD
Michael M. Johns III, MD Bradley Marple, MD
Eric Kezirian, MD Anna H. Messner, MD
Daniel J. Kirse, MD Robert Miller, MD
Joseph Walter Kutz, MD Michael G. Stewart, MD
Anna H. Messner, MD Randal S. Weber, MD, FACS
Liana Puscas, MD, MHS
Matthew Ryan, MD
Ivan Wayne, MD
ii
Milestone Reporting
This document presents milestones designed for programs to use in semi-annual review of resident performance and reporting to
the ACGME. Milestones are knowledge, skills, attitudes, and other attributes for each of the ACGME competencies organized in a
developmental framework from less to more advanced. They are descriptors and targets for resident performance as a resident
moves from entry into residency through graduation. In the initial years of implementation, the Review Committee will examine
milestone performance data for each program’s residents as one element in the Next Accreditation System (NAS) to determine
whether residents overall are progressing.
For each period, review and reporting will involve selecting milestone levels that best describe a resident’s current performance and
attributes. Milestones are arranged into numbered levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to
expert. These levels do not correspond with post-graduate year of education.
Selection of a level implies that the resident substantially demonstrates the milestones in that level, as well as those in lower levels
(see the diagram on page v).
Level 1: The resident demonstrates milestones expected of an incoming resident.
Level 2: The resident is advancing and demonstrates additional milestones, but is not yet performing at a mid-residency level.
Level 3: The resident continues to advance and demonstrate additional milestones, consistently including the majority of
milestones targeted for residency.
Level 4: The resident has advanced so that he or she now substantially demonstrates the milestones targeted for residency.
This level is designed as the graduation target.
Level 5: The resident has advanced beyond performance targets set for residency and is demonstrating “aspirational” goals
which might describe the performance of someone who has been in practice for several years. It is expected that only
a few exceptional residents will reach this level.
3
Additional Notes
Level 4 is designed as the graduation target and does not represent a graduation requirement. Making decisions about readiness for
graduation is the purview of the residency program director. Study of milestone performance data will be required before the
ACGME and its partners will be able to determine whether milestones in the first four levels appropriately represent the
developmental framework, and whether milestone data are of sufficient quality to be used for high-stakes decisions.
Some milestone descriptions include statements about performing independently. These activities must occur in conformity to
ACGME supervision guidelines, as well as institutional and program policies. For example, a resident who performs a procedure
independently must, at a minimum, be supervised through oversight.
Answers to Frequently Asked Questions about Milestones are available on the Milestones web page:
http://www.acgme.org/acgmeweb/Portals/0/MilestonesFAQ.pdf.
4
The diagram below presents an example set of milestones for one sub-competency in the same format as the milestone report
worksheet. For each reporting period, a resident’s performance on the milestones for each sub-competency will be indicated by
selecting the level of milestones that best describes that resident’s performance in relation to the milestones.
Selecting a response box on the line in between levels

Selecting a response box in the middle of a
indicates that milestones in lower levels have been
level implies that milestones in that level and
demonstrated as well as some milestones in the higher
in lower levels have been substantially
level(s).
demonstrated.
5
Version 10/2013 Otolaryngology Milestones, ACGME Report Worksheet
Salivary Disease — Patient Care
Level 1 Level 2 Level 3 Level 4 Level 5

• Obtains basic history and • Obtains focused history and • Interprets appropriate lab, • Accurately tumor node • Performs ultrasound guided
physical physical, including pathologic, and radiologic metastasis (TNM) stages a FNA of salivary gland mass
• Understands normal comprehensive head and studies specific patient • Teaches pathophysiology
salivary gland function neck exam, neck and cranial • Describes an accurate • Makes correct diagnosis • Performs extended
• Knows treatment of nerve exam; orders differential diagnosis of a from clinical, radiologic, and dissection of parotid bed
sialadenitis appropriate labs, fine- salivary gland mass; able to pathologic information; neoplasm with preservation
• Knows how to scrub; needle aspiration (FNA), clinically distinguish knows histopathologic of neurovascular (NV)
performs surgical time and radiologic studies neoplastic from non- findings of common structures as appropriate;
out; maintains sterile field • Understands factors neoplastic etiologies neoplastic processes teaches procedure
precipitating inflammatory • Discusses appropriate • Formulates appropriate • Treats complex
salivary disease therapeutic options and treatment plan for a specific complications
• Discusses treatment understands implications of salivary gland cancer patient
modality options in general those options based on primary site,
terms (including adjuvant • Performs procedure with disease stage, and patient
treatment) assistance; identifies factors
• Performs intra-operative neurovascular structures • Completes procedure with
patient prep; raises skin • Recognizes common oversight
flaps in appropriate plane; complications; obtains • Recognizes and is able to
able to aesthetically close appropriate consultations treat and/or develop
wound for patient management treatment plan for common
• Lists some potential complications
complications
Comments:
Copyright © 2012 Accreditation Council for Graduate Medical Education and American Board of Otolaryngology. All rights reserved. The
copyright owners grant third parties the right to use the Otolaryngology Milestones on a non-exclusive basis for educational purposes. 1
Aerodigestive Tract Lesions (ADT) — Patient Care

• Obtains basic history and • Obtains focused history and • Orders appropriate labs, • Interprets appropriate lab, • Performs flexible
physical physical, including functional, and radiologic functional, and radiologic fiberoptic laryngoscopy
• Demonstrates limited comprehensive aerodigestive studies; performs flexible studies with manipulation with
understanding of normal tract and cranial nerve clinic and rigid endoscopic • Makes correct diagnosis oversight
laryngeal function exam with recognition of evaluation from clinical, radiologic, • Teaches pathophysiology
• Demonstrates limited normal anatomy and obvious • Knows differential diagnosis and pathologic • Teaches management of
knowledge of treatment abnormalities of vocal cord lesion; able to information; knows complex aerodigestive
options • Understands normal clinically distinguish histopathologic findings of tract (ADT) lesions
laryngeal and esophageal neoplastic from non- common neoplastic • Performs
function; understands factors neoplastic etiologies processes microlaryngoscopy in the
precipitating inflammatory • Discusses appropriate • Formulates appropriate difficult to expose patient
laryngeal disease therapeutic options and treatment plan for a with complete exposure of
• Discusses treatment modality understands implications of specific vocal cord lesion the anterior commissure
options in general terms each patient based on lesion and • Performs esophagoscopy
• Positions patient properly for • Able to consistently visualize patient factors with complex intervention
laryngoscopy, and sometimes the larynx during • Performs efficiently in the difficult
able to visualize the larynx laryngoscopy and perform microlaryngoscopy to expose patient
• Positions patient properly for binocular microlaryngoscopy consistently with complete • Treats complex
esophagoscopy, and • Performs esophagoscopy exposure of the anterior complications
sometimes able to visualize with biopsy in patients with commissure
the esophagus favorable anatomy • Recognizes and is able to
• Lists some potential • Recognizes common treat and/or develop
complications (e.g., identifies complications; obtains treatment plan for
and appropriately treats local appropriate consultations common complications
injury from endoscopic for patient management
instruments)
Comments:
Sleep Disordered Breathing (SDB) — Patient Care

• Obtains general history • Recognizes signs and • Performs detailed • Interprets examination • Teaches focused history
and performs basic symptoms of SDB and the examination with and advanced diagnostic and physical exam
physical exam differences between evaluation of upper airway testing • Recognizes interaction
children and adults; orders anatomy and interprets • Demonstrates thorough between SDB and other
appropriate routine lab, basic diagnostic testing understanding of sleep disorders in
radiologic, and sleep • Demonstrates moderate spectrum of sleep children and adults
studies understanding of spectrum disorders in children and • Identifies indications and
• Demonstrates basic of sleep disorders in adults risks of non-surgical
understanding of spectrum children and adults • Able to list and prioritize treatment plans for sleep
of sleep disorders in • Demonstrates deepening treatment options for the disorders other than SDB,
children and adults understanding of medical patient with SDB in and disorders of initiating
• Demonstrates beginning treatments, role of complicated patient and maintaining sleep
understanding of surveillance, and alternate populations • Teaches T&A and
treatment measures therapies • Performs T&A and palatopharyngoplasty
• Performs tonsillectomy • Performs palatopharyngoplasty on
and/or adenoidectomy palatopharyngoplasty on complex patients
(T&A) on typical pediatric typical patient • Recognizes and is able to
or adult patient • Lists rare complications; treat and/or develop
• Lists common potential recognizes common treatment plan for
complications complications and is able common and uncommon
to initiate treatment in the complications in the
typical patient complex patient
Comments:
Facial Trauma — Patient Care

• Obtains history and • Recognizes symptoms of • Obtains focused history and • Interprets appropriate lab • Develops appropriate
performs basic physical mandible and facial performs focused exam, and radiologic studies; treatment plan for
exam fractures; able to quickly including airway evaluation identifies and orders panfacial fracture patient
• Demonstrates basic assess airway, breathing, and survey for other head necessary adjunctive • Performs revision/infected
knowledge of normal and circulation (ABC's) and and neck injuries; orders studies (i.e., angiography) mandibular fracture ORIF
facial skeleton and need for urgent intervention appropriate routine lab and • Accurately diagnoses • Treats complex
relationships • Localizes zones of the radiologic studies location and extent of complications
• Demonstrates limited traumatically involved facial • Identifies common facial specific facial trauma
knowledge of treatment skeleton (i.e., frontal, orbital, skeleton fracture patterns • Develops appropriate
options midface, and mandible) • Discusses appropriate treatment plan and
• Knows how to scrub; using detailed familiarity therapeutic options for performs ORIF for a facial
Performs surgical time with normal facial boney and major facial fracture fracture patient with
out soft tissue anatomy types/patterns combined mandible and
• Demonstrates limited • Discusses treatment • Facile at placing maxillary- midface fracture
familiarity with modality options in general mandibular fixation (MMF) • Performs uncomplicated
complications terms; demonstrates limited and establishing baseline mandibular ORIF
knowledge of potential patient occlusion; able to • Recognizes and is able to
indications for operative perform surgical treat common
open reduction and internal approaches (location and complications
fixation (ORIF) of the extent) to visualize
spectrum of facial fractures fractures and provide
• Demonstrates beginning adequate exposure for ORIF
ability to apply maxillo- • Recognizes common
mandibular fixation complications; makes
hardware and to perform appropriate consultations
intraoral and external for patient management
incisions
• Lists some potential
complications
Comments:
Rhinosinusitis — Patient Care

• Obtains basic sinonasal • Obtains focused history • Performs nasal endoscopy • Identifies nasal endoscopic • Teaches nasal endoscopy
symptom history and and physical, including and recognizes basic pathologic findings in the • Recognizes and diagnoses
performs basic head and detailed sinonasal sinonasal pathology; previously operated the possible uncommon
neck exam symptom inventory demonstrates basic patient; facile with etiologies of chronic
• Recognizes symptoms • Explains the diagnostic understanding of interpretation/use of bacterial sinusitis
that indicate sinonasal distinction between viral appropriate laboratory, appropriate laboratory, refractory to standard
pathology upper respiratory pathologic, and radiologic pathologic and radiologic therapy
• Demonstrates minimal infections (URI) and acute diagnostic studies diagnostic studies • Provides treatment of
knowledge of treatment bacterial sinusitis • Provides a differential • Distinguishes the recurrent/extensive
options • Discusses treatment diagnosis that includes the pathophysiologic and frontal sinus disease
• Performs surgical time modality options in general most common spectrum of clinical presentations of • Performs revision and
out; familiar with pre-op terms; prescribes medical bacterial sinusitis disease the various subtypes of advanced endoscopic
documentation therapy for simple processes chronic rhinosinusitis sinus surgery
requirements (e.g., common conditions (i.e., • Discusses appropriate • Formulates appropriate • Treats complex
consent, history and viral URI, acute bacterial therapeutic options for treatment plan for patient complications
physical, imaging) Knows rhinosinusitis [ABRS]) chronic rhinosinusitis (CRS) with acute exacerbations
how to scrub • Performs intra-operative and chronic rhinosinusitis of CRS or recurrent
• Lists some complications patient nasal decongestion with nasal polyps (CRSNP) polypoid disease; tailors
of rhinosinusitis and local injections under • Performs endoscopic sinus medical therapy to
endoscopic guidance; able surgery (ESS) procedure patient's symptoms level
to apply/register with guidance; recognizes and disease presentation
stereotactic surgical endoscopic surgical • Completes ESS procedure
guidance system landmarks with oversight
• Lists some potential • Recognizes common • Recognizes and is able to
complications of sinus complications; appropriate treat and/or develop
surgery management for common treatment plan for
complications significant complications
Comments:
Nasal Deformity — Patient Care

• Obtains basic history and • Obtains focused history and • Performs limited dynamic • Performs comprehensive • Performs analysis in
performs basic head and physical nasal function analysis and dynamic nasal function revision/post-surgical
neck exam • Demonstrates anterior rhinoscopy analysis; identifies setting
• Demonstrates minimal understanding of normal • Differentiates between aesthetic/cosmetic • Formulates appropriate
knowledge of treatment nasal physiology variable and fixed nasal abnormalities; correlates treatment plan for patient
options • Discusses treatment obstruction contributors examination findings with requiring revision surgery
• Performs surgical time out; modality options in general • Discusses appropriate underlying structural • Performs revision
knows how to scrub terms; prescribes medical therapeutic options for etiologies rhinoplasty, including
• therapy for simple common common nasal deformities • Identifies specific harvest and placement of
condition • Plans and performs components of nasal graft material
• Prepares patient intra- incisions that would be pathophysiology in • Performs revision septal
operatively needed for both intranasal functional obstruction surgery, including
• Plans, performs, and closes and external rhinoplasty; • Formulates appropriate correction of complex
incisions that would be cognizant of landmarks that treatment plan for patient septal abnormalities
needed for adequate mark important with fixed and/or dynamic • Treats complex
exposure; able to intra- neurovascular structures nasal obstruction complications
operatively prepare patient • Elevates septal mucosal • Resects or augments bony
(i.e., pack nose with flaps adequately to address or cartilaginous framework,
decongestant pledgets, identified structural places and secure grafting
inject nose with local abnormalities material, and performs
anesthetic) • Recognizes common osteotomies
• Demonstrates limited complications • Resects, recontours, and
knowledge of potential corrects septal
complications abnormalities
• Recognizes and is able to
treat and/or develop
treatment plan for common
complications
Comments:
Chronic Ear — Patient Care

• Performs general history • Obtains pertinent • Performs reliable • Accurately interprets • Interprets less
and physical otologic history and otomicroscopic exam; orders appropriate diagnostic commonly utilized
• Knows some common performs hand-held appropriate audiometry, studies; understands the diagnostic tests
symptoms of ear otoscopy; differentiates laboratory, and radiologic indications for operative • Manages chronic otitis
infections middle ear/mastoid studies intervention; recognizes media in an only hearing
• Demonstrates limited disease from otitis • Clinically differentiates otitis acute complications in the ear
knowledge of chronic externa; performs cranial media (OM), otitis externa setting of COM • Performs canal wall
ear disease nerve exam (OE), necrotizing OE, chronic • Understands mechanisms down mastoidectomy
• Demonstrates little • Identifies Eustachian otitis media (COM), underlying the skillfully; able to
knowledge of tube (ET) dysfunction and mastoiditis, and development of proficiently perform
medical/surgical the normal and abnormal cholesteatoma intratemporal and facial recess approach
treatments for ear physiologic contributors • Recognizes clinical failure of intracranial complications • Treats major post-
disease • Prescribes appropriate medical management; of chronic ear disease surgical complications
• Knows how to scrub; systemic and/or topical describes surgical risks, • Formulates appropriate
performs surgical time antibiotic therapy for benefits, and alternatives; treatment plan for care of
out; maintains sterile chronic otitis media; understands concept of a patient with
field understands basics of recidivism and understands complications of chronic
post-operative wound need for long-term ear disease
care surveillance plan • Removes granulation tissue
• Positions, preps, and • Performs ear canal incisions and/or cholesteatoma from
drapes patient; able to and elevates tympanomeatal the middle ear/mastoid;
inject local anesthetic; flap; performs cortical skeletonizes vertical
makes post-auricular mastoidectomy and segment of the facial
incision; able to identifies antrum/horizontal nerve; performs
aesthetically close wound semicircular canal; tympanoplasty and/or
• Lists potential skeletonizes posterior canal ossiculoplasty
complications of ear wall • Recognizes major
surgery • Able to manage routine post- complications
operative complications
Comments:
Pediatric Otitis Media — Patient Care

• Performs basic history • Performs focused clinical • Performs pneumatic • Skilled pneumatic • Skilled pneumatic
and physical examination examination and is able to otoscopy and accurately otoscopist in children of all otoscopist in syndromic
• Understands concept of correctly diagnose acute diagnose acute OM, OM ages; recognizes children
OM and OE OM, OM with effusion, and with effusion, and OE; complications of acute • Places tympanostomy tube
• Participates in surgical OE some of the time; knows knows when additional OM, OM with effusion, and safely in patients with
time out when to order basic imaging is required for OE difficult anatomy
audiometric testing diagnosis • Diagnoses intra- and
• Describes the etiologic • Accurately diagnoses extracranial complications
organisms most commonly patients along the OM of ear infections
associated with OM and OE; natural history spectrum • Treats complications of ear
understands the and identifies ramifications infections
predisposing factors of treated/untreated OM • Places tympanostomy tube
associated with each type of • Recognizes treatment safely in all patients with
ear infection failures/refractoriness and easy anatomy and in some
• Appropriately prescribes indications for surgical patients with difficult
topical and/or oral intervention anatomy
antibiotics for ear • Identifies tympanic • Recognizes and is able to
infections; demonstrates membrane and external treat and/or develop
familiarity with auditory canal (EAC) treatment plan for
effectiveness/ landmark and structures; common complications
ineffectiveness of non- able to consistently
antibiotic medications and perform appropriate
alternative treatments myringotomy
• Inserts ear speculum and • Recognizes common
safely cleans cerumen from complications; obtains
ear canal appropriate consultations
• Lists potential complications for patient management
Comments:
Upper Aerodigestive Tract (UADT) Malignancy — Medical Knowledge

• Demonstrates basic • Demonstrates moderate • Demonstrates proficient • Correlates anatomic • Gives lectures on anatomy
understanding of UADT knowledge of UADT and knowledge of normal knowledge with disease • Articulates treatment
and neck anatomy neck anatomy; teaches anatomy; teaches anatomy physical examination (PEx) protocol specifics for
• Knows normal UADT anatomy to medical to junior residents in the OR and radiologic findings primary chemoradiation
function (mastication, students in the operating • Knows major risk factors for • Understands molecular basis therapy
deglutition, respiration, room (OR) UADT cancer according to for UADT cancer; knows
and phonation) • Knows abnormal UADT type of cancer benign and malignant
• Obtains basic history and physiologic function and • Knows most common differential diagnoses of
physical locoregional disease progression routes common site presentations
manifestations; knows for UADT malignancy • Knows staging system for
tobacco is correlated with • Interprets appropriate lab, most common UADT cancers,
UADT cancer pathologic, and radiologic and can accurately stage
• Knows most common studies using available clinical and
disease state presentations • Understands concepts of radiologic data
for UADT malignancies neo-adjuvant, primary, and • Understands the prognostic
• Performs focused history adjuvant treatments; indicators of tumor
and physical, including describes options for pathology, including
clinic laryngoscopy; securing the difficult airway molecular markers
understands appropriate in the OR • Describes treatment options
labs, FNA, and radiologic based on primary site,
studies for workup disease stage, and patient
• Describes basic treatment factors
algorithm for UADT
malignancies
Comments:
Hearing Loss — Medical Knowledge

• Demonstrates limited • Demonstrates proficient • Demonstrates proficient • Understands congenital • Demonstrates knowledge
knowledge of temporal knowledge of temporal knowledge of normal variations of temporal of central auditory
bone and bone and temporal bone and bone and pathways
cochleovestibular cochleovestibular gross cochleovestibular cochleovestibular anatomy
anatomy anatomy/embryology histopathology • Generates differential
• Demonstrates limited • Understands normal • Generates differential diagnosis for hearing loss
understanding of the middle ear mechanics diagnosis for hearing loss in children, and identifies
physiology of hearing and cochlear physiology in adult patients uncommon causes of
• Demonstrates limited • Understands the natural • Understands the natural hearing loss in adults
understanding of the history of presbycusis history of adult onset • Understands the natural
natural history of hearing and noise-induced hearing loss history of pediatric hearing
loss hearing loss • Recognizes an abnormal loss and uncommon
• Recognizes normal ear ear exam/audiogram; causes of adult-onset
exam and normal orders appropriate hearing loss
audiometry; able to routine audiometric, • Considers unusual causes
identify basic hearing loss laboratory, and imaging for hearing loss and
classifications on an tests for work-up orders/interprets
audiogram; demonstrates • Demonstrates appropriate advanced
limited knowledge of comprehensive audiometric, laboratory,
options for diagnostic awareness of aural and imaging studies
work-up of hearing loss rehabilitation options, • Describes indications/
• Demonstrates awareness including surgical contraindications and
of non-surgical aural management of hearing complications of the
rehabilitation options; loss surgical aural
understands importance rehabilitation techniques;
of hearing surveillance tailors aural rehabilitation
to patient-specific needs
Comments:
Dysphagia-Dysphonia — Medical Knowledge

• Demonstrates limited • Understands basic • Demonstrates mid-level • Demonstrates thorough • Teaches pathophysiology
understanding of anatomy and physiology understanding of anatomy knowledge of anatomy and
aerodigestive functional of voice and swallowing and physiology of voice and physiology of voice and
anatomy • Demonstrates basic swallowing swallowing
• Demonstrates limited understanding of • Demonstrates mid-level • Demonstrates comprehensive
understanding of common voice and understanding of common understanding of most voice and
common voice and swallowing disorders voice and swallowing swallowing disorders, including
swallowing disorders • Understands age-related disorders voice and swallowing
• Demonstrates limited changes to voice and • Demonstrates knowledge manifestations of systemic
knowledge of disease swallowing of disease progression and diseases (i.e., autoimmune
progression and sequelae • Obtains focused history sequelae of untreated disorders, sarcoid,
of untreated voice and and physical, including voice and swallowing neuromuscular disorders)
swallowing disorders clinic laryngoscopy; able disorders • Articulates comprehensive
• Obtains basic history and to list appropriate • Interprets appropriate lab, understanding of risk factors and
physical diagnostic modalities for pathologic, and radiologic timeframe for malignant
• Demonstrates minimal work-up of voice and studies transformation of premalignant
understanding of swallowing disorders • Demonstrates mid-level conditions (laryngopharyngeal
treatment options and • Demonstrates beginning understanding of reflux disease [LPRD], Barrett's,
rationales, and understanding of treatment options and Dysplasia/Leukoplakia, recurrent
risks/benefits of each treatment options and rationales, and respiratory papillomatosis [RRP])
treatment option rationales, and risks/benefits of each • Correlates laboratory and
risks/benefits of each treatment option radiologic work-up with clinical
treatment option diagnosis
• Demonstrates understanding of
treatment options and
rationales, risks/benefits of each
treatment option, and
surveillance algorithms for
malignant disease
Comments:
Inhalant Allergy — Medical Knowledge

• Demonstrates familiarity • Demonstrates basic • Demonstrates knowledge • Demonstrates thorough • Demonstrates advanced
with basic nasal anatomy understanding of of histopathology of understanding of anatomic understanding of allergy
and normal respiratory derangements in nasal allergic rhinitis and impact of allergic diagnostic testing
mucosa histology anatomy and mucosal anatomic factors affecting inflammation on the nasal • Is facile with multiple
• Demonstrates familiarity inflammation the nasal airway airway methods of
with normal functions of • Knows pathophysiology • Knows pathophysiology • Distinguishes immunotherapy
nasal mucosa and nasal of allergic rhinitis (AR) of non-allergic rhinitis presentations of allergic
cavities • Describes comorbidities • Describes the natural and non-allergic rhinitis
• Demonstrates limited in AR history and components patients; demonstrates
knowledge of allergy • Demonstrates familiarity of severity in allergic knowledge of cellular and
work-up with clinical presentations disease molecular features of
of allergic disease • Demonstrates knowledge inhalant allergy
• Prescribes basic medical of testing methods in • Describes systems for AR
treatment for AR allergic disease subtype and severity (e.g.,
• Prescribes advanced seasonal vs. perennial,
medical treatment for intermittent vs. persistent,
allergic disease etc.) and incorporates
knowledge of severity and
natural history into patient
management
• Combines clinical features
and test results to
correctly diagnose allergic
disease
• Demonstrates a working
knowledge of
immunotherapy for
allergic disease
Comments:
Patient Safety — Systems-based Practice

• Understands the need • Participates in the use of • Consistently uses tools • Advocates for quality • Educates other services
for formal patient safety tools to prevent adverse to prevent adverse patient care and optimal re patient safety issues
measures (e.g., surgical events (e.g., checklists events (e.g., checklists patient care systems in otolaryngology head
time out) and briefings) and briefings) • Analyzes M&M findings and neck surgery OHNS
• Understands and uses • Identifies potential and provides feedback
chain of command to patient safety issues to improve patient
develop and implement (patient positioning in safety
patient care plans OR, aspiration risk) and
(junior to senior resident means to prevent those
to attending) problems
• Presents at morbidity
and mortality (M&M)
conference (organizes
data and identification
of some pertinent
patient safety issues)
Comments:
Resource Utilization — Systems-based Practice

• Uses resources (social • Actively functions as • Incorporates cost issues • Practices cost-effective • Designs measurement
work, patient care part of an inter- into care decisions care (e.g., managing tools to monitor and
manager) to coordinate disciplinary team to care • Contributes to length of stay, operative provide feedback to
patient care for patients leadership of the efficiency) providers/teams on
• Aware of socio- interdisciplinary care • Leads interdisciplinary resource consumption
economic issues in team team in patient care to facilitate
patient care and takes • Uses technology and improvement
those into consideration other hospital/clinic
when developing patient resources in patient care
care plans
Comments:
The ability to investigate and evaluate the care of patients, to appraise and assimilate scientific evidence, and to continuously improve
patient care based on constant self-evaluation and life-long learning — Practice-based Learning and Improvement

• Is aware of one’s own • Continually seeks and • Demonstrates • Demonstrates consistent • Is competent at
level of knowledge and incorporates feedback improvement in clinical behavior of performing meta-
uses feedback from to improve performance thought and action incorporating evidence- analyses to answer
teachers, colleagues, • Develops a learning plan based on continual self- based information in complex patient care
and patients and uses published assessment common practice areas questions
• Identifies learning review articles and • Selects an appropriate • Organizes educational • is a sophisticated user of
resources guidelines evidence-based activities at the program learning resources
information tool to level
answer specific
questions
Comments:
Professionalism

• Demonstrates behavior • Is aware of ethical issues • Recognizes ethical issues • Analyzes and manages • Helps lead institutional
that conveys caring, in patient care, including in practice and is able to ethical issues in and organizational ethics
honesty, and genuine issues of autonomy, discuss, analyze, and complicated and programs
interest in patients and end-of-life care and manage common ethical challenging situations
families research ethics situations • Develops a mutually
• Exhibits professional • Recognizes individual • Displays sensitivity and agreeable care plan in
behavior (e.g., reliability, limits in clinical responsiveness toward the context of conflicting
industry, integrity, and situations and asks for all patient populations physician and patient
confidentiality) assistance when needed values and beliefs
• Maintains respect for • Understands and
patient confidentiality manages the issues
related to fatigue and
sleep deprivation
• Completes paperwork,
administrative tasks and
assignments in a timely
manner
Comments:
Interpersonal Communication Skills

• Develops a positive • Effectively • Sustains effective • Develops working • Develops
relationship with communicates during relationships with relationships across models/approaches to
patients and transitions of care services requesting specialties and systems managing difficult
understands patients’ • Communicates with OHNS consultation of care communications
and families patients and families, • Works effectively as a • Organizes and facilitates • Coaches others to
perspectives taking into account the member of a health care family/health care team improve communication
• Utilizes interpreters as socioeconomic and team conferences skills
needed cultural backgrounds of • Uses multiple forms of
these individuals communication (e.g., e-
• Ensures that the medical mail, patient portal,
record is timely, social media) ethically
accurate, and complete and with respect for
patient privacy
Comments:

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The Otolaryngology Milestone Project: A Joint Initiative of

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The Otolaryngology Milestone Project

Chair: Terry Tsue, MD, FACS

Working Group Advisory Group

Level 1: The resident demonstrates milestones expected of an incoming resident.

Selecting a response box on the line in between levels

Salivary Disease — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Aerodigestive Tract Lesions (ADT) — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Sleep Disordered Breathing (SDB) — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Facial Trauma — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Rhinosinusitis — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Nasal Deformity — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Chronic Ear — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Pediatric Otitis Media — Patient Care

Level 1 Level 2 Level 3 Level 4 Level 5

Upper Aerodigestive Tract (UADT) Malignancy — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5

Hearing Loss — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5

Dysphagia-Dysphonia — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5

Inhalant Allergy — Medical Knowledge

Level 1 Level 2 Level 3 Level 4 Level 5

Patient Safety — Systems-based Practice

Level 1 Level 2 Level 3 Level 4 Level 5

Resource Utilization — Systems-based Practice

Level 1 Level 2 Level 3 Level 4 Level 5

Level 1 Level 2 Level 3 Level 4 Level 5

Level 1 Level 2 Level 3 Level 4 Level 5

Interpersonal Communication Skills

Level 1 Level 2 Level 3 Level 4 Level 5

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