GUIDELINES FOR COMPETENCY BASED

POSTGRADUATE TRAINING PROGRAMME FOR MS IN

OTORHINOLARYGOLOGY
Preamble:
The purpose of PG education is to create specialists who would provide high quality
health care and advance the cause of science through research & training.

The purpose of MS ENT is to standardize Otorhinolaryngology teaching at Post Graduate

level throughout the country so that it will benefit in achieving uniformity in
undergraduate teaching as well and resultantly creating competent ENT Surgeons with
appropriate expertise.

The purpose of this document is to provide teachers and learners illustrative guidelines to
achieve defined outcomes through learning and assessment. This document was prepared
by various subject-content specialists. The Reconciliation Board of Academic Committee
has attempted to render uniformity without compromise to purpose and content of the
document. Compromise in purity of syntax has been made in order to preserve the
purpose and content. This has necessitated retention of “domains of learning” under the
heading “competencies”.

SUBJECT SPECIFIC LEARNING OBJECTIVES

At the end of postgraduate training the student should be able to:

1. Practice his specialty ethically keeping in mind the requirement of the patient,
community and people at large.
2. Demonstrate sufficient understanding of basic sciences related to his specialty and
be able to integrate such knowledge in his Clinical practice.
3. Diagnose and manage majority of conditions in his specialty (clinically and with the
help of relevant investigations)
4. Plan and advise measures for the promotive, preventive, curative and rehabilitative
aspects of health and diseases in the specialty of ENT.
5. Should be able to demonstrate his cognitive skills in the field of ENT and its
ancillary branches during the formative and summative evaluation processes.
6. Play the assigned role in the implementation of National Health Programs
7. Demonstrate competence in basic concepts of research methodology and writing
thesis and research papers.
8. Develop good learning, communication and teaching skills.

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9. Demonstrate sufficient understanding of basic sciences and the clinical applications
related to the specialty to be able to integrate this knowledge into Clinical practice.
Acquire in-depth knowledge in the subject including recent advances.
10. Demonstrate that he is fully conversant with the latest diagnostics & therapeutics
available.

SUBJECT SPECIFIC LEARNING OBJECTIVES

1. Theoretical Knowledge:
A student should have fair knowledge of basic sciences (Anatomy, Physiology,
Biochemistry, Microbiology, Pathology and Pharmacology) as applied to ENT
and be able to integrate such knowledge in his clinical practice. She/He should
acquire in-depth knowledge of his subject including recent advances. She/He
should be fully conversant with the bedside procedures (diagnostic and
therapeutic) and having knowledge of latest diagnostics and therapeutics
available.

2. Clinical / Practical skills:

A student should be adept at good history taking, physical examination, providing
basic life support and advanced cardiac life support, common procedures like
FNAC, Biopsy, aspiration from serous cavities, lumber puncture etc. She/he
should be able to choose the required investigations to enhance the attitude,
communication skills, including dealing with patient’s relatives with the required
empathy, adapt to changing trends in education, learning methods and evolving
new diagnostic and therapeutic techniques in the subject of ENT.

3. Research:
She/He should know the basic concepts of research methodology, plan a research
project, plan and write a thesis and should know how to use library facilities.
Basic knowledge of statistics is also required. Knowledge about use of internet
resources is required.

4. Teaching:
The student should learn the basic methodology of teaching and assessment and
develop competence in teaching medical/paramedical students and their
assessment.

SUBJECT SPECIFIC COMPETENCIES

A. Cognitive Domain

At the end of training, the student should be able to demonstrate ability to

practically apply knowledge gained during training period. This would include the
following:

Basic Sciences related to Otolaryngology

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 Physiology- Mechanism of perception of smell and taste, mechanism of breathing
and voice production, lacrimation, deglutition and salivation. Functional tests of
the nose and paranasal sinuses, mechanism of cough and sneezing.
 Physics of sound, theories of hearing, mechanism of perception of sound and
speech production, physiology of equilibrium and cerebral function. Physiology
of brain in connection with hearing, speech, smell and phonation. Audiologic
tests like audiometry, impedance, evoked potentials, OAE, Speech audiometry.
 Physiology of larynx, tracheobronchial tree and oesophagus - Histology of
mucous membranes, internal ear and other associated organs and structures, nose,
PNS NPx, Larynx, Tracheo-Bronchial tree, Lymphoepithetical system.
Mechanism of immune system/immunology and genetics.
 Anatomy-Embryogenesis of ear, nose and throat including palate and the larynx,
Oesophagus, trachea and lungs, tongue, salivary gland Head and Neck and skull
base etc.
 Parapharyngeal spaces in the neck including connective tissue barriers of larynx.
 Applied anatomy of the skull bones, accessory sinuses, external, middle and inner
ears, nose, PNS, nasopharynx, meninges, brain, pharynx, larynx, trachea and
bronchi, lungs, pleurae, oesophagus and the mediastinum.
 Anatomy of all cranial nerves with their functions.

Principles and Practices of Otolaryngology, Audiology and Speech Pathology

 Clinical Methodology as applied to ORL HN diseases in adult and children and

the accessory sinuses, diagnosis and surgical treatment of diseases of nose, throat
and ear in adult and children. Prevention and treatment, infectious diseases of
Otolaryngology and Head Neck region. Circulatory and nervous disturbances of
the nose, throat and ear and their effects on other organs of the body.
Deformities, injuries sinus infections, polyps and the tumors of the nose, and
paranasal sinuses.
 Examination of the ear, deafness and allied diseases, complications of diseases of
the ear. Injuries, tumors, nervous and circulatory neurological disturbances of the
ear. Diagnosis and treatment of tinnitus and vertigo. Diagnosis and rehabilitation
of the Hearing handicapped including, dispensing of hearing aid other vibrotatile
aids.
o Surgical pathology of Otolaryngology and Head Neck region.
o Basic knowledge of anaesthesia as related to ENT.
o Examination of diseases of children (Paediatric ORL) in connection
with throat and larynx. Neurological and vascular disturbances.
Congenital and neonatal stridor.
o Pathology of various diseases of the larynx and throat, tracheo-
bronchial tree and their causative organisms.

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 o Indications and various techniques of direct laryngoscopy, nasal
endoscopy. Bronchoscopy and oesophagoscopy, including
microlaryngoscopic procedures.
o Reading of radiograms, scans, audiograms, nystagmograms and
tympanograms in connection with ENT diseases/disorders.
o Special apparatus for the diagnosis and treatment of the diseases of ear,
nose and throat including audiometer, BERA, Speech analyser etc.

Recent advances in Otolaryngology and Head Neck surgery

 Recent developments in the diagnosis, pathogenesis and treatment of the ENT

diseases
 The knowledge of the frontiers of the oto-laryngology and lateral skull base
surgery
 Rhinoplasty, endoscopic sinus surgery, and anterior cranial fossa surgery
 Knowledge of LASERS and fibre optics
 Other methods of managing Hearing loss
 Implantable hearing aids cochlear implants
 Phonosurgery
 Etiology and Managements of sleep apnoea/snoring
 Hypophysectomy and optic nerve decompressions
 Immunotherapy and modalities of the gene therapy
 Newer techniques for Radiotherapy including, use of gamma knife for treatment
of Intracranial tumors and other malignancy
 Chemotherapy of cancer

General Surgical Principles and Head-Neck Surgery

 General Surgery, Head and Neck oncology, and Medicine as applicable to the
ENT disorders/diseases. Surgery of congenital deformities of nose, ear (Pinna)
and trachea/oesophagus etc.
 Radiology, Imaging – computed tomography and magnetic resonance imaging,
(MRI) and intervention radiology and angiography as related to ENT
 General Pathologic aspects such as wound healing and also pathology and
Pathogenesis of ENT diseases, Pharmacology, molecular biology, genetics,
cytology, haematology, and immunology as applicable to otolaryngology
 General Principles of faciomaxillary traumatology and neck injury
 Plastic Surgery as applicable to Otolaryngology

B. Affective Domain

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1. The student will show integrity, accountability, respect, compassion and dedicated
patient care. The student will demonstrate a commitment to excellence and
continuous professional development.
2. The student should demonstrate a commitment to ethical principles relating to
providing patient care, confidentiality of patient information and informed consent.
3. The student should show sensitivity and responsiveness to patients’ culture, age,
gender and disabilities.
4. The student should be able to choose the required investigations to enhance the
attitude, communicative skills, including dealing with patient’s relatives with the
required empathy, adapt to changing trends in education, learning methods and
evolving new diagnostic and therapeutic techniques in the subject of ENT.

C. Psychomotor Domain

By the end of the training, a student should be able to demonstrate his skills in:

 Taking a good history and demonstrating good examination techniques.

 arrive at a logical working diagnosis, differential diagnosis after clinical
examination and order appropriate investigations keeping in mind their relevance
(need based) and thereby provide appropriate care that is ethical, compassionate,
responsive and cost effective and in conformation with statutory rules.
 Should be able to perform and demonstrate the practical skills in the field of ENT
including the following:
o Examination of the ear, nose and throat oral cavity examination
o Clinico-physiological examination and evaluation of the audio-vestibulo
neurological system
o Examination of the larynx and the throat including flexible endoscopy,
stroboscopy, voice analysis and the clinico-physiological examination of
the speech
o Examination of the otological and audiological system including Tuning fork
testing, audiological evaluation, micro and otoendoscopy
o Clinical and physiological evaluation of the nose and paranasal sinuses
including nasal endoscopy and olfactory evaluation
o Examination of the neck and its structures
 Should demonstrate and perform various therapeutic skills related to the
speciality such as :
 Tracheostomy
 Anterior/ posterior nasal packing
 Ear Packing and Syringing
 Foreign body removal from air nose and throat

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  Airway management including basic life support skills, Cardiopulmonary
resuscitation, intubation, homeostasis maintenance, IV alimentation and
fluid, electrolyte maintenance and principles of blood transfusion
alimentation including Nasogastric feeding, gastrostomy
 Wound suturing, dressings and care of the wounds
 Basic principles of rehabilitation
 common procedures like FNAC, biopsy, aspiration from serous cavities,
lumber puncture etc.
 Should understand principles of and interpret X-rays/CT/MRI, audiograms,
ENG, BERA, OAE, ultrasonographic abnormalities and other diagnostic
procedures in relation to the speciality
 Should have observed/performed under supervision the various surgical
procedures in relation to the speciality

Syllabus
Course contents:

1. Anatomy and Physiology of Ear, Nose and Throat, Trachea and esophagus.
2. The generation and reception of speech
3. Radiographic anatomy of the ear, nose, throat and imaging.
4. Bacteriology in relation to Otorhinolaryngology
5. Allergy and rhinitis
6. Haematology in relation to Otolaryngology
7. Anaesthesia for Otolaryngology
8. Pharmacology of drugs used in ENT
9. Electrolyte, fluid balance/shock conditions
10. Use of teaching aids
11. Routine blood, urine testing
12. Preparation of slides
13. Facial nerve stimulation test
14. Audiometric tests like pure tone Audiometry, Impedance Audiometry, Free field
Audiometry, Specialized tests of hearing including SISI, Tone decay, ABLB,
Speech discrimination score etc.
15. Vestibular tests like caloric testing (Water and Air) stopping test, Fukuda’s test,
16. Evoked response audiometry.

Ear:

1. The physical and functional examination of the ear

2. The functional and physical examination of the vestibular system.
3. Tinnitus
4. Affections of external ear
5. Repair of deformities of the external ear.

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 6. Congenital conditions of the middle ear cleft
7. Traumatic conductive deafness
8. Acute inflammation of the middle ear cleft
9. Non-suppurative otitis media
10. Chronic suppurative otitis media
11. Management of chronic suppurative otitis media
12. Complications of infections of middle ear.
13. Tumors of the middle ear cleft and temporal bone
14. Diseases of the otic capsule-otosclerosis
15. Diseases of the otic capsule-other diseases
16. The deaf child
17. Acoustic neuroma
18. Ototoxicity
19. Presbycusis
20. Diagnosis and management of sudden and fluctuant sensorineural hearing loss
21. Meniere’s disease
22. Neurologic aspects of vertigo
23. Facial paralysis
24. Rehabilitation of adults with acquired Hearing loss-Hearing aids
25. The cochlear Implants
26. Nystagmus
27. Otoacoustic emissions

Nose:

1. Examination of the nose

2. Conditions of the external nose
3. Injuries of the facial skeleton
4. Congenital diseases of the nose
5. The nasal septum
6. Foreign bodies in the nose, rhinolith
7. Epistaxis
8. Acute chronic inflammations of the nasal cavities
9. Vasomotor rhinitis-allergic and non-allergic
10. Nasal polyposis
11. Abnormalities of smell
12. Acute sinusitis
13. Chronic sinusitis
14. Nasal Allergy/Fungal allergic sinusitis
15. Complications of acute and chronic sinusitis
16. Tumors of nose and sinuses
17. Facial pains
18. Trans-ethmoidal hypophysectomy

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 19. Functional endoscopic sinus surgery (FESS)

Throat:

1. Methods of examination of the mouth and pharynx

2. Diseases of the mouth
3. Diseases of the salivary glands
4. Pharyngeal lesions associated with general diseases
5. Diseases of the tonsils and adenoids (excluding neoplasms)
6. Tumors of the pharynx
7. Hypopharyngeal diverticulum (Pharyngeal Pouch)
8. Methods of examining and larynx and tracheobronchial tree
9. Congenital diseases of the larynx
10. Laryngeal disorders in singers and other voice users
11. Neurological affections of larynx and pharynx
12. Intubation of the larynx, laryngotomy and tracheostomy
13. Cervical node dissection
14. Skin grafts in Otolaryngology and reconstructive methods including regional and
distant flaps for repair of defects after excision of tumors or trauma.
15. Micro laryngeal surgery/thyroplasty

Miscellaneous and head and neck:

1. Cranial nerves
2. Raised intracranial tension-causes, diagnosis, management with particular
reference to otitis hydrocephalus
3. Head injuries and I.C. Haemorrhage
4. Pituitary gland, anatomy, physiology hypo - and hyper - pituitarism, new growths.
5. Intracranial venous sinuses and their affections
5. Osteology: skull, mandible cervical and thoracic vertebral sternum
6. Cervical fascia, facial spaces in neck, retro-pharyngeal and parapharyngeal
Abscesses
7. Anatomy and physiology of thyroid gland, goitre, diseases of the thyroid and
carcinoma of thyroid
8. Large blood vessels in neck, thoracic duck development of major cervical and
thoracic blood vessels.
9. Head and neck reconstructive surgery

Drugs used in ENT:

1. Antibiotics Antihistaminic
2. Nasal vasoconstrictors
3. Local anaesthetics
4. Corticosteroids

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 5. Cyto-toxic agents
6. Antibiotics
7. Radioactive isotopes
8. Antifungal agents
9. Vasopressive and other agents used in shock like states.

General:

1. Physiology of circulation, regulation of blood pressure, reactions of body to

haemorrhage, patho-physiology of shock, fluid balance, blood transfusion and its
hazards, fluid replacement therapy, burns
2. Agents used in shock like states

Desirable

1. The ears and nasal sinuses in the aerospace environment

2. Physiological consideration of pressure effects on the ear and sinuses in deep
water diving
3. The principles of cancer immunology with particular reference to head and neck
cancer
4. Principles of chemotherapy in head and neck cancer
5. Recording of nystagmus by ENG and its interpretation

Ear:

1. Traumatic lesions of the inner ear

2. Inflammatory lesions of the vestibular and auditory nerve
3. Vascular lesions of the inner ear
4. Electronystagmography
5. Skull base/Neurologic surgery

Nose:
1. Cosmetic surgery of the nose
2. Non-healing granuloma of the nose
3. Surgery of the pterygopalatine fossa
4. LASER Surgery

Throat:
1. Oesophageal conditions in the practice of ear, nose and throat surgery
2. Disorders of speech
3. Lower respiratory conditions in Otolaryngology

Miscellaneous and head and neck

1. Functional Anatomy of cerebellum and brainstem

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 2. Anatomy of mediastinum
3. Pleura, plural cavity, broncho-pulmonary segments and their clinical importance
4. Facial plastic surgery

TEACHING AND LEARNING METHODS

Teaching methodology

Didactic lectures are of least importance; small group discussion such as seminars,
journal clubs, symposia, reviews and guest lectures should get priority for theoretical
knowledge. Bedside teaching, grand rounds, structured interactive group discussions and
clinical demonstrations should be the hallmark of clinical/practical learning with
appropriate emphasis on e-learning. Student should have hand-on training in performing
various procedures and ability to interpret various tests/investigations. Exposure to newer
specialized diagnostic/therapeutic procedures concerning her/his subject should be given.
Self-learning tools like assignments and case-based learning may be promoted. Exposure
to newer specialized diagnostic/therapeutic procedures concerning ENT should be given.

1. Rotations:
 A major portion of posting should be in ENT Department. It should
include in-patients, out-patients, ICU, trauma, emergency room, specialty
clinics includingVertigo Clinic, Rhinology Clinic, Otology Clinic, Cancer
Clinic, Cadaveric dissection Lab, Audiology and speech therapy.
 Inter-unit rotation in the department should be done for a period of up to
one year.
 Rotation in appropriate related subspecialties for a total period not
exceeding 06 months.
2. Clinical meetings:
There should be intra- and inter- departmental meetings for discussing the uncommon
/interesting cases involving multiple departments.

3. Log book: Each student must be asked to present a specified number of cases for
clinical discussion, perform procedures/tests/operations/present seminars/review
articles from various journals in inter-unit/interdepartmental teaching sessions. They
should be entered in a Log Book. The Log books shall be checked and assessed
periodically by the faculty members imparting the training.
4. Thesis writing and research:
Thesis writing is compulsory.
5. The postgraduate students shall be required to participate in the teaching and training
programme of undergraduate students and interns.
6. A postgraduate student of a postgraduate degree course in broad specialities/super
specialities would be required to present one poster presentation, to read one paper at

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 a national/state conference and to present one research paper which should be
published/accepted for publication/sent for publication during the period of his
postgraduate studies so as to make him eligible to appear at the postgraduate degree
examination.
7. The student should know the basic concepts of research methodology, plan a research
project, be able to retrieve information from the library. The student should have a
basic knowledge of statistics.
8. Department should encourage e-learning activities.

During the training programme, patient safety is of paramount importance;

therefore, skills are to be learnt initially on the models, later to be performed under
supervision followed by performing independently; for this purpose, provision of
surgical skills laboratories in the medical colleges is mandatory.

ASSESSMENT

Assessment should be comprehensive & objective. It should address the stated

competencies of the course. The assessment needs to be spread over the duration of the
course.

FORMATIVE ASSESSMENT, i.e., assessment during the training would include:

Formative assessment should be continual and should assess medical knowledge,
patient care, procedural & academic skills, interpersonal skills, professionalism, self
directed learning and ability to practice in the system.

General Principles

Internal Assessment should be frequent, cover all domains of learning and used to
provide feedback to improve learning; it should also cover professionalism and
communication skills. The Internal Assessment should be conducted in theory and
clinical examination.

Quarterly assessment during the MS training should be based on following

educational activities:

1. Journal based / recent advances learning

2. Patient based /Laboratory or Skill based learning
3. Self directed learning and teaching
4. Departmental and interdepartmental learning activity
5. External and Outreach Activities / CMEs

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The student to be assessed periodically as per categories listed in postgraduate
student appraisal form (Annexure I).

SUMMATIVE ASSESSMENT ie.,at the end of the training

The summative examination would be carried out as per the Rules given in
POSTGRADUATE MEDICAL EDUCATION REGULATIONS, 2000.

The examination will be in three parts:

1. Thesis
Every post graduate student shall carry out work on an assigned research project
under the guidance of a recognised Post Graduate Teacher, the result of which shall
be written up and submitted in the form of a Thesis. Work for writing the Thesis is
aimed at contributing to the development of a spirit of enquiry, besides exposing the
candidate to the techniques of research, critical analysis, acquaintance with the latest
advances in medical science and the manner of identifying and consulting available
literature.

Thesis shall be submitted at least six months before the Theory and Clinical /
Practical examination. The thesis shall be examined by a minimum of three
examiners; one internal and two external examiners, who shall not be the examiners
for Theory and Clinical examination. A candidate shall be allowed to appear for the
Theory and Practical/Clinical examination only after the acceptance of the Thesis by
the examiners.

2. Theory

The examinations shall be organised on the basis of ‘Grading’or ‘Marking system’ to

evaluate and to certify candidate's level of knowledge, skill and competence at the
end of the training. Obtaining a minimum of 50% marks in ‘Theory’ as well as
‘Practical’ separately shall be mandatory for passing examination as a whole. The
examination for MS shall be held at the end of 3rd academic year. An academic term
shall mean six month's training period.

Theory shall consist of four papers of 3 hours each.

Paper I: Basic Sciences related Otolaryngology
Paper II: Principles and Practices of Otolaryngology
Paper III: Recent advances in Otolaryngology and Head Neck surgery.
Paper IV: General Surgical Principles and Head-Neck Surgery.

3. Clinical / Practical and viva voce Examination

Clinical examination shall be conducted to test the knowledge, skills, attitude and
competence of the post graduate students for undertaking independent work as a

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 specialist/teacher, for which post graduate students shall examine a minimum one
long case and two short cases.

The Oral examination shall be thorough and shall aim at assessing the post graduate
student’s knowledge and competence about the subject, investigative procedures,
therapeutic technique and other aspects of the specialty, which form a part of the
examination.

Assessment may include Objective Structured Clinical Examination(OSCE).

Oral/Viva-voce examination needs to assess knowledge on X-rays, instrumentation,

operative procedures. Due weightage should be given to Log Book Records and day-
to-day observation during the training.

Recommended Reading:

Books (latest edition)

 Scott-Brown's Otorhinolaryngology and Head and Neck Surgery
 Cummings Otolaryngology - Head and Neck Surgery
 Otolaryngology, Otology &Neurotalogy by Paprella&Micheal
 Glasscock-Shambaugh'sSurgery of the Ear
 Essentials of Functional Sinus Surgery by Heinz Stammberger MD
 Color Atlas of Head & Neck Surgery by Jatin P Shah
 Handbook of Clinical Audiologyby Jack Katz

 Stell& Maran's Textbook of Head and Neck Surgery and Oncology

Journals
03-05 international Journals and 02 national (all indexed) journals

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 Annexure I
Postgraduate Students Appraisal Form
Pre / Para /Clinical Disciplines
Name of the Department/Unit :
Name of the PG Student :
Period of Training : FROM…………………TO……………
Sr. PARTICULARS Not Satisfactory More Than Remarks
No. Satisfactory Satisfactory
1 2 3 4 5 6 7 8 9
1. Journal based / recent
advances learning
2. Patient based
/Laboratory or Skill
based learning
3. Self directed learning
and teaching
4. Departmental and
interdepartmental
learning activity
5. External and Outreach
Activities / CMEs
6. Thesis / Research work
7. Log Book Maintenance

Publications Yes/ No

Remarks*______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
________________
*REMARKS: Any significant positive or negative attributesof a postgraduate student to be mentioned.
For score less than 4 in any category, remediation must be suggested. Individual feedback to
postgraduate student is strongly recommended.

SIGNATURE OF ASSESSEE SIGNATURE OF CONSULTANT SIGNATURE OF HOD

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