Otolaryngology Residency Rotations

The PGY-1 year is structured as follows:

• Six months on the Otolaryngology service
• Two months on General Surgery service
• One month each on Anesthesia, ICU, Plastic Surgery, Radiology

During the Otolaryngology rotation, residents are taught the skills to perform complete head and neck examination including indirect laryngoscopy, rigid nasal endoscopy, fiberoptic laryngoscopy, microscopic otoscopy and pneumatic otoscopy. They obtain a general and a targeted history and physical exam through supervised patient encounters in the outpatient clinics, learn to present new and established patients in a concise and focused manner, and become adept at preoperative assessment and postoperative patient care.

First-year residents become familiar with the perioperative management of otolaryngology patients by participating on daily rounds with the team, assisting on a variety of operative cases, and helping with floor work and the resident clinic.

The non-otolaryngology rotations are designed to enhance the basic knowledge of the otolaryngologist-in-training, providing exposure to difficult airway management, critically ill patients, and patients undergoing odontogenic, cosmetic/reconstructive, and craniofacial procedures.

The second year of training is divided into equal rotations covering a variety of general otolaryngology, pediatric ENT, basic otology, and facial plastic surgery. While obtaining a solid core of “basic training,” residents are also exposed to several subspecialties in early training.

While working on the inpatient wards, junior residents are responsible for overseeing the perioperative inpatient care of the otolaryngology service. With guidance from senior and chief residents and the attending staff, they evaluate patients in the emergency department, the active surgical inpatient service, the intensive care unit, the step-down unit, and the general ward. They also manage the consultation service for bedside percutaneous, and operative tracheostomy, as well as the postoperative management of these patients. Basic airway management skills are taught in-depth during this year.

On the head and neck services, residents become familiar with the perioperative management of otolaryngology inpatients including: management of patients undergoing major head and neck surgery; treatment of hypo and hypercalcemia; management of complex wounds; diagnosis and treatment of salivary and chyle fistulae; management of nutritional and metabolic deficits; perioperative pharmacotherapy including antibiotics and analgesics; and management of electrolyte imbalances.

During this year, residents develop skills in interpretation of diagnostic medical imaging modalities including: plain radiography, computerized tomography, magnetic resonance imaging, positron emission tomography, and contrast studies of the aerodigestive tract. Residents also become familiar with other diagnostic modalities common to the evaluation of otolaryngology patients, such as audiology, vestibular testing, and electrophysiologic evaluation of the facial nerve.

The PGY-3 year is structured to allow exposure and additional training in the areas of general otolaryngology, head and neck surgery, and pediatric ENT. Residents deepen their understanding of disease states, as well as treatments for them. They also have increasing opportunity to perform surgical procedures ranging from endoscopic sinus, to pediatric airway, to endocrine (thyroid and parathyroid) surgery.

In addition to the clinical rotations, PGY3 residents are scheduled to spend 3 months performing a research rotation which is combined with clinical and surgical activities. Residents work with a faculty mentor to develop a question and a research design to answer it. They meet with a faculty research committee to help hone the study design and obtain institutional approval. Opportunities for clinical and basic research exist within the otolaryngology department, but there are also a wide variety of options in other departments including Immunology, Radiation Oncology, Neurosurgery, Plastic Surgery, Neurology.

During the PGY4 year, more advanced training takes place, particularly in the areas of facial plastic surgery, laryngology, rhinology and trauma. The PGY4 resident serves as the chief resident on the VA rotations, allowing them to gain valuable leadership and team management skills. During this year, many residents are able to complete basic graduation requirements in terms of “key indicator procedures” tracked by the ACGME. As such, PGY4 residents are able to complete the research projects initiated during the prior year, with a shorter dedicated rotation scheduled to allow for this. Clinically, they are able to explore areas of particular interest, and begin to map out plans for future training and career goals.

As chief residents in otolaryngology, PGY5’s take on more administrative responsibilities of managing the resident teams and inpatient services. Clinically and surgically, they are sharpening basic skills and developing more advanced techniques. We encourage chief residents to pursue particular areas of clinical interest, and acquire leadership skills to help them in their future careers.