The first year of training is composed of six months of Otolaryngology and 6 months of non-Otolaryngology rotations. The non-otolaryngology rotations include: Neurosurgery, Anesthesiology, Critical Care Medicine (ICU), Thoracic Surgery, Plastic Surgery, and Vascular Surgery. Under the direct supervision of teaching staff, PGY-1 residents are involved in preoperative, intraoperative, and postoperative patient management. In general, we try to organize the PGY-1 schedule with the first half of the year composed of primarily non-otolaryngology rotations, and the bulk of the otolaryngology rotations in the second half of the year.
The progression of otolaryngology rotations in the PGY-1 year includes working one-on-one with faculty in the outpatient clinics, participating in all aspects of peri-operative care of patients on the inpatient otolaryngology service (at the UW Hospital and American Family Children’s Hospital), and taking part in a variety of surgical procedures. By the end of the first year of training, PGY-1 residents will be functioning at the level of a full-fledged otolaryngology junior resident – this includes operating with faculty, fielding consults in the Emergency Department and the inpatient wards, and joining the night float call schedule.
During the second year of specialty training, you’ll spend nine months on the inpatient, surgery, and clinical otolaryngology service.
On the UW service, you’ll be teamed with a PGY-3, PGY-4, and an otolaryngology chief resident. You’ll participate in patient care, including outpatient management in the resident clinic with supervision by the faculty, as well as in selected faculty clinics. You’ll be a part of the daily management of inpatients under the supervision of faculty and as a member of the four-resident team.
As a second-year otolaryngology resident, you’ll also see inpatient consultations initially and follow that with staffing by the faculty. A significant portion of the second year of specialty training is devoted to gaining operative experience in routine general otolaryngology procedures: tonsillectomy; adenoidectomy; myringotomy and tube placement; septoplasty; minor head and neck surgery; tracheostomy; and endoscopy. You’ll also function as an assistant to the chief resident and to the faculty in major head and neck, plastic reconstructive, and neurotologic cases.
In the first year of specialty training, you’ll participate in the preoperative evaluation as well as the surgical management, inpatient care, and postoperative follow-up of surgical patients in the clinic. You’ll also rotate through audiology, speech pathology, allergy immunology, sleep medicine and radiation oncology.
Audiology/Speech Pathology Month
During the audiology rotation, you’ll be familiarized with various aspects of audiologic evaluation, rehabilitative techniques, and special auditory procedures including performing pure-tone and speech evaluations. You’ll also be directly involved in the actual testing and interpretation of ENGs, ABRs and other evoked potentials. All through the audiology rotation, you will become better acquainted with electrocochleography, otoacoustic emissions, electroneuronography and pediatric audiologic techniques. You will be involved in all phases of diagnostic audiology and rehabilitation, including hearing aid evaluation, use of assistive listening devices, cochlear implant evaluation, and cochlear implant programming as well as post-therapy sessions. Reading assignments, articles, cases and discussion are provided to the PGY-2 and PGY-3 every three months on various audiological topics.
This one-month rotation is shared with the Speech Pathology and Voice Disorders Clinic. Speech pathology is now a second-year rotation in which the resident works closely with speech pathologists in a variety of hospital settings (otolaryngology, neurology, communicative disorders). In this rotation, you examine and observe patients with problems in speech, voice, language, and/or swallowing. You’ll become better acquainted with techniques for assessing, identifying, and treating these disorders, and learn the relationship between behavioral management and medical/surgical intervention. You’ll attend patient staffings and conferences, and observe various non-hospital services for these patients. Supplementary learning aids, including audiovisual aids, computer programs, and reading assignments, are available on selected topics concerning speech-language-voice-hearing disorders.
Allergy and Immunology/Sleep Medicine/Radiation Oncology Month (Includes Microsurgery)
During this rotation, you will work in the outpatient clinic as well as see inpatient consultations under the supervision of the faculty in the Division of Allergy and Immunology in the Department of Medicine. Allergy rotation consists of several weeks working in the Allergy and Immunology clinics at UW Hospital and Clinics and the VA Hospital. Time is also spent in the Pediatric Allergy Clinic.
During this month, you’ll see a variety of patients with allergic upper and lower respiratory problems. You’ll learn to manage such disorders as rhinitis, sinusitis, and asthma, all with a particular emphasis on pharmacotherapy. Each week, topics of relevance to allergy — with an occasional overlap to otolaryngology — are discussed, such as the approach to a patient with chronic steroid-dependent asthma and sinusitis. You also learn the intradermal and scratch test application and interpretation. The value and benefits of immunotherapy are also discussed, along with patient selection for this type of treatment.
During this month, you will also have a mini-rotation through the radiation oncology service under the direction of Dr. Paul Harari, a head and neck radiation oncology specialist. A reading list and formal training in the pretreatment and post treatment evaluation of the radiation oncology patient is provided. Intensive teaching in an outpatient setting includes consultation, treatment, planning and simulation, administration of therapy, physics, dosimetry, and post treatment follow-up. You’ll also take a one-week laboratory course with intensive instruction in microvascular and microneurosurgical technique in the Microsurgery Teaching Lab.
Throughout the second year on both clinical and surgical rotations as well as on the other three months previously described, you will participate in weekly Grand Rounds, Basic Sciences, and all other scheduled lectures, conferences, and workshops.
Responsibilities will increase in the inpatient and outpatient clinical setting as well as in the operating room during year 3. Specialty training will include three months on each of the following services: UW Hospital and Clinics Otolaryngology, William S. Middleton VA Hospital, Meriter Hospital, and dedicated research time.
During the three months you spend on the UW Hospital service, you will be involved in the management of outpatients and inpatients, and receive a progressive increase in operative experience. This includes basic ear surgery, such as tympanoplasty and canalplasty, as well as initiation in endoscopic sinus surgery. Outpatient responsibility is increased, and under supervision, you’ll work in the weekly resident clinic. During this year you will also gain increasing experience in head and neck surgery, including the performance of neck dissection and salivary gland surgery.
The three-month VA Hospital rotation provides you with broad experience, emphasizing head and neck surgery. Residents perform surgery at the VA Hospital on Tuesdays, Wednesdays and Thursdays. PGY-3s also work specifically with the chief resident in the care and management of patients in the outpatient VA clinics.
The intensive three-month research experience is based on a project initially approved by a faculty counselor and the research committee. Before beginning research, you will have planned a project in conjunction with one of the faculty members and will have completed an abstract, hypothesis, and literature review. At monthly Friday conferences, basic teaching in research methodology and analysis, including medical writing, ethics, biostatistics, and design, are presented. Each resident must present their prospective research project at the Resident Research Seminars. Each resident is expected to present and publish at least one paper during his or her residency experience.
Year 3 residents will also participate in the structured 12-session Temporal Bone Anatomy and Dissection course that is provided for both PGY-3 residents. This course provides didactic as well as hands-on training, emphasizing basic sciences, pathology, anatomy, and temporal bone surgical techniques. PGY-3 residents must demonstrate proficiency in the Temporal Bone Lab by midway through their third year of specialty training.
In addition to techniques in temporal bone dissection, all residents participate in cadaver dissections of the nose and paranasal sinuses utilizing endoscopic instruments. This dissection course takes place on an annual or biannual basis and involves the second- and third-year otolaryngology residents. Therefore, each resident will have at least two of these courses completed prior to beginning their final year of training. PGY-3 residents also participate in all Basic Science, Grand Rounds and weekly divisional conferences.
The PGY-4 residents spend nine months at UW Hospital and Clinics, and three months at Meriter Hospital.
During the rotations at UW and Meriter, you’ll have a very intensive operative experience involving all aspects of otolaryngology-head and neck surgery, including pediatric otolaryngology, endoscopic sinus surgery and otology as well as facial plastic and reconstructive surgery. In addition, you’ll be involved in the preoperative and postoperative care of surgical patients. The rotation through Meriter Hospital provides an excellent experience in the surgical management of patients with endocrine diseases, including thyroid and some parathyroid cases. While on Meriter rotation, PGY-4 residents also attend and participate in the outpatient facial plastics surgery clinic.
Your operative responsibilities are gradually increased throughout the fourth year of specialty training until you are performing all aspects of otolaryngologic surgery. During this year, you’ll complete any research projects initiated during the third year of specialty training and participate in all courses, workshops, and conferences.
At this level, you will be largely responsible for overseeing patient care and training other residents. Assignment of residents to participate in surgical cases will be largely at your discretion. You will be ultimately responsible for monitoring the condition of all inpatients and keeping the attending faculty informed. During the fifth and final year of specialty training, you’ll spend six months as chief resident at UW Hospital as well as six months as chief resident at the VA Hospital.
The UW chief is responsible for coordinating the resident clinics at UW Hospital and planning resident case conferences. The VA chief is in charge of coordinating and presenting cases at the Head and Neck Oncology Tumor Board as well as coordinating the VA resident clinics.
Operative experience increases during this year as you continue to hone your skills in all aspects of otolaryngology-head and neck surgery. Under the supervision of the faculty, you’ll teach more routine surgical procedures to junior-level residents. You’ll also be responsible for assigning cases to the junior residents.
All ongoing research projects are completed during the final year of residency. Again, all senior residents participate in all Grand Rounds, Basic Science, and divisional conferences. In addition, PGY-5 residents will attend one faculty meeting (July or August) that will be dedicated to discussion of the residency training program.
Goals of the Residency Program
At the completion of the PGY-5 year, you will have exceeded the requirements of the Accreditation Council for Graduate Medical Education and the Residency Review Committee for Otolaryngology. You will demonstrate competency in six areas including:
- Patient Care
- Medical Knowledge
- Practice-Based Learning Improvement
- Interpersonal and Communication Skills
- Systems-based Learning
You will be prepared to care for patients of all ages with medical and surgical disorders of the upper aerodigestive system, ears, and other structures of the head and neck. You will be competent to perform diagnostic and therapeutic procedures appropriate to otolaryngologic pathological conditions. Your teaching and research experiences will have augmented the integration of didactic and clinical experiences. You will be prepared for a spectrum of career options and have the foundation for demonstrating excellence in the field of otolaryngology-head and neck surgery.