As a resident in our program you will experience a balanced approach to your clinical education. Each year, residents spend time on two to three of the inpatient teams (Head and Neck, Subspecialty, and Consult services). The Head and Neck service is dedicated to the in-patient care of patients requiring head and neck oncologic surgery, endocrine surgery, and facial plastic and reconstructive surgery. The Subspecialty service emphasizes in-patient care of rhinology, laryngology, cosmetic facial plastic surgery, sleep surgery, endocrine, and skull base surgery. Lastly, the Consult service manages consultations from both the emergency department and other inpatient teams within TJUH. The remainder of the rotations for each year are primarily structured by subspecialty (with the exception of the 20 week research block during PGY4) and are designed in such a way that time is split evenly between the clinic and operating rooms. During these “off-service” rotations, residents do not have any inpatient responsibilities outside of the operating room. Time is also reserved each week during the subspecialty rotations for research and studying.
As of 2005, the intern year has been incorporated into the Otolaryngology training program. Interns will spend three consecutive months on the Head and Neck Service at Thomas Jefferson University Hospital. They will also rotate one month each on Anesthesia, Emergency Medicine and Neurosurgery. The remaining six months will be spent in a traditional general surgery internship that is coordinated with the Department of General Surgery.
Call Schedule (ENT service)
There is no in-house or home call while on the ENT service. However, the intern will assist in the hospital on Saturday mornings only. Call responsibilities while on other services are handled at the discretion of those services.
The Head and Neck rotation PGY2 is separated into two distinct blocks- one during which the resident works exclusively with two different Head & Neck attendings in the clinic and OR. These rotations introduce residents to the breadth of head & neck oncologic surgery early in training and provide excellent continuity of care. Ten additional weeks are spent on-service with the Consult Team. While on this rotation, PGY2’s enjoy a diverse case mix in the OR, work up new consultations, formulate treatment plans with the assistance of senior residents, and become adept at handling common ORL problems such as epistaxis and peritonsillar abscesses. During the Facial Plastics block, the resident spends two days per week in the office engaged in facial analysis, injections, and minor procedures. Two days are also spent in the OR participating in cosmetic and reconstructive surgery. A third component of the rotation involves a microvascular lab. The final rotation is at A.I. DuPont Hospital for Children. During this time, the resident begins his or her experience in pediatric OTO-HNS. Time is split between the office and the operating room and all aspects of the care of pediatric OTO-HNS patients are covered. While at A.I. DuPont, service responsibilities are shared with a PGY-4 resident and a pediatric OTO-HNS Fellow.
Five in-house calls per month. Two of these calls are a Friday and Sunday of one weekend. The remaining three weekends are free of clinical responsibility. Residents do not round on the weekends unless they are on call.
The PGY-3 on-service rotations include 10 more weeks with the Consult team, as well as 10 weeks with the Subspecialty service. The Consult rotation again offers a diverse, high volume operative experience. Outside of the OR, there is a level-appropriate escalation of responsibility, as the PGY3 essentially runs the Consult team and presents plans directly to attendings during one-on-one rounds. During the Subspecialty block, the residents are immersed in the peri- and post-op care of patients undergoing Endocrine, Laryngologic and Sinus and Skullbase surgery. The remaining 30 weeks of the year are spent off-service. During the Neurotology rotation, one to two days are spent in the office and two to three days are spent in the operating room, where there is a focus on tympanoplasty and mastoidectomy. During this time, the residents are also exposed to audiology. The Laryngology rotation affords the resident an opportunity to see a variety of patients suffering from voice, swallowing, and sleep disorders, and to participate in office-based procedures such as transnasal esophagoscopy, video stoboscopy, and transcervical vocal fold injections. Cases in the operating room range from micro direct laryngoscopy with vocal fold injections to the laser treatment of subglottic stenosis and formal laryngotracheal reconstructions. Lastly, the Rhinology block provides a vast operative experience with both functional endoscopic sinus surgery and complex cranial base surgery. While in clinic, the Rhinology resident is also introduced to allergy testing and immunotherapy.
Two in-house calls per month. One of these calls is a Saturday. The remaining weekends are free from clinical responsibility. Residents do not round on the weekends unless they are on call. The PGY-3’s are also responsible for the office home call, answering questions and directing patients that call the outpatient office after hours.
PGY4 residents rotate through the Consult service one more time and return to the Head & Neck team as well. During both of these rotations, residents are starting to take a lead role in many of the operative procedures, including thyroidectomy, parathyroidectomy, rhinoplasty, facial fracture repair, and neck dissection. The PGY4 on the Consult team provides oversight and takes on a teaching role. While on Head & Neck, the PGY4 runs the weekly Tumor Board conference. Residents also return to A.I. DuPont Hospital in the 4th year for ten additional weeks dedicated to pediatric otolaryngology with a heavy emphasis on otology and airway reconstruction. Finally, a 20-week block is reserved for research. Aside from one operative day per week, research time is completely protected from inpatient obligations.
Four to five home-calls per month backing up to the junior in-house resident. Two of these home call days are absorbed by a Saturday/Sunday shift. The remaining three weekends are free from clinical responsibility.
During the final year, three months each are spent as chief of the Head & Neck and Subspecialty services at Thomas Jefferson University Hospital. During the resident’s time as the Head & Neck chief, he or she spends two days in the office. All aspects of patient care are coordinated by the resident under the guidance of the attending, from arranging for pre-operative imaging and testing, to scheduling surgery, to arranging for ancillary services when appropriate. Two days are spent in the operating room. Here the resident takes a lead role in the operative cases, ranging from neck dissections to parotidectomies to thyroidectomies to free flap reconstructions. This is a longitudinal experience wherein the resident sees the patient from the initial office visit to the operating room and finally during post-operative management. In addition to the outpatient and operative experiences, the Head and Neck chief resident is responsible for all aspects of in-patient care of the Head and Neck Service patients, as well as managing the team of residents and mid-level practitioners (Nurse Practitioners and Physician Assistants) who are providing that care. While chief of the Subspecialty team, the resident spends 3-4 days per week in the operating room further gaining mastery of the surgical procedures in OTO-HNS. The final subspecialty rotation is the chief level neurotology experience. Here, the resident splits time between the operating room and the office, often operating on the more complicated neurotologic patients. Finally, a three-month period as Academic Chief Resident is dedicated to departmental administrative duties and medical student education. During this rotation, the resident will operate approximately 2 days per week.
Four home-calls per month. As a senior resident you provide back up to the junior in-house resident. There are no weekend calls for the chief except for one Friday night per month.
William Keane, MD
Edmund Pribitkin, MD
Maurits Boon, MD
Associate Program Director
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