Breakdown of Rotations
As a resident in our program, you will experience a balanced approach to your training and education. Our teams consist of senior and junior residents working closely to manage patients taken care of by our department. The Head and Neck Service is dedicated to the inpatient care of individuals requiring head and neck oncologic surgery, endocrine surgery, and facial plastic and reconstructive surgery. The Subspecialty Services provide expertise and knowledge in rhinology, laryngology, otology, cosmetic facial plastic surgery, sleep surgery, endocrine surgery, and skull base surgery. During these rotations, residents do not have any inpatient responsibilities outside of the operating room and clinic. The Consult Service manages consultations from both the emergency department and other inpatient teams within TJUH. On every rotation, time is reserved each week for academics including research, guest lectures, simulations, and group and independent study.
Interns spend six months in our department. Half of their time will be with the Head and Neck Service, where they will round on the head and neck oncology patients and operate four days a week. The other half is on the Consult Service, where they have an opportunity to see common consults on their own with senior resident support and formulate treatment plans. Finally, they will spend a month at A.I. DuPont Hospital for Children as well as a month with Drs. Fisher and McGettigan, two graduates of the program who practice general otolaryngology. Interns also rotate one month each on Anesthesia and Neurosurgery. The remaining four months are spent in a general surgery internship that includes Trauma Surgery, Plastic Surgery, General Surgery, and the Surgical Intensive Care Unit.
Call Schedule (ENT Service)
There is no in-house or home call while on the ENT services. The service does require support of one intern on inpatient rounds on Saturday/Sunday mornings - to be alternated between the two on-service interns. Call responsibilities while on other services are coordinated with those services.
One of the many unique experiences that Jefferson residents have beginning at the PGY-2 year includes our apprenticeship style of learning. Residents spend two, 3-month blocks with head and neck attendings, establishing relationships with patients from the time of diagnosis in clinic, to the operating room, and through follow-up and adjunct therapies. Additionally in the PGY-2 year, residents spend 3 months with our facial plastics team, meeting and caring for patients undergoing cosmetic or reconstructive procedures. Residents spend three days per week in the clinic engaged in facial analysis, injections, and in-office procedures. Two days per week are spent in the OR participating in cosmetic and reconstructive surgery. At A.I. DuPont Hospital for Children, residents manage consults and participate in clinics. This is an immersive operative experience where residents can expect to become proficient in common pediatric procedures as well as complex otologic, reconstructive, and airway procedures.
Five to seven in-house calls per 10-week block. Two to three weekend calls which include Friday and Sunday per 10-week block. The remaining weekends are free of clinical responsibility. Residents do not round on the weekends unless they are on call. Residents rotating at A.I. DuPont take home call, split between on-service residents.
In the PGY3 year, residents rotate at the Jefferson Hospital for Neuroscience (JHN) on the same campus as our main hospital and participate in General ENT, Otology, and Rhinology cases. The first of two dedicated research blocks, each 10 weeks in length, occurs during the third year of residency. 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 runs the Consult team and presents plans directly to attendings during one-on-one rounds. The Rhinology block provides a vast operative experience with both functional endoscopic sinus surgery and complex cranial base surgery. While in the clinic, the Rhinology resident is also introduced to allergy testing and immunotherapy. Residents also return to A.I. DuPont Hospital in the PGY-3 year for ten additional weeks dedicated to pediatric otolaryngology with a heavy emphasis on endoscopic ear surgery, congenital malformations, and airway reconstruction.
Three to four in-house calls per 10-week block and two to three weekend calls per 10-week block which includes Saturday only. The remaining weekends are free from clinical responsibility. Residents do not round on the weekends unless they are on call. The PGY-3 class is responsible for office home call, answering questions and directing patients that call the outpatient office after hours.
During the PGY4 Consult Team and Head and Neck rotations, residents take a lead role in many operative procedures, including thyroidectomy, parathyroidectomy, rhinoplasty, facial fracture repair, and neck dissection. The PGY4 on the Consult team provides supervision to junior residents and takes on a teaching role. While on the Head & Neck service, the PGY4 serves as the acting chief and runs the weekly, multidisciplinary Tumor Board conference. During the Laryngology rotation, the residents get extensive exposure to sleep medicine and surgery through their time with Drs. Boon and Huntley. This includes drug-induced sleep endoscopy, UPPP, and upper airway stimulation with the hypoglossal nerve stimulator. Additionally, residents receive an unparalleled professional voice experience under the tutelage of Dr. Joseph Spiegel. Finally, a 10-week block is reserved for research. Aside from one operative day per week and call, research time is completely protected from inpatient obligations.
Five to seven weekday calls per 10-week block. Weekday calls are second-call as a back-up to the junior in-house resident. Senior residents on call come into the hospital to assist with emergencies and operate after hours. The PGY4 class also takes two to three weekend calls per 10-week block during which they are required to be in the hospital to lead inpatient rounds and discuss patient management with attending surgeons. The remainder of the weekend call is home call.
In the PGY5 year, the Operating Room Chief is responsible for coordination of resident coverage for the entirety of the Otolaryngology service. This rotation additionally serves as an opportunity for the Chief to electively participate in his or her first-choice of procedures to prepare for fellowship or a career in General Otolaryngology. This is strictly an operative block with no inpatient clinical responsibility outside of call. The Academic Chief is responsible for organizing and executing educational opportunities for residents and medical students, including yearly book reviews, lectures, simulations, dissection labs, and preparation for In-Service examinations. During this rotation, the resident will operate approximately 2-3 days per week. As the Head & Neck chief, residents spend two days in the office with the department chair, Dr. Cognetti. 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 and ancillary services when appropriate. In the operating room, the resident takes a lead role in the operative cases, ranging from neck dissections to parotidectomies to thyroidectomies to free flap reconstructions.
Four weekday calls per 10-week block (no weekdays while on the head and neck oncology service). Weekday calls are second-call as a back-up to the junior in-house resident. Senior residents on call come into the hospital to assist with emergencies and operate after hours. One to three weekend calls per 10-week block which includes only Friday night. Chief residents do not take Saturday/Sunday call.