New M3 with ENT Q's

[deleted481566]

I apologize if I'm duplicating any threads. I did not find any that were similar to my questions. I'm a newly minted M3 (on my medicine rotation), and I'm one of those people who isn't sure what I want to pursue. I'm currently on medicine, and I have surgery next, so I'll get to compare the two back to back. The only interaction I've had with surgeons at this point other than shadowing some ortho guys has been my own surgery with a local ENT. Despite that, I know very little. So I have some general questions about otolaryngology:

1) Trauma: What is ENT's role in trauma? Do they perform reconstructions, etc. of the H&N? I would assume yes, but I wondered if plastics or another service was also involved.

2) Do otolaryngologists perform cleft lip/palate repairs and other facial defect repairs? Does that work require a fellowship?

3) What other specialties were people interested in other than ENT when in medical school? I'm still very much an open book in terms of specialty interests at this point, so I would curious as to whether everyone was interested in doing general surg. if ENT wasn't an option, etc. I've spent the most time in pre-clinical preceptorships with EM and critical care physicians, both of which I enjoyed.

4) By what point in the third year should one know that they want to pursue ENT (or a similar, competitive specialty)? Seems like all of my peers know exactly what they want to do or have it narrowed to a couple of things. I only know I'm not interested in OB/GYN - otherwise I'm open. Would that hurt me in the long run?

Anywho, thanks for entertaining my newbie questions. Any thoughts would be great!

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[neutropeniaboy]

1. The involvement of ENTs in facial trauma varies widely in institutions. In residency, we rotated every 10 days with OMFS and plastics to cover facial trauma. However, general surgery trauma did the neck explorations. Still moreover, we covered the laryngeal fractures and penetrating injuries. There were practical reasons for this arrangement. In private practice, I would guess that most ENTs don't do facial trauma any more. Some might, but a lot of OMFS bread and butter is facial trauma, so many hospitals that aren't academic have OMFS cover the trauma. I'm sure at some academic institutions ENT isn't heavily involved in facial trauma. In any event, I think it's sad that ENTs go through their training without exposure to these things. So, you should look for a program that does cover trauma.

2. Cleft lip is a very territorial subject. In most places, this is managed by fellowship trained plastic surgeons or OMFS. Just the way it is. There are some ENTs who do this. Training in this area is rare for ENT residents. However, you don't need a fellowship to repair someone's cleft lip or palate. Just like anything, your ability to perform these things depends on your training, your confidence, your referral patterns and the privileges your hospital will give you. Other facial defects are anyone's game. ENTs can do them.

3. I was interested in orthopedics and neurosurgery.

4. You should know before the middle of your 3rd year. You need to start planning out your fourth year, and if this includes away rotations, some of these may be competitive for spots. Also, some institutions have their own students do there ENT sub-I in June of the third year.

 

[VisionaryTics]

I might as well jump on to this thread rather than make a new one.

What level of acuity does the average ENT see? I love ENT's good outcomes and healthy patients, but I also enjoy physiology and critical care. I know that H&N patients are pretty damn sick; how much of a role does their surgeon play in their peri-operative care?