A couple of questions

Discussion in 'Otolaryngology' started by hiya20, Aug 10, 2015.

  1. hiya20

    5+ Year Member

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    Hello everyone,

    Newly minted MS4 here getting geared up to apply for Otolaryngology. I wanted to start off by thanking all of the attendings/residents on the forum who put in the time to enlighten us lowly medical students. It is greatly appreciated!!

    I just had a few questions regarding the ENT residency process for those more knowledgable than I. With applications around the corner I hate to be another one of those "what are my chances" posts but I would love to hear some of the attending/senior members take on my application given how competitive ENT has become. I have read Neutropeniaboy's informative sticked thread a few dozens times throughout third year but would appreciate more individualized feedback on my chances of matching and if there are any glaring weaknesses in my applications:

    - U.S. News top 25 medical school with pretty good home ENT program
    - Step 1= 260, Honors in all core rotations except for Ob/Gyn & Family Medicine, Honored ENT Sub-I
    - 3 ENT/cancer biology manuscripts (1 first authors), 1 oral podium presentation, and 4 ENT related poster presentations.
    - Several leadership roles throughout medical school but nothing to write home about
    - Strong letters from chairman, program director, and 2 senior ENT faculty at home institution

    In addition to your take on my app I had a few additional questions regarding interviewing/ranking programs:

    1.) With most surgical specialities I think everyone agrees that a program's case load and case diversity are important for resident education. Aside from simply how many cases a given institution is doing what are some of the other qualities that you looked for when you were interviewing and ranking programs?

    2.) When you were going through the interview process what were some of the important questions you asked program directors?

    3.) Are there any red flags that you noticed while interviewing that immediately turned you away from a specific program?

    4.) From reading this forum it is clear that most ENT programs will provide you with a great training experience. However, when it comes to choosing where to interview and finalizing your rank list I find that it helps to classify programs by tiers. I know that there are several published ranking lists of ENT hospital and residencies such as Doximity and US News. Are there any programs that typically aren't considered "top tier" by these various rankings metrics but are known to have excellent clinical training?

    Thank you and good luck to everyone about to undergo this crazy process.
     
  2. neutropeniaboy

    neutropeniaboy Blasted ENT Attending
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    Diversity is equally if not more important than case numbers. In fact, you should ask about "key indicator" cases. These are the cases that the Academy determines are the most essential cases ENT residents must know how to perform prior to graduation. Deficiencies in these cases often result in (among other things) probation of a program, loss of a resident (or denial of additional resident approvals). These are things like ethmoidectomies, mastoids, thyroids, neck dissections, etc. More important cases.

    What program has the better experience - the program with an average of 1500 cases or the program with an average of 2000 cases? What if I told you the former program had residents that averaged 200 sinus surgeries, 200 mastoid/tymp-mastoids, 200 neck dissections, 200 laryngeal cases, 200 pedi neck cases, etc. while the other program had 500 tubes and tonsils, 500 DLs/bronchoscopies/esophagoscopies and residents were counting sinus scopes and laryngeal scopes as procedures? Make sure you know how diverse case load is.

    You should look for clinic-OR balance. There are some programs that are all OR and no clinic. This is bad. I've never met a doctor that can efficiently run a clinic without ever having to learn how to manage a load of patients. I've met residents who are excellent surgeons who couldn't work up a patient if the steps were written down on a piece of paper.

    Look for diversity of faculty - you want representation from all the subspecialties.

    Look for research experience; make sure you look strongly at programs that give you experience doing research.

    Look for programs that have regular didactics. This can be grand rounds, M&M, cochlia, resident/attending grand rounds, visiting lecturers, etc.

    Look for resident cohesiveness. They don't have to all be lovey-dovey or go to parties together, but if they all get along well, that's a good sign. Hard to gauge while on an interview because everyone behaves well.

    Look for new hires. Find out who has left in the last 5 years and why. Who's on the verge of retirement?

    Is ENT a division of surgery or a department? Seek the latter program.

    How is the hospital system? Is the hospital recently acquired or has it been a stable system?

    How about trauma? Is it split among plastics, ENT and oral surgery?

    Don't ask about call schedules; it makes you seem lazy. It is what it is.

    Don't ask about book allowances and whether you get loupes or not. This is petty when juxtaposed to the educational value of a residency program.

    Will the program pay for your trips to meetings if you present? What if you don't present? (Formulate this question to make it sound like you're not asking about the money.)

    What is the publication track record of residents?

    How are the fellows integrated into the program with the residents (if there are fellows)?

    How many residents go into fellowships each year and what fellowships are awarded?

    I don't remember what I asked, but if I were able to do it again, I'd ask about what I stated above.

    Attendings being jerks or generally being disinterested in me. One attending picked up the wrong folder and started asking me questions about my experience as an Outward Bound instructor (I never was). When I was applying, I got annoyed that attendings hadn't read my application closely, but being an attending now and having reviewed many applications each year, it's tough to keep them all straight or remember every detail.

    Look at the department library. Look at the age of the books. Look at the conference room facilities. Pay close attention to the equipment in the clinic -- is it modern? Do they have aged microscopes? Do they lack sinus video equipment? Look for nurses, PAs and medical assistants in clinic. Are they around helping docs or are they no where to be found? Look at the ORs (if you get a chance). Old equipment? New equipment?

    What is the age range of the faculty? Are they all old? All young? (Both are less than ideal.)

    Probably many.
     
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  3. hiya20

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    Thank you for taking the time to write out that detailed and informative response neutropeniaboy, it was very helpful.
     
  4. OtoHNS

    OtoHNS ENT Attending
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    I think you know the answer to that already ;). Assuming you can avoid coming off as cocky or arrogant in your interviews, I'd say you're a shoo-in to match if there is such a thing in ENT these days.

    Excellent info above from Neutropeniaboy. I have a few comments/additions:

    -Agree 100% on needing good clinic/OR balance. I would add to look for programs that have rotations at VA or County hospitals to get experience seeing your own clinic patients, not just seeing your attending's patients. There is still some very loose attending oversight (i.e. signing your notes while drinking coffee/surfing the internet in their office), but running a VA clinic as a chief resident gave me the best simulation of what it's like to be in private practice.

    -By far the best time to learn surgery and how to do specific procedures is during your residency. Look for a broad range of surgeries according to the criteria above. In general, bigger departments with multiple faculty in each subspecialty will provide more surgical exposure and more viewpoints/ways to do particular procedures.

    -Regarding trauma: the best situation in my opinion is a program at a busy level 1 trauma center that shares facial trauma call with plastics and OMFS. That way, you'll get plenty of experience but it won't consume your life (except every 3rd week). Sewing up drunk a-hole's faces at 3am is no fun, but it's how I became expert at wound closures. As a more senior resident, you'll learn various exposures to different parts of the face by doing trauma cases.

    -Call schedules. You don't have to ask, someone will tell you during your interview day.

    Good luck!
     
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  5. hiya20

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    Thank you for your input OtoHNS! I would have never given a second thought about if a program was attached to a VA, but the points you brought up were very insightful. It's also hard to imagine how people can be "cocky or arrogant" these days with how many great candidates there are in every specialty but your point is well taken.
     
  6. Pir8DeacDoc

    Pir8DeacDoc Cerumen Extractor
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    I would add that an independent clinic experience need not be just at a VA or County hospital (though those can certainly be VERY valuable experiences). We had a VA but it hadn't been integrated into the program (I was the first resident all the way through).

    Our chief's clinic was once a week for the entire year. Loose/no oversight from the staff who were covering the clinic was expected. I've been in PP for three years and besides having to work on my speed a little bit in the beginning, felt pretty comfortable seeing clinic patients 3+ days a week 30+ per day.
     
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  7. Cranio

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    That post by NPB should be stickied....a lot of great advice in there. I'll add a couple thoughts and things I asked about.

    -US News is probably the worst way to make your rank list; really any ranking system is flawed. The best way is to run things by your attendings and mentors - still imperfect (attendings dont seem as in tune to out of region programs) but still miles better than doximity.

    -I'll add that some programs do some procedures that are relatively unique to them - if you might have an interest in say clefts, or peds airway recon, those might be things to ask about and factor in. I know clefts are pretty rare for ENT residencies, and airway recon even more so. I'm sure there are other procedures that I am not even aware of that fall under this category.

    -Some programs also have an emphasis on mission trips and will pay for the whole shebang. It was mildly important to me so I asked about it.

    -Even though you're fantastic on paper, still apply broadly....there were a couple superstar candidates I knew that didnt match, and I personally didnt see anything wrong with their personalities. There's always a couple that fall through the cracks, dont let 1000 bucks be the reason why you do.
     
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