AMA-ENT Edition

[medstud268]

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Hey all, I’m about to be a PGY-2 ENT resident. I remember when I was a medical student I used to read these threads and I don’t think I saw an ENT specific one. Happy to answer any and all questions about ENT, applying, or how intern year has been thus far.

 

[Stuck on CCL2]

Hey thanks for setting up this ama!

What aspects of ENT drew you to the field and what did you look for when ranking the programs you interviewed at?

 

[highway31]

When did you realize you were interested in ENT? What advice would you give to an incoming M1 interested in ENT? What are things you would have done differently if you went through med school all over again? Things you would have done the same?

Thanks for doing this AMA.

 

[TheVagüs]

Favorite procedure?

Favorite thing you can do in clinic?

How common is it to collaborate with neurosurg on skull base tumors?

What proportion of ent patients are kids outside of the usual tubes and tonsils? I want to have kids in my practice and don’t want do a fellowship and entirely exclude adults

Did you seriously consider other fields? Is so, which ones?

Thanks so much for taking the time.

 

[Gilakend]

How was your intern year?
Did you feel like you learned a lot or just did a lot of grunt work?

 

[Deecee2DO]

1. As we all know, ENT is insanely competitive-what kind of board scores did you have and how did you prepare for them during your second year of med school balancing class material and board material? I am a rising MS2 and want to make sure that I am efficiently using my time to find that happy medium where you are prepping for boards and still passing your classes.
2. What drew you to ENT? Are you finding there is a good amount of variety or more repetitive?

 

[DoctorPeanutButter]

I realize you may or may not have residency experience yet w the big H+N recon cases but drawing from any subI experiences you’ve seen, what’s the logistics of an 8-16 hour operation? I.e. how often do you end up scrubbing out and scrubbing back in and what is considered reasonable? At what point in your program will these big onc cases be a frequent part of your schedule and what do your seniors say are strategies to deal w intra op fatigue?

 

[medstud268]

Hey thanks for setting up this ama!

What aspects of ENT drew you to the field and what did you look for when ranking the programs you interviewed at?

I came into medical school pretty open to specialties. I quickly decided medicine and rounding wasn’t for me as I felt that there were too many other parts you had to deal with, especially during residency and even as an attending. As i was looking for other specialties, I kind of fond ENT out of the blue as one of my friends had done research with the department one summer and said they were nice. After shadowing, I realized I liked the fact that I could choose to work with kids or adults, I could have long term relationships with patients even as a surgeon(as opposed to something like ACS where you just operate on them and may see them once more) , and I liked that I could kind of choose myself how much OR vs in clinic procedures I want to do. Generally, compared to most other surgical fields, People in ENT are nicer and I felt like I got along better with them.

With regards for ranking programs, my number 1 most important factor was location. I was trying to move back by my family and fiance, and so that was most important. The next most important thing for me was to go to a strong program that would allow me to do anything I wanted in either academics or private practice. Finally, how I got along with the residents and the program as a whole(sort of a gut feeling) was also high on my list. I think the key with ranking programs is figuring out what is the most important thing for you. I have friends who got "the best" interviews in their given specialty, however, they ended up staying at our home program because it made more sense for them for a variety of factors.

 

[medstud268]

When did you realize you were interested in ENT? What advice would you give to an incoming M1 interested in ENT? What are things you would have done differently if you went through med school all over again? Things you would have done the same?

Thanks for doing this AMA.

I kind of answered the first question in the first response, but to be more specific it was as an M2 when I started shadowing and doing some research. However, that is not to say that you have to decide early to do any competitive specialty. One of my classmates decided late M3 and still got plenty of interviews at both academic powerhouses as well as more regional programs.

As far as advice for someone interested in ENT as an M1, I think that is great that you have such a specific interest so early. I would focus on learning your lecture material well and building a solid foundation as that will only help you moving forward. Additionally, I think though its good to have a focus, don't pigeonhole yourself into thinking that ENT is the only field for you. I think its a great field, however, I think that you should always give yourself the opportunity to explore other specialties before deciding on one. If you don't at least somewhat consider other specialties, M3 can be quite difficult to get through.

As far as things I would've done differently/the same in medical school, I'm honestly not sure. I think that I would have spent more time solidifying information so that it was easier to recall now that its over. Additionally, I wish that I had taken a medical spanish elective as its very useful no matter where you practice. As far as things I would have done the same, I think that I got involved early in research and met great mentors, which helped me when it came time to apply for residency. I think not going to class was also a decision I would definitely have done again. I personally thought I was able to save quite a bit of time by listening to lectures at home. Let me have a much more relaxed first two years since I had a lot of time to do personal and other academic things.

 

[medstud268]

Favorite procedure?

Favorite thing you can do in clinic?

How common is it to collaborate with neurosurg on skull base tumors?

What proportion of ent patients are kids outside of the usual tubes and tonsils? I want to have kids in my practice and don’t want do a fellowship and entirely exclude adults

Did you seriously consider other fields? Is so, which ones?

Thanks so much for taking the time.

Favorite Procedure: Hard to say since honestly I can't say how it is to do a lot of the bigger cases yet, but so far as an intern I think tonsils and skin cases are fun. Tonsils are immediately rewarding and they really do teach you quite a bit about traction and counter traction. Skin cases and recon is interesting because it shows you how many different ways there are to reconstruct different defects and how much you have to think when you have to recon someone.

Favorite thing in clinic: I think scoping is fun, everytime you do it, there is something that you can improve on

Proportion of kids: Tubes and tonsils are most commonly your pediatric patients like you said for the most part. Depending on where you go, you can ask your partners if you could be the "peds person", and they could refer most of their pediatric patients to you. Also, you can do a peds fellowship if you are interested in the bigger/more complex pediatric surgeries, and then join a community practice and still see both adults and children

Other fields: I thought about ortho pretty seriously. I liked the people and the immediate gratification, however, the surgeries weren't very interesting to me. I also briefly thought about plastics but didn't get much experience to it. I tried to like a fellowship out of IM, however, I couldn't do it. I think anesthesia could be interesting as well for the airway stuff, however, I got bored while on rotation.

 

[medstud268]

How was your intern year?
Did you feel like you learned a lot or just did a lot of grunt work?

My intern year was busy but a lot of fun. I think everyone is shocked when they start intern year because its such a change, but it was great to grow and learn. I learned quite a bit, from how the EMR worked, how to place lines, how to suture more efficiently, how to operate (slowly lol) and how to manage my time more. I also had a lot of positive personal milestones, so it made it a great year. However, there is always grunt work, especially in general surgery, and so its unfortunately just the name of the game

 

[medstud268]

1. As we all know, ENT is insanely competitive-what kind of board scores did you have and how did you prepare for them during your second year of med school balancing class material and board material? I am a rising MS2 and want to make sure that I am efficiently using my time to find that happy medium where you are prepping for boards and still passing your classes.
2. What drew you to ENT? Are you finding there is a good amount of variety or more repetitive?

1. IMHO, I think that board scores are slightly overstated for competitive specialties. I know people who had <240s who matched at top ENT programs, and I know people with 260s who didn't match this last year. However, it is the part of your application that you most directly control. I got in the 250s for both Step 1 and Step 2. I didn't do anything out of the ordinary that you hear on Reddit and from classmates. I did u world, First aid, Pathoma, and some sketchy. I did the 5 weeks of dedicated or so that most people recommend with some breaks in the middle. I think for me, I focused more on classes with some adjunct board studying during most of M2 until it became closer to test date. However, I know friends who did all of Kaplan by the time the year finished and they did great. Unfortunately, its mostly just a grind and seeing what things work for you by comparing how your practice test scores change.

2. I talked a bit about the first part above. With regards to repetition, I think there is a huge amount of variety. For example, the last two days themselves I've seen a laryngectomy, did some skin cases with reconstruction, did some direct laryngoscopies with biopsies, closed a complex wound, did an esophageal dilation, and also did a little clinic with new skin cancer, mucosal cancers, and a little smattering of facial plastics.

 

[medstud268]

I realize you may or may not have residency experience yet w the big H+N recon cases but drawing from any subI experiences you’ve seen, what’s the logistics of an 8-16 hour operation? I.e. how often do you end up scrubbing out and scrubbing back in and what is considered reasonable? At what point in your program will these big onc cases be a frequent part of your schedule and what do your seniors say are strategies to deal w intra op fatigue?

Fortunately (or unfortunately depending on your thoughts), my program is known to be one of the busiest H+N programs in the country. I think this mont alone we have had more than 10-15 free flaps. The logistics really depend on your program, the attending, and what your role is. Most of the time, micro is the fellows domain while the resection is the resident. Of course, if you are interested in micro or it is a busy day you will do some micro, however, most of the time its what the fellows are there for so they will do the majority of is. Most of the residents will often scrub out during micro to use the restroom/eat etc.

With regards to when its our schedule, we do 10-11 months of head and neck in residency and we start as interns, so we do them quite early. I think intra-op fatigue is something that you start to develop a tolearnce to as you go on in training. However, even the attendings at time realize when it is time to take a break or look away for a second to refocus yourself, and I think that it is appropriate to do so

 

[kinginthenorth123]

Thank you for doing this!

Can you explain the fellowships following ENT residency? There seems to be so many avenues you can go down, kind of hard to get a feel for what's what from the internet.

 

[CherryRedDracul]

Largest volume of earwax you've removed from a patient?

 

[4thtimeretaker]

Thank you for this! Would you classify yourself as naturally a good test and standardized test taker? Do you think that doing well on MCAT strongly correlates to Step performance?

 

[TheVagüs]

Thank you for this! Would you classify yourself as naturally a good test and standardized test taker? Do you think that doing well on MCAT strongly correlates to Step performance?

bruh

low effort post for a resident donating their time to talk about ENT. There are plenty of other places on the forums for step and mcat neuroses. He/she even just said that test score concern is overblown.

To answer your question, there is no clear correlation. Set a goal score based on the career you want and work hard. The end.

 

[medstud268]

Thank you for doing this!

Can you explain the fellowships following ENT residency? There seems to be so many avenues you can go down, kind of hard to get a feel for what's what from the internet.

Sure!

H+N: This is the fellowship you do if you want to do the big whacks and the crazy reconstruction. Almost universally now you also will learn to do micro vascular reconstruction in most fellowships since it’s almost impossible to get a job doing only resections. There are some fellowships that still do only resections such as at MSKCC. Length is usually 1 year but can do a second for research purposes.

Laryngololgy: Lot of airway surgeries from long airway reconstructions for bad stenosis to dilations and lasering to vocal cord injections. Also professional voice and working with singers/actors. Usually less intense than something like H+N. 1 year in length.

Pediatric: probably the most variable fellowship. You will do things from big airway cases to cochlear implants to tumor resection, just all in kids. Depending on where you go for fellowship you may lean more towards ears or airway or something else. Length is usually 1 year except for a few 2 year programs with required research.

Rhinology/skull base: You deal with the sinuses which includes management or chronic sinusitis as well as sinus surgery. Most fellowships have some aspect of anterior skull base as well, while some are almost exclusively focused on skull base. With the skull base, often you are performing massive tumor resection in conjunction with neurosurgery. There is also a component of allergy involved. 1 year in length.

Sleep: A newer fellowship; there are some that are more medicine sleep related where you learn how to read PSGs, some that are more operative in nature for the more complex sleep surgeries, and some that combine them. Usually 1 year long.

Otology/neurotology: The ear experts. They do cochlear implants, vertigo, mastoidectomies, reconstruction of your ossicles, as well as approaches to the lateral skull base with neurosurgery for vestibular schwanommas or other tumors. This is the only required 2 year fellowship.

Facial plastics: most fellowships are a mix of cosmetics as well as reconstruction. Some train you in micro vascular reconstruction, while others are purely cosmetic and train you to be a cosmetic surgeon. Length of 1 year.

Hope that was helpful

 

[medstud268]

Largest volume of earwax you've removed from a patient?

I haven't actually removed a huge amount so far, but I did have a little kid who had some the size of my finger in each ear which was a little crazy

 

[medstud268]

Thank you for this! Would you classify yourself as naturally a good test and standardized test taker? Do you think that doing well on MCAT strongly correlates to Step performance?

I think I'm a relatively good test taker, but I don't think that matters much in Step 1. IMO its all about repetition and understanding what they are asking. I don't think MCAT and Step 1 totally correlate. My roomate got something like a 270 and got <30 on the old MCAT.

 

[RocuROMANium]

So which fellowship do you plan on pursuing and why?

 

[Stuck on CCL2]

What part of the field/your job has been your least favorite so far? How do you overcome it?

 

[TheVagüs]

Scariest moment so far? Most rewarding moment? Could we get a picture of what a typical week looks like as an intern at your program?

 

[neriticzone]

How many months of ENT residency is usually spent doing SICU/critical care stuff? Do you think it is important for an ENT resident to like critical care?

 

[medstud268]

So which fellowship do you plan on pursuing and why?

So I came into residency thinking peds, but as I said above our program is very h+n heavy. Most people in our program think about h+n for at least a little bit. I thought peds at first because I enjoy working with kids, the airway recons are very cool surgeries, and you can make large impacts on these kids who were just born with congenital abnormalities. However, the parents can sometimes be difficult to deal with. Surprisingly, I’ve also found working with our cancer patients very rewarding. Speaking of impact, you make a huge impact on each of your patients, both positively and negatively with our surgeries by curing them of cancer but also changing the way they live with tracheostomy or laryngectomies. I think the surgeries are amazing as well, however the fistulas and complications of the big oncologist surgeries are hard to deal with. It makes your lifestyle hard to predict at times. Luckily I have 3 more years before I have to make a decision.

 

[medstud268]

What part of the field/your job has been your least favorite so far? How do you overcome it?

I think my least favorite is disposition of patients. We luckily have a great support staff on the weekdays, but on weekends it’s a pain to try to get a hold of he appropriate people to try to discharge a patient, especially if the ball didn’t get rolling during the week. There is not much you can do to overcome it, it’s something that you just have to keep working at.

 

[medstud268]

Scariest moment so far? Most rewarding moment? Could we get a picture of what a typical week looks like as an intern at your program?

Scariest moment so far was when we had to do an emergency tracheostomy on a newborn since it was so tiny and everyone was relying on us to get the airway.

Most rewarding moment was when we decannulated a little kid and her mom heard her talk for the first time and started crying.

Typical week varies based on the rotation. I'm on our head and neck service right now, which is generally our busiest service. Most mornings we start rounding around 5:30 or so and I get there around 5 to get numbers ready and print lists. I'll usually be in the OR 3-4 days a week with clinic interspersed in there. Some days we will get out earlier around 6, some days we'll stay till midnight depending on how the flaps are going. Generally we have 2-4 flaps twice a week, and a few more other random days depending on the week. We have resident didactics in the mornings once a week as well as service specific didactics once a week.

 

[medstud268]

How many months of ENT residency is usually spent doing SICU/critical care stuff? Do you think it is important for an ENT resident to like critical care?

We all did 1 month of SICU. Some programs have all of their flaps go to the SICU; we have our flaps go to our floor instead. I don't think its necessary to like critical care to do ENT, however, we do deal with airway emergencies quite regularly so its important to be able to respond to emergencies appropriately

 

[operaman]

Can you talk about your ent experience as an intern more specifically?

What kinds of cases are you being assigned? Now that end of intern year, what cases do you feel reasonably comfortable performing? Any specific operative or Procedural tasks on ent services that are reserved for the intern (ie DLs, trachs, etc)?

Do interns at your program take primary ent call? In-house or home?

Any specific ent intern-focused didactics beyond those aimed at all your ent resident complement?

Does your program have any structured mentoring program for interns?

In our program we’re evolving but I feel we could do more to enhance the educational experience of our interns, especially now that you’re on ent rotations for 6 months or more. General surgery has a long history of training their interns and off-service surgical interns but we in sub specialty land are still learning so I’m always curious how other programs are approaching this. Thank you for sharing your experiences here!

 

[kinginthenorth123]

Sure!

H+N: This is the fellowship you do if you want to do the big whacks and the crazy reconstruction. Almost universally now you also will learn to do micro vascular reconstruction in most fellowships since it’s almost impossible to get a job doing only resections. There are some fellowships that still do only resections such as at MSKCC. Length is usually 1 year but can do a second for research purposes.

Laryngololgy: Lot of airway surgeries from long airway reconstructions for bad stenosis to dilations and lasering to vocal cord injections. Also professional voice and working with singers/actors. Usually less intense than something like H+N. 1 year in length.

Pediatric: probably the most variable fellowship. You will do things from big airway cases to cochlear implants to tumor resection, just all in kids. Depending on where you go for fellowship you may lean more towards ears or airway or something else. Length is usually 1 year except for a few 2 year programs with required research.

Rhinology/skull base: You deal with the sinuses which includes management or chronic sinusitis as well as sinus surgery. Most fellowships have some aspect of anterior skull base as well, while some are almost exclusively focused on skull base. With the skull base, often you are performing massive tumor resection in conjunction with neurosurgery. There is also a component of allergy involved. 1 year in length.

Sleep: A newer fellowship; there are some that are more medicine sleep related where you learn how to read PSGs, some that are more operative in nature for the more complex sleep surgeries, and some that combine them. Usually 1 year long.

Otology/neurotology: The ear experts. They do cochlear implants, vertigo, mastoidectomies, reconstruction of your ossicles, as well as approaches to the lateral skull base with neurosurgery for vestibular schwanommas or other tumors. This is the only required 2 year fellowship.

Facial plastics: most fellowships are a mix of cosmetics as well as reconstruction. Some train you in micro vascular reconstruction, while others are purely cosmetic and train you to be a cosmetic surgeon. Length of 1 year.

Hope that was helpful

I've read that the work environment for head and neck specialists is pretty much exclusively academic for attendings. Would you say that's true?

 

[medstud268]

I've read that the work environment for head and neck specialists is pretty much exclusively academic for attendings. Would you say that's true?

Can you talk about your ent experience as an intern more specifically?

What kinds of cases are you being assigned? Now that end of intern year, what cases do you feel reasonably comfortable performing? Any specific operative or Procedural tasks on ent services that are reserved for the intern (ie DLs, trachs, etc)?

Do interns at your program take primary ent call? In-house or home?

Any specific ent intern-focused didactics beyond those aimed at all your ent resident complement?

Does your program have any structured mentoring program for interns?

In our program we’re evolving but I feel we could do more to enhance the educational experience of our interns, especially now that you’re on ent rotations for 6 months or more. General surgery has a long history of training their interns and off-service surgical interns but we in sub specialty land are still learning so I’m always curious how other programs are approaching this. Thank you for sharing your experiences here!

Cases are kind of all over the map, depending on the rotation. On peds, mostly tubes and tonsils with some DLs and injections here and there. On our head and neck rotation, been in plenty of DL biopsies, a couple of trachs, and a lot of skin cases and reconstruction. I've been assigned to a fair bit of free flaps as well, but my role is more retraction and learning and closing, which I think is useful as an intern still learning to be efficient. Generally we are assigned to the intern level cases, however, sometimes we have to cover bigger cases when someone is on vacation or its a busy day, etc.

We have a buddy call system in place as interns on ENT and we take in house call on gen surg services. The buddy call system is basically we just hang out on call for the night until we are sent home. Usually not as helpful on weekdays, but weekends are good. ITs kind of up to us how much we take.

With regards to ENT intern focused didactics, we have a unique experience as interns that is built around teaching ENT interns with regards to common consults, lectures, etc that I found quite helpful. If you want more specifics feel free to PM me about it.

We have a structured mentoring program for the residents in general, with junior residents having a more senior resident as a mentor. Interns are not required/expected to have one, but we are encouraged to.

 

[medstud268]

I've read that the work environment for head and neck specialists is pretty much exclusively academic for attendings. Would you say that's true?

It is mostly true. There are a few practices out there in the community where you can do free flaps and resections not at an academic center, however, they are much rarer than academic jobs

 

[Dwight Snoot]

What does the lifestyle look like for a typical attending? I have heard that ENT has one of the best lifestyles for a surgical specialty.

Also, I know this is kind of difficult to answer, but what are the personalities look like in ENT? Do you find the people to be especially "nerdy" or is there a good mix of personality.

Thanks!

 

[RocuROMANium]

Are there trauma ENT's? Do ENT's ever get trauma pages if there is damage to the patient's head, neck, throat, ears, etc? If so, what is the route one takes to become a trauma ENT?

 

[medstud268]

What does the lifestyle look like for a typical attending? I have heard that ENT has one of the best lifestyles for a surgical specialty.

Also, I know this is kind of difficult to answer, but what are the personalities look like in ENT? Do you find the people to be especially "nerdy" or is there a good mix of personality.

Thanks!

Lifestyle is very dependent on specialty. Head and neck attending work long hours and may need to come in emegerntky at anytime for a flap going down or a hematoma, etc. On the other hand, if you do allergy and sinus, there is very rarely any complication that is immediate and you have a great lifestyle.

I think the personality in ENT is generally someone who is nice who enjoys operating. Some people are nerdy, but within our program we have multiple former collegiate athletes as well. I would say there’s a good mix

 

[medstud268]

Are there trauma ENT's? Do ENT's ever get trauma pages if there is damage to the patient's head, neck, throat, ears, etc? If so, what is the route one takes to become a trauma ENT?

It depends on the institution, but we will often get called for approaches to the neck in trauma. We also do bony facial trauma. Facial plastics and recon people can do a lot of trauma and you could make a niche of it, but it’s not a common thing. You would probably do residency and then either a head and neck or facial plastics fellowship that focuses more on recon than cosmetics