ENT matching concerns?

[ESPN]

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Hi everyone, Im new here, but have been reading posts here for a while.
Im a first year medical student who is interested in ENT. Ive read some of the older threads, but have two questions unique to my own situation:

1. In general, Im really interested in cancer. Since Im a first year, I cant say for sure whether Im more interested in the surgical or medicine route in its treatment. In any case, the two fields I am most interested in are ENT (cancer ressections) and IM-heme/onc (cancer treatment). I know that ENT is extremely difficult to match into, which is why Im posting here so early regarding that. But lets say 4 years down the line Im still interested in ENT and IM, is it possible for me to apply to both residencies in case I am not accepted to ENT? Would this adversely affect me?

2. Im doing clinical research right now, specifically in regards to cancer clinical trials. However, I am not working in the ENT cancer dept, but rather, in internal medicine cancer dept. I really like my PI however and am very interested in the work I am doing, but based on what Ive seen in ENT, Im really interested in that as well. Is it OK for me to continue this path of research, or would ENT residencies demand that I do ENT specific work?

I would really appreciate any suggestions and comments you might have. I know ENT is extremely difficult to match into, so as an only slightly above average student at a school not ranked in the top 10 (my school is in the next tier: 10-25), Im really worried about my chances. Thanks for any help you can provide, and I apologize if my post was too long. Thanks again! =)

 

[ny skindoc]

I would spend more time in ENT to be sure thats its what you really want as well as to make contacts and improve your chance of matching.Getting into internal medicine is no problem so if you want ENT then you will need to focus more on this specialty specifically.I dont think too many people have IM as a backup for ENT,as they are quite distinct and require very different skills.I would imagine that good alternatives to ENT would be things like general surgey,Anesthesiology,EM.

 

[TheThroat]

I agree with above. IM and Oto are very different in management styles, skills required, etc. That said, plenty of cancer runs through Oto.

Re: matching, I would first determine whether you like the OR. Most IM's determine early on that the OR is not the place for them. Conversely, surgeons find that they love the OR and want to be their all the time and would rather not be in clinic if given the choice.

This decision is best made in the third year during rotations. Prior to the third year, you can prepare for Oto match by doing some research, doing well in classes, and doing well on Step 1. Any research will do, but basic science stuff with Oto applicability is better. Otherwise, you can "think" you like something, but until you do it, just be ready for anything.

 

[ESPN]

Thanks for the helpful responses.

The thing for me is, Im not quite sure between IM and Surgery yet as a first year. However, the bad thing for me is, its likely by the time I figure out which is for me it might be too late to do the things necessary to match ENT if I end up liking surgery. Ive shadowed, but from the 3rd and 4th years Ive talked to, its a completely different world between voluntary shadowing and being on IM and surgery rotations.

From an academic standpoint, Im very interested in cancer and am sure regardless of what specialty I do, it will somehow be related to cancer. Unfortunately, Im still not even sure between the medicine and surgery dichotomy.

Thanks for the replies though, you all have been very helpful.

 

[pikachu]

Have you thought about radiation oncology? It's an easy match. 🙄

Seriously, though, your choices in oncology are not limited to medicine and surgery and you should look into rad onc if you're sure you want to treat cancer patients but can't make up your mind between the other 2 disciplines. If you try to do well in your preclinical years, and (even more important, rotations), do well on the boards, and get some research under your belt, you will be competitive in any specialty (even the scarily competitive ones). The nice thing about research is that you can make personal connections in the fields you're working in, which also helps for residency applications. and you probably won't be able to make up your mind before third year anyway...so trying to decide right now is basically mental masturbation. Which certainly has its charms but might not be what you want to spend your energies on right now.

 

[ESPN]

Have you thought about radiation oncology? It's an easy match. 🙄

Thanks for your reply. I really havent considered radonc from my own philosophy regarding cancer treatment. Its bad enough that chemo is nonspecific and thus toxic, but radiation is just as bad if not worse IMHO. I think (or hope) in the long run, radiation will be less emphasized as newer, more targetted drugs (and hence less side effects) come out.

Its definitely a great field right now, but might not be by the time I'm through training.

 

[pikachu]

Sorry if your prejudices against radiation oncology keep you out of the field. It's here to stay. New therapies are quite elegantly tailored to anatomy and are much less toxic than they were before.

I would suggest you inform yourself a little better before you go off and flame an entire specialty by hoping it's obsolete soon. Wait until you're a second year at least.

 

[TheThroat]

I wholeheartedly agree with pikachu on the subject of radonc. In fact, XRT as treatment for head and neck cancers has largely replaced, if not augmented, surgical modalities. IMRT, gamma knife, and similar RT methods have made XRT the treatment of the future of head and neck ca. This is coming from a surgeon, mind you.

 

[Blade28]

Its definitely a great field right now, but might not be by the time I'm through training.

Not sure if I can agree with this. The new advances that this field is coming up with, like the aforementioned gamma knife, etc. are just amazing. I think radiation is being used more and more nowadays, and not only as an adjunct to chemotherapy and surgery.

 

[pikachu]

thanks blade and thethroat for supporting a field that is much maligned (pun intended) by the ignorant. I might not like the side effects post mandibulectomy with radical neck dissection, but that doesn't mean I think ENT surgery shouldn't exist as a cancer treatment modality. Let's face it, head and neck cancer treatment is not fun for the patient, no matter how you approach it

Gamma knife is pretty amazing but it's not that new. Leksell (swedish neurosurgeon) invented the technology back in the late 60's. The first machine in the US was installed at Pitt in 1987. You are right that RT alone is used in the management of some lesions, but it can really only be used by itself for early stage lesions so in this respect it's much like surgery. Increasingly the trend is toward trimodality therapy for advanced tumors in the head and neck as well as many other sites.

 

[ESPN]

I would suggest you inform yourself a little better before you go off and flame an entire specialty by hoping it's obsolete soon. Wait until you're a second year at least.

First off, I didnt flame an entire specialty, I just said it didnt match my philosophy on cancer treatment. Secondly, I dont "hope" it becomes obsolete. Thirdly, not only did I thank you for your response, but at no point did I ever say that anyone entering the field is crazy, etc, I just said it didnt match MY view on how cancer should be treated.

Of course, I guess this is the problem with SDN. You ask a question, give an honest answer to a question, and then when you disagree with someone based on your own philosophy it is automatically 1) that the person is flaming any other specialty and 2) if younger than you, doesnt know what they are talking about and 3) must be responded to in the most condescending manner possible.

And frankly, pikachu, how have you convinced me that radonc is a good specialty to me? Do you think calling me ignorant or insulting my intelligence is going to make me go, "gee, well, dumping radiation on tumors 10 years from now when we have targetted therapies IS a good idea."

And yes, I know all about the gamma knife. But I also know more about the side effects, more than you think.

The sad thing is, you never really cared to wonder why I might be averse to radiation therapy in practice. Could it be because I know someone who experienced all the negatives with none of the benefit? Thanks for being a real a-hole Pikachu. Obviously it couldnt be that I have personal contact with the negative effects of radiation therapy, but rather, I must be some "ignorant" premed with an axe to grind. Get over yourself Pikachu, you're a real a-hole, and the world doesnt revolve around you and your supercharged ego. Thanks for nothing. Then again, thanks for something-- I know better than to enter a specialty that is full of arrogant self-absorbed jerks with nothing better to do than flame med students on an anonymous messageboard because theyre compensating for something...

 

[Winged Scapula]

Please keep things civil guys. While disagreement is allowed, personal attacks or name calling are not. Please read your PMs.

 

[neutropeniaboy]

ESPN,

I think a lot of the reaction was based on a number of issues:

1) You're new here. While everyone is "new" at one time or another, if you make your debut by expressing a fair degree of negativity towards another medical specialty, people aren't going to like that.

2) You're a first year medical student with 2.5 months of experience. Now, I don't know what kind of stuff you did prior to medical school (maybe you hold 3 PhDs or have a family full of radiation oncologists). But, the fact of the matter is that you're a first year student. Attendings and residents don't react well to people with your level of experience telling them what's the proverbial low down with anything.

3) Your statements reflect a lot of ignorance about radiation oncology and head and neck oncology. You clearly aren't well-versed in the literature, and you let your personal anecdotal experience get the better of your developing medical judgment.

While I think pikachu's response suffers from his trick knee jerk, he does make a point.

I won't echo the sentiments stated here previously by my colleagues, except to say that radiation therapy plays a BIG part in many forms of head and neck cancer.

 

[pikachu]

I guess I do have a trick knee when it comes to rad onc (not to mention sarcastic posting style) but there is so much negativity and ignorance out there about the field, it becomes quite frustrating. So many people shrink back in horror and look at me like I'm crazy when they hear what I want to do with the rest of my life. If I really was planning on running a chamber of horrors, it would be one thing, but radiation is well known to be a safe and effective treatment for cancer! modern radiation techniques revolutionized breast and prostate cancer treatment, can sterilize tumor beds postop, palliate bone mets, not to mention ... ok, I will get off the soapbox again. sorry.

For the purposes of full disclosure I am a fourth year applying for a rad onc spot this year. I have done a few electives and I worked in radiation oncology clinical research for a year (and worked on research throughout med school) so I do have experience with the patients and the overwhelming majority do quite well in terms of side effects and many become long term survivors of their disease. Whatever happened in the OP's experience, I feel bad, but a good radiation oncologist will back off when the side effects get too bad, and side effects don't mean the whole field should be written off. My mom got heparin induced thrombocytopenia post-MI, but I don't go around hating on Cardiology.

By the way neutropeniaboy, I'm actually a she. What made you think I was a boy?

 

[Blade28]

Strange...but whenever I meet a resident/attending in rad onc, the first thought that comes to mind is, "wow, this person must have rocked Step 1." 🙂

It is truly a noble, compassionate profession.

 

[HiddenTruth]

Strange...but whenever I meet a resident/attending in rad onc, the first thought that comes to mind is, "wow, this person must have rocked Step 1." 🙂

It is truly a noble, compassionate profession.

O wow--is it that competetive? As compet. as ortho/rads/ent/uro?

 

[neutropeniaboy]

By the way neutropeniaboy, I'm actually a she. What made you think I was a boy?

My apologies.

...a combination of old world sexism (probably) and my general disdain for writing "he/she" or doing any amount of background investigation before I open my fat mouth...

 

[Blade28]

I would have guessed female based on "pikachu," but then again, I'd just be guessing too. 🙂

O wow--is it that competetive? As compet. as ortho/rads/ent/uro?

Hmmm...good question. I usually put derm first, then rad onc, ENT, plastics, rads, etc. all lumped together.

 

[Celiac Plexus]

Some more personal anecdotal idiocy sure to undermine my credibility:

All rad onc residents are hot females.

Seriously, in the brief span of my medical career it seems like 90% of the rad onc residents I meet are f***in' beautiful women. (n~7)

Derm chicks come in a close second.

 

[neutropeniaboy]

Derm chicks come in a close second.

That's funny. I used to say it was that way about peds, but I have to agree with the derm thing.

 

[doc05]

That's funny. I used to say it was that way about peds, but I have to agree with the derm thing.

thing is that with derm, they all look good. in peds, it's really hit-or-miss. 😉

 

[Blade28]

Agree with derm.

 

[funkless]

This thread is, if nothing else, great comedy. How in the hell did ESPN manage to get banned inside his first 10 posts?



--Funkless

 

[neutropeniaboy]

This thread is, if nothing else, great comedy. How in the hell did ESPN manage to get banned inside his first 10 posts?



--Funkless

Dunno.

I bet he unleashed it within a PM he sent. Maybe he imploded with frustration.

 

[Spiff]

It's too bad when you get people all fired up about something they don't know a whole lot about. Rad-Onc is starting to offer some real possibilities in the head & neck cancer area. Once IMRT gets more established in the head and neck oncology arena, I think it is going to be a great boon to patients. A friend of mine was showing me some pretty impressive study (to me at least) data from UCSF the other day regarding IMRT vs. glossectomy on morbidity/survival rates fro primary tumor treatment. We're talking about equivalent outcomes with minimal xerostomia/odynophagia/mucosal irritation. Prejudices die hard, I guess.

 

[pikachu]

Dunno.

I bet he unleashed it within a PM he sent. Maybe he imploded with frustration.

Probably he's throwing instruments all over the Gross Lab in a fit of rage.