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ENT Programs that OPERATE a lot...

flashMD

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Jun 22, 2005
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    I LOVE ENT, but was really disappointed when I did my clerkship rotation....the residents really didn't get to operate! I sat through so many cases where even the chief resident was retracting most of the time! I know for a fact that I will not enjoy a residency experience where I don't actually learn to operate.

    What programs emphasize teaching/allowing their residents to operate?

    Thanks!
     
    Last edited:

    resxn

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    Oct 2, 2006
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    1. Attending Physician
      I would strongly recommend that you do not look strictly at volume of surgical cases, but ask residents at the programs to which you apply if they have a good miz of supervision.

      I trained at Colorado at it went something like this
      R-2 year - 4 months University - little operating and mostly not as primary
      4 months Children's - tons of operating mostly as primary
      4 months County - tons of operating about 50% as primary
      R-3 year - 4 months VA - tons of operating, primary depends on how good your chief is
      4 months University - moderate operating mostly as assistant
      4 months Private Hospital/Research - plastics essentially, little as primary
      R-4 year - 4 months University - good operating significant numbers as primary
      4 months Kaiser - tons and tons of operating vast majority as primary
      4 months Children's - chief, operate as much as you want as primary
      R-5 year - 4 months University - chief, operate a ton, all as primary
      4 months VA - chief, operate as much as you want as primary, but you'll be taking cases away from your jr resident
      4 months County - chief, operate a lot, all as primary

      I finished with over 3,000 cases in ENT. Granted most were at children's. I think I did 432 as primary in my first rotation their as an R-2 (it's not unusual to do 15-20 cases a day their that rotation but it's all tubes and tonsils to start)

      I had a great mix of supervision and autonomy. I don't think I would have liked it on one extreme or another. The university rotation was the best because you graduate in autonomy each year and it was not uncommon to be left alone on major head and neck cases in your chief year for the extirpation parts anyway. Same went for ear cases and others.

      Don't look for volume alone, I've heard of a major program in CA where you are primary from the get go and do a huge volume no matter where you rotate, but I've heard a lot of complaints that people wanted to have more opportunity to learn surgical technique, not just getting through cases.

      that's really all I have to say about that.
       

      flashMD

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      Jun 22, 2005
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        Thanks for the advice...I definitely agree with you. I'm not so much interested in knowing about volume of cases, but more QUALITY of the surgical training and experience. Good supervision is certainly an integral part of good training.

        I'll definitely keep Colorado in mind (I actually grew up there!) Any other programs out there with "solid" surgical training? (i.e. lots of supervision and guidance from attendings who realize they are at a TEACHING hospital and don't just want to get through the case by doing it themselves and letting you watch/retract)
         
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        chirurgino

        A pound of flesh
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        Oct 21, 2006
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        The dark side of the moon
        1. Resident [Any Field]
          I'm not a current resident (applying right now), so take this with a grain of salt--but one thing I've noticed on the interview trail is that places with a VAMC affiliate or a serious inner-city hospital affiliate tend to give a lot more autonomy at those sites. My take on it is that you want maybe 50% of your time at the university hospital where you'll learn "the right way" and then maybe 25% at the VAMC where you'll figure out "your way" combining all the techniques you learn from different attendings. FYI, one top program where the residents operate like crazy is Penn--they were essentially 3-4x the national average for "important" cases (not tubes and tonsils) except for sinus cases, where they were like 10x the national average.

          I'll also mention as an aside that places with a VAMC tend to have a LOT more semi-independent facial plastics time, if you're into that (it's free for the vets).
           

          TheThroat

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          Jan 18, 2001
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          1. Attending Physician
            I'm not a current resident (applying right now), so take this with a grain of salt--but one thing I've noticed on the interview trail is that places with a VAMC affiliate or a serious inner-city hospital affiliate tend to give a lot more autonomy at those sites. My take on it is that you want maybe 50% of your time at the university hospital where you'll learn "the right way" and then maybe 25% at the VAMC where you'll figure out "your way" combining all the techniques you learn from different attendings. FYI, one top program where the residents operate like crazy is Penn--they were essentially 3-4x the national average for "important" cases (not tubes and tonsils) except for sinus cases, where they were like 10x the national average.

            I'll also mention as an aside that places with a VAMC tend to have a LOT more semi-independent facial plastics time, if you're into that (it's free for the vets).

            Agree that having a VA or public hospital is helpful at getting more autonomy.

            I was really impressed by UT Southwestern as far as residenct autonomy.

            Iowa is a place where you would get a lot of very complex cases (skull base, neuro-oto, reconstruction). I really enjoyed my time there. I feel extremely comfortable with major ear cases and major head and neck cases coming out.
             

            aggernodi

            Private Practice ENT
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            Dec 23, 2006
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            1. Attending Physician
              At Duke where I trained, they recently had a change in policy where the attendings' pay is determined by the grade the residents give them. The program also is based on a mentorship. A resident is assigned to one attending in 6 week rotations. Where the attending is, you are whether it be in the clinic or OR. If you are a PGY2 and doing a major head & neck case, you did it as a PGY2. The Chief Resident is the only one not assigned to any attending and picks what cases he/she wants to do. Given that there are 2 or 3 OR cases going on and the chief can only be in one place at a time, juniors operate a ton right from as from the get-go and not on just tonsils and tubes.

              Only 2 residents per year... 3-4 residents in the university hospital at any given time. 9 attendings. Do the math. Needless to say, I graduated with over 3000 cases and feel quite confident both clinically and surgically.
               

              resxn

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              Oct 2, 2006
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              1. Attending Physician
                At Duke where I trained, they recently had a change in policy where the attendings' pay is determined by the grade the residents give them. The program also is based on a mentorship. A resident is assigned to one attending in 6 week rotations. Where the attending is, you are whether it be in the clinic or OR. If you are a PGY2 and doing a major head & neck case, you did it as a PGY2. The Chief Resident is the only one not assigned to any attending and picks what cases he/she wants to do. Given that there are 2 or 3 OR cases going on and the chief can only be in one place at a time, juniors operate a ton right from as from the get-go and not on just tonsils and tubes.

                Only 2 residents per year... 3-4 residents in the university hospital at any given time. 9 attendings. Do the math. Needless to say, I graduated with over 3000 cases and feel quite confident both clinically and surgically.


                That is a cool system. I'm impressed that the attendings allowed such a system to be instituted, but from a resident-advocate standpoint, I love it.
                 

                aggernodi

                Private Practice ENT
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                Dec 23, 2006
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                1. Attending Physician
                  That is a cool system. I'm impressed that the attendings allowed such a system to be instituted, but from a resident-advocate standpoint, I love it.

                  Well, the attendings don't like it from what I understand. The new chairman (Dr. Esclamado) imposed it... Wish it happened while I was there!
                   

                  TheThroat

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                  1. Attending Physician
                    I can imagine that some attendings suddenly became VERY nice. Overall, though, if you really think about it, some attendings who are great educators are not necessarily really easy to get along with. It would be neat to see if it worked, but if you look below the surface, it still may not be ideal.
                     

                    ny skindoc

                    Senior Member
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                    Jul 30, 2002
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                      I am from a top medical school and LOVE ENT, but was really disappointed when I did my clerkship rotation....the residents really didn't get to operate! I sat through so many cases where even the chief resident was retracting most of the time! I know for a fact that I will not enjoy a residency experience where I don't actually learn to operate.

                      What programs emphasize teaching/allowing their residents to operate?

                      Thanks!
                      SUNY Downstate residents operate!!
                       
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