Head and Neck Oncology/Microvascular

[Gonefishing]

Does anyone know which residency programs are known for having the most extensive head and neck experience?

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[exmike]

probably the ones with h&n fellowships along with a few others..

 

[resxn]

I may add a corollary to that. I'd find a program that has good H&N without a fellow. Fellows tend to take too many of the good cases. When you're the chief last thing you need is for a fellow to swoop in on your craniofacial resection and take it away last minute. You then have to go boot the 3rd year off their sinus case. The 3rd year isn't going to clinic and boots the 2nd back there so he can do the thyroglossal duct cyst. Jr resident is pissed and in clinic AGAIN.

I always have heard that places without fellows tend to have a better operative experience for residents than those with fellows. I'm sure there are exceptions.

 

[TheThroat]

Most programs prepare you pretty well for H&N. I went to a program with a H&N fellow, but they had very strict restrictions on cases that they could do. Basically, they're job was to learn microvascular. Other complex cases were for the chiefs.

 

[otopico]

I'm interviewing for H&N/Micro fellowships right now, and at least at the places I've been they are pretty strict on the fellow's role. They flat out have said the fellowship is not a remedial course in head and neck - they expect you to come in comfortable with most types of cases (obviously complex cases are an exception). Your role is to a) learn micro b) take residents through resections. That being said, there are some places doing things such as transoral laser surgery that isn't being done at a lot of centers. I would necessarily want to be doing these cases, at least early on. I guess each person is different, and some people may take cases away from residents but that should not be the norm.

 

[Gonefishing]

Thank you for the advice. I will be looking for a PGY2 spot in the near future, and my options will be limited. So I didn't want to end up at a program that doesn't do a lot of craniofacial, oncology, trauma, microvascular, and facial nerve surgery which are my main interests.

Any advice on which programs have the best residency experiences in these fields? Everyone I talk to says Penn, MEEI, OSU, Baylor, and Oregon. Any others?

 

[otopico]

Thank you for the advice. I will be looking for a PGY2 spot in the near future, and my options will be limited. So I didn't want to end up at a program that doesn't do a lot of craniofacial, oncology, trauma, microvascular, and facial nerve surgery which are my main interests.

Any advice on which programs have the best residency experiences in these fields? Everyone I talk to says Penn, MEEI, OSU, Baylor, and Oregon. Any others?

I think most programs will give you a fairly good head and neck experience. From what I know, the programs you listed all have great head and neck programs. Penn does a diverse mix of resection, endocrine, transoral laser with/without robotics, skullbase, and free flaps; OSU does a ton of resections with more local/regional than free flaps, Oregon does a ton of flaps (Wax is a very active micro guy there), not sure about MEEI or Baylor. Bottom line is regardless of where you go most places will train you well in head and neck.


The areas you listed interest in are pretty broad so you may not find all of them wrapped up into one. Particularly if you are going to try and fall into a PGY-2 spot which is pretty difficult I wouldn't be too concerned about all the specifics.

 

[Leforte]

If you're looking for a PGY2 spot - take any that open up. Can't be too picky, as there are 50 other people right behind you who would jump on it. If your program is weak in H&N (which most are not) - you can pick up the advanced stuff in fellowship. The advanced skull base stuff (lateral T-bone resections, up and downs with neurosurg,) microcascular, etc are becoming the domain of the fellowship trained surgeon. Some in the past were able to do this without the additional training, but I think things have changed in the past 10 years or so. Also, once you get out into practice, you may be proficient with the advanced stuff once you leave residency - but the skills can atrophy quickly once you set up your own practice. Plus the fact that you can do 10 tubes in 2.5 hrs and be home by noon for the same remuneration as a 14 hr flap that sits in the hospital for the next 10 days. I think like 75% of our applicants this year said they loved H&N, wanted to do a fellowship, etc - but <<10% of our residency graduates nationally pursue a fellowship in this area. My guess is that this is in part due to time (as an attending) and financial considerations.

You'll get all the trauma, FN/parotids and oncology you need at any ENT program.