The first year of residency is spent under the guidance of Otolaryngology, but most of the time spent is on rotations in the Department of General Surgery. Interns spend 2 months on the ENT Service. They are required to spend one month on neurosurgery, one month in the emergency room, one month in the intensive care unit setting, and one month of anesthesia. The six remaining months are spent on rotating General Surgery Services at MUSC and the Ralph H. Johnson V.A. Medical Center. These can include but are not limited to pediatric surgery, surgical oncology, general and vascular surgery, thoracic surgery, transplant surgery, and GI surgery. During each rotation, the intern focuses on developing skills in obtaining a complete history and perfecting physical examination skills. The intern learns how to manage basic and progressively more complicated patient issues in both in-patient and out-patient settings. The intern is required to take and pass the USMLE Step 3 examination. The intern has the opportunity to begin to develop surgical skills on the various services during the intern year.
The first full Otolaryngology year (PGY-2) focuses on developing clinical skills, such as taking patient histories and performing thorough head and neck examinations. The resident spends nine months on services at the Medical University Hospital and two months at the VA Medical Center otolaryngology service. During each rotation and at all PGY levels, residents help staff by attending clinics when they are not in the Operating Room. In addition to serving as first assistant on more complex cases such as head and neck cancer resections, the PGY-2 gains proficiency at basic otolaryngological surgical techniques, including the following:
- Endoscopy of the upper aerodigestive tract
- Myringotomy and tube placement
- Basic rhinologic procedures
PGY-2 residents also complete a one-month rotation in audiology, speech pathology and allergy. Call responsibilities for PGY-2 residents are every sixth night as the junior resident on call. The PGY-2 resident is responsible for taking the majority of daytime inpatient and Emergency Department consults. Experience in the management of facial trauma is gained during the four months of the year in which the otolaryngology service covers call for Facial Trauma.
The second clinical Otolaryngology year (PGY-3) builds on the principles developed during the PGY-2 year. The PGY-3 resident spends six months on services at the Medical University Hospital, two months at the VA Medical Center and four months on a research rotation. Operative experiences become more complex as the PGY-3 resident participates actively in the following:
- Oncologic cases
- Rhinology and Sinus surgery
- Uncomplicated Otologic procedures
- Facial Plastic and Reconstructive cases
- Thyroid and major salivary gland cases
A greater role is played in the operative management of facial trauma, and call responsibilities are every sixth night as the junior resident.
The third clinical Otolaryngology year (PGY-4) continues the theme of graduated responsibility as PGY-4 residents serve as chiefs of their respective services. They spend four months as chief of the VA Medical Center otolaryngology service, seven months as chief of various services, and one month on a facial plastics and reconstructive service. PGY-4 residents serve as the resident surgeon on the majority of cases in which they are involved over the entire spectrum of surgical Otolaryngology, including the following:
- Otologic surgery
- Nasal and Sinus surgery
- Plastic and Reconstructive procedures
- Thyroid and Salivary Gland surgery
- Head and Neck Cancer resection and reconstruction
- Facial Trauma repair
PGY-4 residents take senior level call every sixth night. The responsibility as chief of service during this year provides exceptional opportunity for clinical and leadership maturation, and it facilitates the transition to chief resident.
During the chief year, the residents spend three months on the Head and Neck Service, four months on the other two General Services and one month on the facial plastics rotation. The chief resident year (PGY-5) is one in which the resident refines his or her skills in preparation for certification in otolaryngology – head and neck surgery. In addition to serving as resident surgeon or supervisor on all of the above-mentioned procedures, the chief resident plays an active role in the most complex cases, including advanced head and neck cancer, skull base surgery, CSF leak repair and neurotologic cases. In addition, the chief residents have a number of administrative responsibilities in planning the educational and lecture curriculum, making the call schedules, and overseeing the daily function of various services. Chief residents take senior level call every sixth night.