otorhinolaryngology surgery training

With subspecialists in every Otolaryngology discipline at University of Maryland Medical Center, in addition to clinical experiences at the attached R Adams Crawley Shock Trauma Center, Baltimore VA medical Center, University of Maryland Midtown center our residents benefit from a high clinical volume and a broad surgical experience. Our rotation schedule provides an immersive and progressive education in each subspecialty, tailored to resident growth.

The addition of physician extenders ensures that resident time is devoted to educational tasks, with less educationally beneficial tasks performed by the extenders under the guidance of the physicians.

UMMC is an NCI accredited Comprehensive Cancer Center, one of few such centers in the nation.

View a block diagram of the resident rotation schedule by year.

Post Graduate Year 1

PGY-1 residents are completely integrated into the Otolaryngology department and spend six months rotating through general otolaryngology, pediatric otolaryngology and head and neck surgery. In addition, PGY-1s rotate through plastic surgery, radiation oncology (where they also spend time in neuroradiology), surgical intensive care, anesthesiology, emergency medicine and general surgery.
Each PGY-1 spends their first month within the Otolaryngology service where they learn key skills such as flexible laryngoscopy, performance and interpretation of audiograms, vestibular testing and other audiology tests, and basic surgical skills. The residents spend dedicated time with our audiologists and speech pathologists to learn key facets of those specialties to facilitate future professional collaboration.

Post Graduate Year 2

The PGY-2 residents have dedicated rotations in pediatric otolaryngology/laryngology, otology and neurotology/general otolaryngology, head and neck surgery and two months as the dedicated inpatient consult resident. They also spend 4 months at the Baltimore VA medical center.  During the pediatric otolaryngology rotation, residents experience a blend of supervised outpatient, inpatient and surgical experiences across the breadth of the subspecialty at the University of Maryland Children’s Hospital. Residents will have the opportunity to treat both common and complex pediatric disorders of the head and neck including pediatric sleep apnea, laryngomalacia, airway stenosis/abnormalities and congenital neck masses. Residents work closely with the attending faculty and pediatric nurse practitioners as a part of the team managing all inpatients and outpatients.

During the laryngology portion of the rotation, there is a balance of outpatient evaluation, treatment, and surgical care including the performance of stroboscopic examinations and assisting on outpatient laryngeal procedures. The resident will have the ability to participate in our multidisciplinary voice and swallowing team with our Speech-Language Pathologists, learning the fundamentals of the evaluation process of voice, swallowing and airway disorders. Specialty-focused teaching includes “stroboscopy rounds” with the attending to review clinical videos. 
While on the otology and neurotology rotation, residents spend time learning the outpatient evaluation and management of otologic problems and get early exposure to ear and lateral skull base surgery. Surgical cases are discussed at the semi-weekly interdisciplinary Otology-Audiology conference. The addition of endoscopic middle ear surgery technology broadens the resident’s surgical training and allows them to gain exposure to principles of this innovative technique.

Residents also spend time in the temporal bone lab on a regular basis, with ready access to fresh cadaveric bones. During the General Otolaryngology days of the rotation the resident will spend time in the operating room at two of our satellite hospitals, Maryland Midtown Medical Center and St. Agnes Hospital, where they will have exposure to community-based ENT and early exposure to sinus surgery.

At the Baltimore VA Medical Center, PGY-2 residents care for veterans with a wide range of otolaryngologic problems both in the outpatient clinic and the operating room. The VA is staffed entirely by departmental faculty who practice both at university and at the VA. Progressive responsibility and independence are given to the PGY-2 resident as competence is demonstrated.

On the Head and Neck service residents spend time both in the inpatient and outpatient setting learning the management of complex cancer patients. They participate as junior surgeon in operative cases, including both ablative and reconstructive oncologic procedures. They will also be exposed to elements of non-oncologic Head & Neck pathology such as salivary disease and endocrine surgery. There is a weekly multidisciplinary tumor board meeting as well as regular head and neck journal clubs to keep abreast of recent literature.

As the consult resident, the PGY-2 and 3 residents are responsible for inpatient and emergency room consults during the day across the breadth of the specialty. They will have the opportunity to perform inpatient surgical procedures such as tracheostomy, drainage of deep neck space abscesses and surgical control of epistaxis. During the weeks we are on facial trauma the resident will also be involved in the surgical and non-surgical management of facial trauma. Our service rotates for one full week every three weeks as the on-call team for maxillofacial trauma at the University of Maryland’s R. Adams Cowley Shock Trauma Center (STC), the busiest trauma center in the country. During the weeks we are on call we have a dedicated OR suite for the entire week in the STC for all trauma cases.

Post Graduate Year 3

All PGY-3 residents will have a dedicated research block of four months.  This research block is fully dedicated time without clinical responsibilities during the day. Our department has 5 independently funded labs specializing in auditory genetics and genomics, tumor immunology and stem-cell research. Residents prepare an approved research protocol before beginning their rotation and the presentation of findings at national meetings or publication of research manuscripts is supported by the department.
PGY-3 Residents also spend 2 months each as the junior resident on the Head and Neck, Peds/laryngology and general/otology services is addition to 2 months as the consult resident.  These are very similar to the experiences of the PGY-2 resident as described above but with progressive autonomy. 

Post Graduate Year 4

The PGY-4 and PGY-5 residents are considered chief residents and the leader of their service. The PGY-4 residents have dedicated rotations in Head and Neck Surgery, Facial Plastics/Rhinology, Adult and Pediatric Airway/Flex as well as 4 months at the Baltimore VA medical center.

On the Head and Neck Surgery rotation the resident participates in both the outpatient and inpatient care of the head and neck cancer patient on our high-volume head and neck cancer service. The resident has increased autonomy compared to junior residents and perform complex head and neck ablative and reconstructive procedures under the supervision of the faculty as the senior trainee.

The senior head and neck resident will also learn principles and techniques of robotic surgery on the DaVinci system and participate in endocrine surgical procedures with faculty in the endocrine surgery division of our surgery department. 

During the trauma/facial plastics rotation the senior residents are responsible for caring for patients with facial trauma at the R Adams Cowley Shock Trauma Center, as well as patients undergoing cosmetic and reconstructive procedures. The Cowley STC is the busiest trauma center in the country, and is a dedicated, full-service, level 1 trauma hospital physically connected to UMMC. Residents have broad exposure to the full range of facial plastic surgery from office based cosmetic procedures (including Botox, fillers, lasers) to rhinoplasties to free flaps for head and neck cancer reconstruction.

On the rhinology portion of the rotation residents participate in advanced sinus cases as well as skull base surgery such as anterior open and endoscopic skull base surgery, including endoscopic transsphenoidal pituitary surgery, repair of CSF leaks, anterolateral approaches to the skull base. They will also obtain experience in allergy testing and interpretation in our Allergy clinic.

The PGY-4 and PGY-5 resident each spend a two 2-month block as the Adult and Pediatric Airway resident where they serve as the chief resident for the pediatric otolaryngology/laryngology service and participate in all complex airway cases in adults and children including endoscopic airway surgery, laryngotracheal reconstructions, tracheal resections, laryngeal framework surgery, and have the opportunity to participate in the multidisciplinary adult airway conference. This rotation also serves as a “flex” rotation where residents can spend extra time in areas of interest or in areas where they may feel deficient (especially as it relates to COVID related cancellation of elective surgeries).  Residents also have the opportunity to work with a Moh’s surgeon at UMMC during this rotation to improve their skills in local flaps.  

At the Baltimore Veterans Administration Hospital, the PGY-4 resident carries out all major otolaryngologic surgery under the direction of the attending staff. Cases include laryngectomy and radical neck dissection, endoscopic sinus surgery, cochlear implants and tympanomastoidectomy. Every other Monday at the VA hospital is dedicated to facial plastic and reconstructive procedures.

Post Graduate Year 5

During the PGY-5 year, residents spend 4 months on a dedicated Otology/General ENT rotation, 4 months on Head and Neck Surgery, 2 months on Facial Plastics/Rhinology and 2 months Advanced Airway/Flex and act as the chief of each of these services.

On the Otology-Neurotology rotation chief residents are completely immersed in the care of patients with otologic disease and tumors of the lateral skull base. Residents are actively engaged in the pre, intra and post-operative care of patients in addition to their long-term follow up in the outpatient clinic. Residents also evaluate and treat patients with medical Otologic and Neurotologic disorders in the outpatient offices. In addition to classic general surgical Otology, with a large volume of chronic ear disease, ossicular chain reconstruction and otosclerosis surgery, the Department has a very busy hearing restoration program with a large volume of cochlear and bone conduction implants, and a busy skull base service. There are no fellows in the Department, and residents participate in all these procedures as the senior surgeon in training.

The chief resident will be primarily focused on Otology during this rotation but will have the opportunity to prepare for going into practice by working with our general ENTs at our community-based sites as desired.

As a PGY-5 the resident will again spend time on the Head and Neck, Facial Plastics/Rhinology and the Advanced Airway/Flex Rotation. These rotations are similar to the PGY-4 descriptions but with increased responsibility and autonomy.

Resident Call

  • PGY-1 residents do not take primary call for Otolaryngology, though they do a “buddy” call for the first half of the night on some days. Residents can learn the ropes of the call this way in a supervised fashion.
  • PGY-2 and 3 residents take in house call every 6th night, on average. We transitioned to in-house call based on resident feedback and it has been felt to be a significant improvement over home call.
  • PGY-4 and 5 residents take senior resident back up call from home.  They are always immediately available by phone and physically present when necessary.  

Duty hours regulations are adhered to strictly for all levels. Faculty physicians on call are always immediately available by phone and physically present in the hospital when necessary for supervision.  Faculty round on every inpatient daily, even on weekends/holidays.