The Otolaryngology Training Program at Vanderbilt University Medical Center accepts four residents per year. The 5-year training program in Otolaryngology consists of 4 years of progressive training in Otolaryngology-Head and Neck Surgery, preceded by 1 year in general surgery. All residents do their general surgery training at Vanderbilt under the direction of the Otolaryngology Program Director and in collaboration with the Program Director for the Department of General Surgery. The general surgery training takes place at Vanderbilt University Hospital and the Veterans Administration Hospital, which is located on the Vanderbilt campus. During the first year on general surgery (PGY-1), the residents are expected to gain sufficient experience in the basic understanding of pre- and postoperative patient care, management of acute trauma of the head, chest, and abdomen, understanding of soft tissue surgical techniques, diagnosis and treatment of pulmonary and cardiac diseases, understanding of the basic problems of the surgical subspecialties, including anesthesia, neurosurgery, vascular surgery, thoracic surgery, plastic surgery, general surgery, trauma surgery, oral surgery, and emergency medicine. One month of the PGY-1 year is spent on the otolaryngology service.
The four years of Otolaryngology training are divided into four services at Vanderbilt: The Head and Neck Service, the General Otolaryngology Service, the Pediatric Otolarygology Service, and the Otology/Neurotology Service. Each resident rotates on all of these services. In addition, the PGY-5 and the PGY-2 residents rotate at the Veteran’s Administration Otolaryngology service.
The first year of otolaryngology is directed toward developing clinical skills, in taking a history and performing a physical examination of the head and neck, as well as determining the diagnosis and treatment of common pathologic conditions of the ears, nose, throat, head and neck. Each resident spends 3 months on the Head and Neck Service at Vanderbilt, 3 months on the Pediatric Otolaryngology Service, and 3 months on the General Otolaryngology Service. In addition to the 9 months spent at Vanderbilt, the PGY-2 resident will spend 3 months working with a PGY-5 resident at the VA Medical Center. All of the residents participate in the outpatient clinical activities and gain significant experience in examination techniques and develop diagnostic abilities in Otolaryngology on both adult and pediatric patient populations. While on the General Otolaryngology and Pediatric Otolaryngology Services, thePGY-2 resident is also responsible for seeing consults during the day. Each resident also participates in specialty clinics, such as laryngology, rhinology/allergy, adult and pediatric otology, neurotology and head and neck clinics. Exposure and experience with the following surgical procedures are required from the PGY-2 Otolaryngology residents: excision of neck masses, tonsillectomy and adenoidectomy, SMR/septoplasty, myringotomy, myringoplasty, closed and open reduction of facial fractures, repair of complicated soft tissue defects, adult direct laryngoscopy and diagnostic endoscopy, surgery of the maxillary sinus, tracheotomy, skin grafts, nasal polypectomy, CO2 laser microlaryngosurgery, and much more.
In the second year of training (PGY-3), each resident will spend 6 months in the research laboratory working with one of the Department’s full-time faculty or other approved Vanderbilt faculty on a particular research project. The other 6 months is divided between the General/Rhinology Service and the Otology/Neurotology Service. During this time, the PGY-3 resident will gain continued experience and comfort in the management of otolaryngology patients. Increasing responsibilities are reflected by the resident’s involvement in teaching of medical students and residents of other programs in the Vanderbilt system, continuation of experience in managing patients seen in the outpatient clinic, and refining diagnostic and treatment skills. Knowledge of the workup and differential diagnosis is acquired for complex diseases related to Otolaryngology-Head and Neck Surgery (acoustic neuroma, Ménière’s disease, vertigo, hearing loss, allergy-mediated diseases, sinonasal malignancy, and skull base tumors). The second year Otolaryngology resident also acquires knowledge and develops skills in the management of complex postoperative problems. Exposure to and experience with the following surgical procedures are considered essential during this year of training: tympanoplasty, mastoidectomy, sinus surgery, cochlear implantation, ossicular chain reconstruction, stapedectomy, endoscopic orbital decompression, septoplasty, and transphenoidal approaches to pituitary lesions.
This year the resident spends 12 months at Vanderbilt University Hospital. During these 12 months, the resident will spend time divided between the Head and Neck Service, the General Service, and the Pediatric Otolaryngology Service. During this year, the resident has tremendous responsibility in the management of his patients. This is the year that the resident develops knowledge and experience in the management of various medical and surgical complications, as well as becoming aware of the various rehabilitation techniques and procedures currently being performed in Otolaryngology-Head and Neck Surgery. Surgical skills learned during this year include: superficial and total parotidectomy, thyroidectomy, modified neck dissection, composite resection, maxillectomy, rhinoplasty, face lift, blepharoplasty, otoplasty, correction of congenital deformities, facial nerve decompression, and removal of nasopharyngeal tumors, composite resections of the head and neck with microvascular reconstruction, total laryngectomy, and skull base surgery. Transoral Robotic Surgery is also experienced starting in the PGY-4 year.
The fourth year of Otolaryngology training (chief resident/PGY-5) is one of total responsibility involving administrative duties pertaining to scheduling, residency training, teaching assignments including medical students, and completion of ongoing research projects. Total exposure to the surgical experience of the full-time and part-time staff is the highlight of this year. This surgical experience should provide each chief resident with adequate training for certification in the specialty of Otolaryngology-Head and Neck Surgery. Each fourth year (PGY-5) resident serves as a chief resident of the Vanderbilt Head and Neck Service, the General Otolaryngology Service, the Veteran’s Administration Hospital Service, and also the Otology/Neurotology Service. The chief resident is administratively responsible for all aspects of patient care and for all categories of diseases in the head and neck including cancer, allergy, neurotology, hearing and equilibrium, plastic and reconstructive surgery, laryngology, adult and pediatric endoscopy, and diseases of the paranasal sinuses, including endoscopic sinus techniques. The chief resident will develop an understanding of chemotherapy and radiation therapy in the management of head and neck cancer and will acquire experience in the following surgical procedures: partial laryngectomy, tracheal resection and reconstruction, laryngotracheoplasty, thyroidectomy (subtotal and total), parathyroidectomy, temporal bone resection including skull base surgery, complicated reconstructive problems of the head and neck (including microvascular reconstructive surgery), neurotology (including middle cranial fossa surgery), and major pediatric otolaryngological surgery. The chief resident develops a great fund of knowledge and experience in the management of difficult medical and surgical complications and their treatment. The chief resident participates actively in teaching medical students, paramedical personnel, junior Otolaryngology residents and residents from other services at Vanderbilt.