After completing an American Board of Otolaryngology (ABOto)-compliant postgraduate year (PGY)-1 year of training, otolaryngology residents at Wake Forest School of Medicine spend the following four years gaining comprehensive inpatient training, outpatient training and research experience.
Inpatient Clinical Training
The entire inpatient experience is gained at the main teaching hospital, Wake Forest Baptist Medical Center, an 885-bed Level I trauma center that serves as the major academic referral hospital for the western half of North Carolina and surrounding regions. Brenner Children’s Hospital occupies an attached tower on the main medical campus.
Within these facilities, there are:
- Separate adult and pediatric emergency departments
- A large surgical suite with 40 operating rooms (including adult inpatient, adult outpatient and pediatric operating areas)
- Multiple subspecialty intensive care units
- Adult day hospital
- Numerous inpatient units
Having all clinical experience on one campus has distinct advantages. Residents can easily participate in the departmental academic curriculum. They get to know each other very well, as they see each other every day, eat meals together and round together. In addition, since the number of faculty is roughly the same as the number of residents, there is ample time for one-on-one interaction between them.
The inpatient clinical services in our department are divided into teams for grouping subspecialties. This forms the basis of collaboration between faculty and residents.
- General otolaryngology
- Facial plastic and reconstructive surgery
- Head and neck cancer
Each service has two to four residents, who round together in teams in the morning and then collaborate with their respective attending physicians.
Generally, residents interact primarily with the attending physicians on their team in the operating room, clinic and inpatient wards. Effort is made to make sure that all residents get a balanced exposure to all of these services during the course of their training.
Surgical experience in our department is extensive and comprehensive. Residents begin to gain experience in the operating room from day one, gradually and consistently developing their skills in performing the full spectrum of surgical procedures in our field.
Total case numbers have traditionally been well above national norms. Graduates are well-equipped to handle the types of surgical problems that typically present to the general practitioner to manage. The reputation of our program also makes our graduates attractive applicants to fellowship programs around the country.
Outpatient Clinical Training
In the outpatient experience, every resident spends one to two days per week in clinic, depending on the rotation. The majority of time is spent in attending clinic, learning how to elicit an accurate history, perform a comprehensive examination and formulate a plan for evaluation and treatment.
Successful otolaryngologists are comfortable evaluating patients in the clinic and providing long-term care for patients of all ages. A unique aspect to our program is that our clinic structure allows residents to “acquire” their own patients when they start their third year of training.
Residents provide the full spectrum of care for these patients for the duration of their training, up to three years. This includes:
- Evaluating a new patient
- Examining the patient
- Formulating a plan for workup and treatment (including surgical treatment), with the close collaboration of an attending physician
- Following up with the patient
The spectrum of pathologies that the resident sees in clinics covers the full breadth of our specialty. An experience based on continuity of care allows the resident to develop the sense of responsibility needed to treat patients and develop long-term patient relationships.
An important part of our residents’ training is learning basic research concepts and contributing original research. Faculty and residents collaborate in both clinical and basic science research.
Residents have four months of dedicated research time:
- One month during PGY-2 is spent organizing at least one research activity, presenting a research prospectus to the otolaryngology department and beginning the process of writing an internal review board application
- Two months during PGY-3 are spent doing the majority of the data acquisition and assimilation and moving projects to completion
- An additional month during PGY-4 is spent bringing open research projects to a close. Residents are required to submit a research project for presentation at any national meeting that they are scheduled to attend
Conferences and Didactics
To lay the groundwork for clinical and research exposure, the department maintains a comprehensive lecture and conference curriculum for the ongoing education of residents and faculty, which includes:
- Faculty lectures
- Wednesday morning conferences
- Temporal bone lab
- Comprehensive Otolaryngologic Curriculum, Learning through Interactive Approach (COCLIA) and Bailey’s readings
- Audiology, speech and pathology lectures
- Journal clubs
- Clinical conferences
- National and regional meetings