The goals of the PGY-1 year are:
- learning the basics of inpatient and outpatient
- mastery of fundamental surgical techniques
- development of interpersonal and communication skills in dealing with
patients, families, staff, and colleagues
- development of habits of professionalism
- introduction of concepts of
- learning to practice as part of
The first year of training require 3 months in General Surgery is offered under the supervision of the Department of Surgery of the University of Maryland School of Medicine. A slot in the General Surgery PGY-1 year is reserved for all residents successfully matching in Otolaryngology, and all residents are required to complete their general surgery at University of Maryland. Residents rotate for 3 months on the General Surgery services at the University of Maryland Medical Center, Mercy Hospital, and the Baltimore Veterans Administration Hospital. At each site, there is close supervision by senior residents and attending staff. Rotations include surgical subspecialties such as Neurosurgery, Pediatric Surgery, and Thoracic Surgery which provide valuable experience. Exposure to the emergency room and trauma care help prepare the resident for Otolaryngology training. During this year, emphasis is placed on training in total care of the surgical patient including ICU evaluations and management. The residents develop proficiency in basic surgical techniques. Residents are carefully evaluated by each of these services and their performance is communicated to the Chairman of Surgery as well as the Director of Otorhinolaryngology.
The goals of the PGY-2 (Oto-1) are:
- To become skilled at history taking
and physical diagnosis of OHNS patients
- To become proficient in the
use of ancillary testing and the interpretation of these tests (imaging, laboratory,
audiology, vestibular testing)
- To learn how to integrate clinical information
in order to formulate a comprehensive differential diagnosis and to accurately
diagnose otolaryngology patients
- To assume increasing responsibility for
the outpatient management of patients in a carefully supervised setting
- To learn the routines and needs special to the in-patient management of OHNS
- To develop a familiarity with the unique surgical tools and
techniques used within the specialty
- To learn to practice with respect,
compassion and integrity
- To participate in practice-based learning through
departmental quality assurance activities such as mortality morbidity conferences
- To begin to learn cost effective health care and resource allocation
that does not compromise the quality of care.
At the University of Maryland
Medical Center, PGY-2 residents divide their time between the outpatient
department, the operating room and inpatient area. On non-operative
days, the PGY-2 resident works in the clinic seeing outpatients. This
includes the initial evaluation and workup of new patients requiring
surgery. This clinical experience allows the residents to become
thoroughly familiar with the patients and their medical problems, and
allows the resident to follow patient progress. Preparation of
patients for admission includes explaining procedures to patients and
their families, obtaining consent, collecting and reviewing laboratory
and x-ray results, and obtaining necessary consultations. PGY-2
residents are supervised in all these activities by attending staff
that provide examples. The faculty observes and evaluates the
resident performance and provides guidance and feedback on a daily basis.
In the outpatient department, PGY-2 residents see patients with an attending,
manage their care and carry out procedures. Outpatient procedures
include insertion of PE tubes, biopsies, reduction of nasal fractures,
control of nasal hemorrhage, incision and drainage of peritonsillar
and other abscesses, fiberoptic laryngoscopies and bronchoscopies and
excision of skin lesions, all under the supervision of the attending
staff. Residents participate in the teaching of medical students.
During this period, intensive instruction is given in the Otolaryngology-Head
and Neck examination. An effort is made to foster standard approaches
to clinical evaluation and treatment.
The PGY-2 residents spend about
one half of their time in the operating room. Residents scrub
and assist in surgery and are questioned on the basic science and clinical
information pertaining to each case. Residents are expected to
have reviewed all medical records, laboratory tests and radiographs
and to have read about the condition necessitating the surgery and the
details of the operation prior to the surgery. PGY-2 residents
are given progressive responsibility to carry out some operations under
direct attending supervision. These include tonsillectomy, adenoidectomy,
tracheostomy, myringotomy, PE tube insertion, direct laryngoscopy, esophagoscopy,
and rigid and fiberoptic bronchoscopy. An attending is physically
present for all cases performed in the operating room and provides careful
supervision and instruction.
At the Baltimore VA Medical
Center, there are two residents at all times, one PGY2 resident and
a more senior resident (either PGY-4 or PGY-5), and these residents
work with VA Program Supervisor, Dr. Rodney
Taylor and Dr. Jeffrey Wolf. PGY-2 residents see patients in the
VA outpatient OHNS clinic two and a half days a week under the supervision
of the faculty, and they participate in surgery two and a half days
a week. The VA assignment in the PGY-2 year provides a large volume
and breadth of clinical experience. Resident responsibilities
and surgery experience are similar to that at UMMS. Systems-based
practice is taught as residents learn to use the completely computer
based medical records system. All outpatient and inpatient notes are typed in by the residents.
Residents benefit by having all medical information quickly available. The VA has had a totally digital radiology system for several years
and residents gain proficiency in accessing this system. Residents
attend teaching conferences at UMMS. The temporal bone laboratory
is located at the VA hospital and residents spend time dissecting temporal
bones and performing operations on them. Every Monday is devoted
to facial plastic and reconstructive cases including skin cancers, blepharoplasties,
rhinoplasties and face lifts.
The goals of the PGY-3 year are:
- To develop further independence in the evaluation and treatment of
- To develop skills in more complex surgical procedures
- To become an accomplished teacher of medical students and more junior
- To design and perform a research project in close collaboration
with a research mentor.
At the University of Maryland
Medical Center, the PGY-3 resident works in the Outpatient Department
seeing patients under the supervision of the attending staff, carrying
out some minor surgery procedures and seeing inpatient consultations
on nights and weekends. The PGY-3 resident also participates in
surgical procedures in the operating room. During this year, the
residents achieve proficiency in nasal septal reconstructions and basic
principles and techniques of endoscopic sinus surgery. The PGY-3
year includes basic surgical experience in otologic procedures ranging
from tympanoplasty to skull base surgery. The residents in this
year also advance their skills in microlaryngoscopy and vocal fold procedures
as well as general aerodigestive endoscopy skills.
At the VA Medical Center, PGY-3
residents see patients in the outpatient offices and participate in
surgery. Progressively more responsibility is given to the PGY-3
resident as competence is demonstrated. The PGY-3 resident attends all
teaching conferences at UMMC.
All PGY-3 residents have a dedicated
research block of either four or six months. This research block
is fully dedicated time without clinical responsibilities or night call. Planning for the research experience starts in the PGY-2 year with the
choice of a mentor followed by preparation of an abstract and budget
for the project by mid-April. The research can be within the divisional
laboratories or within other departments including Anatomy, Environmental
Toxicology, Oncology, Radiation Oncology, and Molecular Biology laboratories
within the Dental School. Our Otolaryngology program has strong
ties with the National Institutes of Health, and residents may choose
to perform their research with a pre-approved mentor from the NIH.
Prior to the research rotation, the resident presents his proposal at
group conferences and obtains suggestions and final approval from the
program director. Scheduled progress reports as well as a final
report are done on each project. Presentation of the results at
national meetings and publication of manuscripts is supported by the
The goals of the PGY-4 year are 1) to become more independent in patient care and to help supervise the care rendered by the more junior residents, 2) to become skilled with complex surgical procedures, and 3) to take responsibility for the urgent management of Shock Trauma patients. The PGY-4 year includes rotations at the University of Maryland Medical Centter, and the Baltimore Veterans Administration Hospital.
In years with two PGY-4 residents, each resident spends 12 months at the University of Maryland Medical Center,(six of these months on the Trauma/Consult service and six months in the outpatient office). In years with three PGY-4 residents, each spends eight months at the University of Maryland Medical Center (four of these months on the Trauma/Consult service and four months in the outpatient office), and four months at the Baltimore Veterans Administration Hospital.
During the trauma rotation the PGY-4 resident at UMMC is responsible for both facial trauma at the R Adams Cowley Shock Trauma Center, and inpatient consults. Under the supervision of the facial plastics team, this resident sees and evaluates patients with facial trauma, scrubs on their surgery and follows them post-operatively. The PGY-4 resident sees an average of four new inpatient consults per day. The PGY-4 resident on this rotation scrubs on surgery done on inpatient consults including transsphenoidal pituitary surgery. Some time during this rotation is spent in the University of Maryland Voice and Swallow Center. During this time experience is gained in laryngeal videostroboscopy, electromyography, esophageal manometry, pH studies and treatment of laryngeal spasmodic dysphonia with injections of Botox.
The PGY-4 rotation in the outpatient office at University of Maryland Medical Center involves seeing patients in the clinic, and helping to teach the PGY-2 and PGY-3 residents and medical students. The PGY-4 resident has one day a week in the operating room and scrubs on cases that include head and neck cancer surgery, sinus surgery, and surgery of the major salivary glands. During this rotation, the PGY-4 resident also participates in the monthly Cleft Palate Clinic held at University of Maryland Rehabilitation & Orthopaedics Institute formerly Kernan Hospital (part of the University of Maryland Medical System). This experience provides valuable training in the evaluation of children with cleft lip, cleft palate, major craniofacial anomalies and with complications of these conditions that affect the ears, nose and throat.
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, and tympanomastoidectomy. Every other Monday at the VA hospital is dedicated to facial plastic and reconstructive procedures including cosmetic surgery of the face. On alternate Mondays, residents participate in a facial plastic surgery clinic. Under direct supervision of our facial plastics team, PGY-4 residents participate in patient care and surgery including local and regional tissue advancement flaps, rhinoplasty, blepharoplasty, face lifts, and hair transplantation.
During the PGY-5 year, residents
round out diagnostic and surgical skills to become experienced and competent
otorhinolaryngologists. Specific goals include:
in the most complex and sophisticated surgical procedures
- taking responsibility and providing first back up to junior residents taking
- developing administrative skill in handling a busy and
In years with two PGY-5 residents,
each resident spends twelve months at the University of Maryland Medical
Center. In years with three PGY-5 residents, each resident spends
eight months at the University of Maryland Medical Center and four months
at the Baltimore Veterans Administration Medical Center.
The chief resident has responsibility
for managing all clinical activities at the University of Maryland Medical
Center and at the Baltimore Veterans Administration Medical Center.
The chief resident acts in a supervisory role with the more junior residents,
assisting in the Outpatient Department and directing the inpatient service.
The resident is given progressive responsibility in patient management
and surgical experience as clinical maturity is demonstrated to the
faculty. Residents obtain experience in all major otolaryngologic
surgery including advanced head and neck cancer resections, tympanomastoidectomy,
stapedectomy, facial nerve surgery, acoustic neuroma resections, cochlear
implants, facial plastic and reconstructive surgery, skull base surgery,
and airway surgery of the pediatric otolaryngology patient.
The PGY-5 resident plays an administrative
role in organizing monthly journal club, a biweekly radiology conference
and other clinical conferences. At the completion of the PGY-5
year, each resident is expected to have proficiency in the diverse patient
care diagnostic and clinical management issues as well as surgical procedures
of Otorhinolaryngology-Head & Neck Surgery.