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The Successful Match

How To Succeed In Your Otolaryngology Rotation: Tips For Medical Students

May 19, 2017

Although NRMP data indicates that otolaryngology has become a bit less competitive over the past 3 years, it continues to attract far more applicants than available positions. In deciding whom to interview, programs will use a variety of residency selection criteria. In the 2016 NRMP survey of otolaryngology residency program directors, "grades in clerkship in desired specialty" was cited as an important factor by 83% of programs. It received a mean importance rating of 4.7 on a scale of 1 (not at all important) to 5 (very important).  

 

It can be argued that rotation performance is even more important if you consider that 100% of program directors cited "letters of recommendation in the specialty" as an important factor in making interview decisions. These letters are often largely based on a student's performance during the rotation. 

 

Given the importance of the otolaryngology rotation in the residency selection process, I am often asked for advice on how medical students can stand out. Below are recommendations that I have gathered from attendings and residents over the years.

 

Know How To Evaluate Common Symptoms Encountered In Otolaryngology

 

Although a small number of patient symptoms account for the majority of encounters in otolaryngology, these symptoms are infrequently encountered by medical students prior to the otolaryngology rotation. Therefore, many students begin the rotation unsure of how to approach patients presenting with these complaints. Fortunately, some preparation on your part in advance of the rotation can help you become familiar with the workup of these complaints. Focus your efforts on the following symptoms or problems:

 

  • Epistaxis

  • Nasal obstruction/rhinitis

  • Hoarseness

  • Sore throat

  • Hearing loss

  • Tinnitus

  • Dizziness/Vertigo

  • Neck mass

  • Oral lesions

  • Snoring

  • Stridor

  • Ear pain

  • Headache/Facial pain

  • Dysphagia

  • Sinus pain

  • Change in taste/smell

 

Review Physical Examination Of The Head And Neck

 

How comfortable are you with the physical exam of the head and neck? If you feel that your clinical skills are lacking in some respect, you're in good company. In one study assessing the comfort levels of junior medical students in performing the head and neck exam, students reported an average comfort level of 2.1 on a scale of 0 (not comfortable to 5 (extremely comfortable). 

 

Your otolaryngology rotation will provide you with many opportunities to improve your skills in this important area. The American Academy of Otolaryngology - Head and Neck Surgery has created an excellent series of instructional videos on how to perform the head and neck exam (see below). 

 

 

 

The ENT Exam: Ear Exam

 

 

The ENT Exam: Oral Cavity and Neck Exam

 

 

The ENT Exam: Face and Nose

 

 

 

The ENT Exam: Nasopharynx and Larynx Exam

 

 

Present Patients Powerfully

 

"It is critical to be able to make an informative, accurate and complete patient presentation on rounds," writes the Department of Otolaryngology at SUNY Downstate. Presentations should follow the SOAP format. The most common mistakes made by students include the following:

 

  • Presenting information out of order

  • Providing unnecessary or superfluous information

  • Skipping relevant parts of the physical exam

  • Delivering an inadequate assessment and plan

 

The latter mistake is particularly common, and usually due to inexperience or lack of sufficient time to process information collected during prerounds. In order to come across as more than just a reporter of information, set aside enough time so that you can put your thoughts together before morning rounds.

 

Another valuable tip involves reflecting on your patients when you go home each and every night, and anticipating what may happen the following day. For example, let's say you have a postoperative patient who is receiving analgesic therapy. What will you do the next day if your patient's pain is not well controlled? Thinking about different possibilities when you have the luxury of time (at home) will help you to develop more thoughtful assessment and plans. 

 

Remember to seek feedback on your oral case presentation skills. If something is lacking in your presentations, don't hesitate to ask the resident or attending to assist you in this very important area. 

 

Look For Ways To Improve The Team's Efficiency

 

The patient census is often high on the otolaryngology service, and anything you can do to increase the team's efficiency will score you points. Some examples:

 

  • Having supplies or materials ready for basic procedures during rounds (dressing changes, removal of drains/staples/sutures, trach suctioning/changes)

  • Gathering vital signs and other pertinent information before afternoon rounds

  • Searching the literature to answer a clinical question pertaining to a patient on the service, and reporting the findings to the team

  • Having films or imaging studies ready to review (hard copy or on computer) with team during rounds

 

Read And Then Read Some More

 

My recommendation is to be well read on every aspect of your patient's problem or condition. In fact, I would take it even one step further. Try to be well read on all patients on the service. This will allow you to make the most of your learning opportunities in the clinics, on the wards, and in the operating room. "One of the most effective teaching methods in medicine is asking questions, whether this is on morning rounds, in the operating room, in conference, or in clinic," writes the Department of Otolaryngology at the University of North Carolina. "We use this method liberally, so please read and be prepared."

 

Shine In The Operating Room

 

Never enter the operating room without having a strong understanding of the patient's presentation, indications for surgery, possible complications, and postoperative considerations. Although you won't be expected to know the individual steps of the surgical approach, you'll be asked questions about surgical anatomy. It's also a good idea to brush up on some basic surgical skills, as you may have opportunities to assist the surgeon. "In the operating room...students will be able to demonstrate and sharpen skills in basic surgical techniques such as knot-tying, suturing and limited dissection," writes the Department of Otolaryngology at the University of Washington

 

Make A Favorable Impression In The Clinic

To meet the needs of your faculty preceptor, be sure to ask about expectations and responsibilities in the clinic. How many patients will you be expected to see? How much time should you take with each patient? Should you see the next patient on the list or will you be assigned patients? Are there any particular preferences with respect to the oral case presentation? Does the attending want you to observe him before venturing out on your own? Fortunately, most attendings will initiate this discussion with you. But if it doesn't happen, don't be afraid to ask these questions. You'll be glad that you did. 

 

In the otolaryngology clinic, you'll typically be given the opportunity to see patients independently. Your goals in performing this evaluation include the following:

 

  • Review the medical chart

  • Establish rapport with the patient

  • Obtain a relevant history

  • Complete a focused exam

  • Present the patient to your otolaryngology attending or resident, including the assessment and plan

  • Decide on the next course of action (further diagnostic tests, treatment)

  • Implement the plan

  • Educate the patient

  • Document the encounter (if allowed)

 

Strive to do as much as possible in the above areas. 

 

Demonstrate Superb Interpersonal Skills and Professionalism

 

Medical students should view the entire rotation as one extended interview. Every interaction or encounter with residents or attendings is an opportunity to demonstrate the interpersonal skills and professionalism valued in the field. Otolaryngology faculty members have also been known to seek the opinions of the entire team when assessing student performance. Dr. Richard Scharf, program director of the ENT residency program at St. Barnabas Medical Center, solicits opinions from colleagues, residents, nurses, office staff, and even patients. "We find out how the individual is in terms of seeing patients," says Dr. Scharf. "And if a student is disrespectful to office staff, we'll hear about it right away."

 

Dr. Samir Desai is the author of The Successful Match 2017 and the co-host of the Success in Medicine podcast.

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