Internship question

[drivesmecraazee]

I heard internship is the first year of residency, when you learn all the basics that you will need in your future residency.
So how's the internship for an ENT residency? Is it a surgery internship, or is it combines with medicine?

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[montypython]

I believe that many categorical programs include a gen surg year for the intern year that is split up between the different disciplines of surgery (i.e. gen surg, gas, truama, plastics, ENT...) and can vary with each program.

 

[otopico]

There are certain month long rotations that are required by the ACGME. It makes sense that we as ENT residents should rotate on plastics, thoracic, neurosurg since we will work closely with those services. We are also required to rotate through SICU, ER, anesthesia and a few others. The remaining rotations are usually the scraps leftover after the general surgery interns get assigned rotations. At my program, we didn't get dumped on too much (at least not as much as the gen surg prelims!) but we did have to do Vascular which was pretty painful as well as Transplant. We don't rotate on Ortho since that would be a fairly useless, grueling month. Needless to say most rotations are at least good for some skills you will use during your otolaryngology training.

 

[drivesmecraazee]

Yeah but you don't rotate medicine? Isn't diagnose or medication important for being an ENT?

 

[TheThroat]

Yeah but you don't rotate medicine? Isn't diagnose or medication important for being an ENT?

Diagnose or medication is not important for being an ENT.

;]

Actually, its mainly that internship provides a basic framework on which years 2-5 are built. Oto is a surgical speciality and can build on basic surgical principles. One could make an arguement for oto internship to rotate though a dozen different specialities, but you can only do so much in a year.

Also, consider that up until recently, otos just rotated through whatever g-surg told them to rotate through. I did 3 months of vascular and 2 months of uro and no path/rads/icu/etc/etc. Did just fine in years 2-5 and beyond.

 

[drivesmecraazee]

Diagnose or medication is not important for being an ENT.

;]

Actually, its mainly that internship provides a basic framework on which years 2-5 are built. Oto is a surgical speciality and can build on basic surgical principles. One could make an arguement for oto internship to rotate though a dozen different specialities, but you can only do so much in a year.

Also, consider that up until recently, otos just rotated through whatever g-surg told them to rotate through. I did 3 months of vascular and 2 months of uro and no path/rads/icu/etc/etc. Did just fine in years 2-5 and beyond.

...I knew ENT was a surgical speciality, but still, I tought specialists needed to know at least SOME medicine, of course all ENTs prefer surgery over medicine, but didn't you enjoyed the clinic part of med school?

 

[otopico]

...I knew ENT was a surgical speciality, but still, I tought specialists needed to know at least SOME medicine, of course all ENTs prefer surgery over medicine, but didn't you enjoyed the clinic part of med school?

One of the things I liked most about ENT was that not only did we operate but we do a fair amount of clinic and medical management. However this usually comes in the form of managing chronic sinusitis or allergy,laryngopharyngeal reflux etc... We use our clinical skills on a daily basis, and trying to diagnose disease in the head and neck can be just as difficult and have just as broad of a differential diagnosis as in any other area. And we do prescribe plenty of medications, it just happens that they are not for blood pressure or diabetes...I think I can live with that!

Personally I couldn't stand Internal Medicine when I rotated through it as a medical student, and can't imaging being forced to do it as an intern.

 

[Pir8DeacDoc]

...I knew ENT was a surgical speciality, but still, I tought specialists needed to know at least SOME medicine, of course all ENTs prefer surgery over medicine, but didn't you enjoyed the clinic part of med school?

It's called medical school. You spend probably 6 months doing IM/FP or similar rotations. Not to mention that in your intern year you'll do enough basic patient management to be comfortable with common disease in post op patients.


Plus, what does managing diabetes and HTN mean to me a a future head and neck surgeon? You have lots of questions which is a good thing, but many of them will be answered for you as you get further in your training.

 

[Winged Scapula]

Some surgical specialists are more comfortable than others in handling non-surgical issues. It would be inappropriate for any surgeon to be the primary consultant for new onset diabetes, for example...but I would venture that most senior residents who have NOT consulted out every medical problem (that's only Ortho, right guys ) are comfortable with basic medical management of DM, HTN, etc. You see enough of it and how others manage these diseases to be able to do it.

Whether or not you choose to, is up to the mind-set of your program and your own personal comfort level.

 

[drivesmecraazee]

Thank you all for you answers...abd yeah, I do ask many questions and I'm aware if it, Im sorry guys, can't help it.

 

[randomedstudent]

...I knew ENT was a surgical speciality, but still, I tought specialists needed to know at least SOME medicine, of course all ENTs prefer surgery over medicine, but didn't you enjoyed the clinic part of med school?

All the "medicine" that will be pertinent to an ENT will be learned during the 5 year ENT residency. There is no need to actually rotate on Internal Medicine.

 

[drivesmecraazee]

What would be the medical part of ENT? The "medical stuff" that an ENT does frequently?

 

[resxn]

What would be the medical part of ENT? The "medical stuff" that an ENT does frequently?

ENT is unique in the world of surgery as we do not have a defined medical counterpart.

For example, CV surgery has the Cardiologist, Urology has the Nephrologist, General Surgery has the internist, Orthopedics has the FP sports medicine guys, etc. ENT has no real counterpart. (Derm is probably the only thing that comes close--but most of them aren't true surgeons--able to get priveleges in the OR).

Therefore, we do quite a bit of medical management. What do we manage medically? Well, I think a good ENT is someone who tries to manage anything that can be managed medically with medicine before resorting to surgery. In other words, treat sinusitis with appropriate maximal medical therapy before jumping in to do a FESS. Don't do a shunt for dizziness until you've tried other conservative measures for Meniere's.

I think that the numbers show that if you took every patient referred to you as an ENT, about 15-20% go to surgery. That is a very bland number, though. An academic subspecialist is going to have a much higher rate. A peds ENT is going to be higher. But for your average joe community general ENT, that number is discussed by our Academy very frequently. (Having said that, I'm the joe community general guy and I think my number is more around 25%. I don't think I'm aggressive about going to the OR, rather I think it's just more my referral pattern. My PCP's are real good at not sending stuff until they think it really needs surgical intervention).

Thus, overall most of our patients are treated medically.