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Residency Program

Residency Overview

 

Structure

The Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine College of Medicine sponsors a residency program in Otolaryngology-Head and Neck Surgery which is five years in duration.  The PGY-1 year is developed around the new American Board of Otolaryngology requirements that include rotations in anesthesia, emergency medicine, neurosurgery and a diverse mix of rotations in the surgical specialties.  The PGY-2-5 years concentrate on Otolaryngology-Head and Neck Surgery.    During the the PGY-2-4 years, residents acquire skills in head and neck history and physical examination techniques, and progressive acquisition of skills in surgical procedures in the specialty.  During these years, training is received at UCIMC, Kaiser Permanente (Anaheim), Children's hospital of Orange County (CHOC), and Long beach Veterans Affairs Medical Center (LBVAMC).  In the PGY-3 year four months is devoted to research.  The final year  (PGY-5) of the residency program is spent primarily at UCIMC and the focus is on leading the team of residents and focused operative experience.  Surgical skills are fine tuned and administrative and leadership skills are developed as chief resident on the service. 

The didactic curriculum for the residency program is designed to be comprehensive, academic, and well organized. A 24 month cycle is utilized, and is patterned after the quartile system of the American Board of Otolaryngology (ABO). Our curriculum follows the quartiles outlined by the ABO as follows:

1. General otolaryngology (including pediatric otolaryngology)
2. Head and neck surgery
3. Otology and neurotology
4. Facial plastic and reconstructive surgery

A working knowledge of related specialties such as neurosurgery, oral and maxillofacial surgery, plastic surgery, general surgery, neurology, and pulmonary medicine are also among the academic goals of the department. Much of this information is learned at joint conferences and via specific clinical experiences.

  Faculty Supervision

Dr. Armstrong and the department faculty actively supervise and administer the educational activities described above (quartiles of the didactic curriculum, surgical caseload, etc.). Formal resident evaluations occur twice each year, with the program director meeting each resident to review evaluations, surgical case numbers, and research progress. 

The chairman and the faculty are dedicated and committed to the education of the residents. Each resident receives lectures and one on one teaching every week. Thorough preoperative evaluation and sound medical/surgical judgment are stressed in addition to excellence in postoperative care. All surgical operations are attended by full-time faculty.  In the faculty private practices, many patients are evaluated by the resident rotating with the attending and presented to the attending physician.  The resident has the benefit of independent assessment with mentored feedback at the time of the patient visit.  In addition there is a resident clinic staffed by full time and volunteer faculty.   In these clinics, all patients are initially seen by the resident, then presented to a senior resident.  Attending oversight is provided and the patients are also seen by an attending physician.  Residents participate in the faculty surgeries, and all operative procedures performed at UCI Medical Center and Long Beach VAMC, are performed in with resident participation.  At the affiliated hospitals (Kaiser, Children's Hospital Orange County)  the number of cases and faculty members exceeds resident availability.  At these sites, residents participate in many but not all of the available surgeries. 

Facilities and Equipment

Libraries
The main Resident library is located in our departmental office.  It contains the major journals of the specialty.   The major Otolaryngology textbooks and other otolaryngology educational aids are also in this library for resident use. In addition, a complete collection of the Otolaryngology Self-Instructional Packets (SIPacs) and the home study course monographs are provided for resident use.  Adjacent to the library is a computer with Internet access, DVD player (and CDs/DVD's on Temporal Bone anatomy, Histopathology, anatomy, and surgical techniques).  This workstation is linked to the University of California Library Resources.  A number of instructional videotapes are also available. A second library is in the clinical space in Pavilion II. This room houses older bound journals and textbooks, some dating to the early 1900's.  The UCI Grunigen Medical Library  is located on the hospital campus, situated between the faculty offices and the outpatient clinic.  The medical library has an extensive journal and textbook collection, and a state-of-the-art computer center available for residents.  Interlibrary loan and electronic document requests are available, as well as professional library assistance for literature searches.

Hospitals
UCI Medical Center (UCIMC) is an approximately 500 bed tertiary medical center. We have just completed a brand new state of the art university hospital.  The new medical center has doubled the number of operating rooms, and has state of the art intraoperative monitoring and digital HD technology.  The brand new ICU and stepdown units Provide a first rate patient experience and optimize workflow for clinicians. The medical center is the only level I trauma center in Orange County, and the Medical Center is situated at the junction of several major freeways.  The medical center has primary care and specialty clinics on site, which provide primary, secondary, and tertiary care services for the region.  Four to five residents rotate at UCIMC. 

Children's Hospital of Orange County (CHOC) is a renowned children's hospital serving Orange County.  It is located 2.2 miles from UCIMC, and is a 5-minute drive from the medical center.  Currently, three pediatric otolaryngologists teach residents at CHOC, lead by Gurpreet Ahuja, M.D.  One resident rotates at CHOC full time, participating in a large number of general pediatric otolaryngology surgeries, difficult airway cases, and pediatric head and neck surgical cases.  There is a weekly pediatric Otolaryngology clinic at CHOC staffed in rotation by the pediatric otolaryngologists and the pediatric otolaryngology resident.

Kaiser Lakeview and Sand Canyon Medical Centers are the hub for the Kaiser rotation.  Two residents rotate at Kaiser, which provides exposure to an integrated HMO setting.  Residents rotate at Kaiser during the PGY-3, 4, and 5 years.  This rotation provides a high volume of sinus surgery, otologic cases, and thyroid surgery.  There is also exposure to head and neck cancer and skull base surgery at this site.  The Kaiser rotation is evolving.  A new facility at Sand Canyon was completed in 2008, and a replacement hospital and medical office building in Anaheim are under construction.   

The Veterans Affairs Medical Center, Long Beach (LBVAMC) is a large VA medical Center located approximately 14 miles from UCIMC.  LBVAMC has an active Otolaryngology clinic with general Otolaryngology, otology, and a strong exposure to facial plastic and reconstructive surgery.  It is also a major referral center for cochlear implants in the VA system.

Equipment
A fully equipped voice and speech laboratory with videostroboscopic capabilities, airway analysis, etc. is available in the clinic area. This was purchased with an NIH grant. Since that time other equipment has been upgraded in this facility. Audiological equipment has been updated from time-to-time and is considered state-of-the-art. As mentioned above, computers, etc. are available to the residents and are considered up-to-date. A full complement of endoscopes is available in the operating room and the outpatient clinic area.

Outpatient Clinics
Each clinical site has outpatient clinics containing fully equipped standard equipment for head and neck examination.  At UCIMC, LBVAMC, and Kaiser, videostroboscopy equipment is on site in the clinic.  Full service audiology is present at all clinical teaching sites as well.  Each site has either a dedicated microscope room, and at several sites, there are wall mounted microscopes for detailed otologic examinations and procedures.

At UCIMC there is an operating room situated in the outpatient clinic.  Currently minor procedures, and facial plastic and reconstructive procedures with conscious sedation are performed.  Plans are underway to upgrade this suite for general anesthesia capability.

Research

This residency training program features several educational goals for each and every resident who completes training here. The faculty expect that each finishing resident will attain a knowledge level, surgical skill level, and resident research capability equivalent to at least the 75th percentile of other graduating residents across the United States. One major goal of the training program is to train future academic surgeons in the specialty of otolaryngology-head and neck surgery. Accordingly, research, both basic and clinical, is an important and stressed aspect of the training program. Each resident is expected to complete a basic science type of research project and a clinical project (such as a retrospective review, etc.) during the training period. It is expected that each of these will result in a scientific manuscript which is presented at a meeting and published paper. The department feels that through such academic goals and pursuits, each resident will easily attain the lesser goal of attaining clinical expertise, scientific adequacy, and passage of the American Board of Otolaryngology certifying examination.

Meetings & Conferences

Grand Rounds
Grand Rounds conferences are held each week on Wednesday afternoons. The Grand Rounds are divided into two separate but interwoven sessions. The first is a Resident sponsored didactic session and the second is the formal Department grand rounds.

The Resident grand rounds are organized by and presented by the residents and is intended to supplement the didactic sessions provided by the Department elsewhere. These meetings are intended to be more informal than the Department's Grand Rounds, and each resident is expected to present basic academic topics. The initial intention of these meetings was to assist in preparation for the annual Otolaryngology Training Examination, as well as the actual Academy Boards. However, these sessions have grown in scope and now are additionally intended to provide residents with an opportunity to practice presenting before formal meetings and to present interesting or special cases. The topics are related to and chosen in conjunction with the topic of the academic quartile. For example, the July 2009 - December 2009 quartile is devoted to Otology and related subjects, and the Resident Grand Rounds during this period are also dedicated to Otology subjects. These session last approximately one hour and include multimedia presentations and "round table" discussion groups.

Departmental Grand Rounds are held from 5 to 7 PM every week (Wednesday afternoon). This period is an opportunity for the residents, faculty and guest speakers to deliver didactic lectures and to promote resident/faculty education. These formal sessions include demonstrations, multimedia presentations, and interactive discussions. Morbidity and Mortality conference is held once a month during the Grand Rounds time. From time-to-time, interdisciplinary conferences are held with the Department of Anesthesia or on occasion the Division of Plastic Surgery. Residents can expect to receive a definitive discourse on the topic presented and utilize this information in clinical and academic settings.

Head & Neck Tumor Board
A weekly tumor board is held at UCIMC.  The UCI tumor board is comprised of a  multidisciplinary team of specialists including head & neck surgeons, radiation oncologists, medical oncologists, head & neck pathologists, and head & neck radiologists.  The clinic is attended by social workers, and when appropriate, neurosurgery, endocrinology, and speech pathology. One resident is assigned to present each new case.  The average volume is three new cases per week.  The board is structured with patients coming to the outpatient clinic, where the board can meet the patients, then the group retreats to a nearby conference room to present diagnostic studies, review pathology, and discuss treatment options.  For more information, click here.

Pediatric Otolaryngology Conference

A monthly pediatric Otolaryngology conference is held on morning of the first Thursday of the month in the department resident library. It is attended by all the residents and the pediatric otolaryngologist on the faculty who are based at the Children's Hospital of Orange County (CHOC).

Pathology Conference
Pathology conference occurs monthly at UCIMC.  The conference is held in the department of pathology at the multi-headed microscope, where interesting and unusual head and neck pathology cases are reviewed with a pathologist.  The conference is held in a room in which every resident observer has his own microscope viewer and can point to pathology and describe it for the senior pathology-observer-teacher.

Neuro-Radiology Conference

Head and Neck Radiology conferences occur each month in a dedicated Grand Rounds session designed to promote the residents' education by presenting interesting patient cases and displaying relevant radiographic studies. We are fortunate to have the recognized authority in head and neck radiology, Dr. Anton Hasso, Director of Neuroradiology of the Department of Radiological Sciences at UCI, to lead these sessions.

Temporal Bone Dissection Laboratory
The main temporal bone laboratory for the training program, however, is a state-of-the-art three station video equipped microvascular and temporal bone laboratory. Temporal bones are procured for this laboratory from the Department of Anatomy at UC Irvine. Residents perform temporal bone dissections at the laboratories whenever they desire (the labs are always open to residents) and in 4 yearly sessions, supervised by our neurotologist.  A second, smaller laboratory is located at the Long Beach VA Medical Center.

Facial Plastic and Reconstructive Surgery Conference
Each month, a three hour conference dedicated to instruction in facial plastic & reconstructive surgery is provided to the residents and community otolaryngologists. These sessions are both clinical and didactic. Patients are presented to the conference when they illustrate a particularly complex or difficult clinical problem. In addition, lectures are delivered on subjects related to facial plastic and reconstructive surgery. The goal of this conference is to supplement the plastic surgery education provided elsewhere in the resident experience.

Vascular Malformations Conference

A monthly vascular malformations conference is held at the Beckman Laser Institute under the direction of Dr. Brian Wong and Stuart Nelson, M.D.

Journal Club
Journal Club is a resident-led session, meeting approximately 3-4 times per academic year.  Classic or otherwise timely and interesting articles are presented and discussed by the residents with faculty facilitation of discussion.   The meetings are held in informal settings, often over dinner in a local venue.  These meetings serve to broaden the educational experience of the residents, as well as increase camaraderie among the residents and faculty. 

Weekly Journal Club meetings are held at the laboratory of Dr. Fan-Gang Zeng. Residents on the otology research rotation attend.

Academic Meetings
Residents are strongly encouraged to attend and present papers at national and regional academic meetings.  The department provides financial assistance to support resident travel to major regional and national meetings where the resident is presenting a paper or poster, and presentation at these meetings by the residents is an expected an required activity.  

 

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Residency Curriculum

 

The program has a very strong background and history of outstanding performance on the American Board of Otolaryngology examination, and coverage of the entire scope of the discipline of otolaryngology-head and neck surgery. In addition, interdisciplinary interaction with such specialties as neurosurgery, pathology, radiology, pediatrics, plastic surgery, general surgery, and oral and maxillofacial surgery are an integral part of the content and planning of the training program. The following areas are included in the educational experience of each resident:

Bronchoesophagology, Facial plastic and reconstructive surgery, Head and neck surgery, Laryngology, Rhinology, Otology, Otolaryngic allergy, Immunology, Endocrinology, Neurology, Speech pathology, Swallowing and speech physiology, and pathophysiology, and therapy Prosthetic management of head and neck deformities, Basic dentistry, Laser medicine and surgery.

The training program results as a graduated one with development of increasing levels of responsibility through the five years of training as follows:

 

	Basic surgical skills, sterile technique, handling of tissue, fluid and electrolyte physiology and disorders, anesthesia, emergency medicine, basic wound care, basic patient management.  Three months rotation on Otolaryngology service
	During the PGY-2 year, the resident learns the complete head and neck history and physical examination, use of the head mirror and diagnostic mirrors, use of endoscopes, and binocular microscopy. Surgical procedures learned include myringotomy with tube placement, tonsillectomy, adenoidectomy, tracheotomy, laryngoscopy, esophagoscopy, bronchoscopy,  and septoplasty.  The majority of the year is spent at UCIMC, and one or two months is spent at CHOC and/or LBVAMC.  Preparatory work for the research project in the PGY-3 year is undertaken this year.  the resident develops a research project which is presented to and passed by the departmental research committee.
	The surgical experience expands in the PGY-3 year. basic endoscopic sinus surgery is undertaken as well as preliminary otologic surgical experiences including the decortication portion of mastoidectomy, extended septoplasty, uvulopalatopharyngoplasty, neck dissection,  microlaryngoscopy,  and laser laryngoscopy. Four months of the PGY-3 year are devoted to research.  Clinical rotations include UCIMC, Kaiser, CHOC, and LBVAMC
	In the PGY-4 year, a significant portion of this year is spent at UCIMC and the Kaiser rotation. More advanced head and neck cancer and otologic procedures are emphasized at UCIMC as well as more advanced sinus procedures.  At Kaiser there is a strong focus on thyroid surgery, endoscopic sinus surgery, otology, and general otolaryngology procedures.  The resident research project(s) that was executed in the PGY-3 year is written up and presented generally during the PGY-4 year.  Clinical research project(s) are also  either completed or extensively worked during this time period.
	Senior resident year. During this year, the resident extends his/her expertise to the entire surgical spectrum of the specialty performing major skull base and other head and neck cancer extirpations, all aspects of otologic surgery, all aspects of sleep apnea surgery, full endoscopic and non-endoscopic sinus surgery, as well as facial plastic and reconstructive surgery including aesthetic facial surgery.

 

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Resident Living

 

Call Schedule
Call schedules differ for junior, senior, and chief residents, and also vary according to the rotation a resident is assigned to at any particular time.
Generally, the schedule conforms to the following guidelines:

 

Location	Year	Call Responsibilities
UCIMC (In-House Call Friday and Saturday))	Junior (PGY-2, 3)	1 - 2 days/week; 2 weekends/month
	Senior (PGY-4)	1 day/week 0 weekends/month
LBVAMC (Home Call)	Junior	2 weeks/month 2 weekends/month
Kaiser	(PGY-3, 4, 5)	QOD until 10PM Every other weekend
CHOC		Call covered by assigned resident during day, and UCI on-call resident at night

Trauma coverage at UCIMC is shared with Plastic Surgery Service (UCIMC ) on a weekly rotation.

The call schedule is determined by the residents and approved by the Program Director.

Proximity to UCI.  Because the majority of the call is from home, the residents are required to reside within a 15 minute proximity to UCIMC.  This includes many of the surrounding communities including Irvine, Tustin, and Anaheim.

At all times, a Chief resident is on call and available by pager at all times to the on call resident. A designated faculty member is also available at all times.

The Area

The residents at UCIMC enjoy certain benefits from participating in one of Southern California's residency programs!
UCIMC is located in the city of Orange, in Orange County, California. Some of the outlying communities include Anaheim, Anaheim Hills, Irvine, Tustin, Newport Beach, Laguna Beach, and other desirable living areas. The LBVAMC is located in Long Beach, California. Nearby cities include Sunset Beach, Seal Beach, Huntington Beach, Palos Verdes Peninsula, and other cities. San Diego and Los Angeles are within a reasonable driving distance and can provide a welcome opportunity to explore different aspects of Southern California living.

The weather is usually fairly temperate. To check out the weather in Anaheim right now, click here. To check out the weather in Long Beach, click here.
Most residents choose to live in Long Beach, Irvine, Newport Beach or Anaheim. Each of these areas provides specific benefits, from easy access to surf, to shopping/recreation centers. Check out the surf at Huntington Beach right now by clicking here.

The lifestyle of a typical Californian varies from person to person, but generally, an active, healthy lifestyle is the rule. Most people find the outdoors to be too great of a draw to avoid... Orange County can be a starting point to the beach or to the mountains for skiing, snowboarding, mountain biking or hiking. It has been often said that living in Orange County permits its residents to surf in the morning, go skiing during the day, and return for a dinner on the beach all in the same day!

UCIMC is located in close proximity to the Anaheim Angel's Big A Stadium, the Anaheim Ducks' Pond, Disneyland, and Knotts' Berry Farm. The list of things to do is simply too exhaustive to list here, but check out some of these sites for further information (or surf the web on your own):
Newport Beach
Seal Beach
Orange County
Disneyland

A Day in the Life of...
Typically, the ENT resident's day start between 6:15 AM and 7:00 AM. Rounds are undertaken on all in house patients and patients on which the service is consulting. The rounds are generally led by the service's chief resident, with all residents and medical students actively participating. During the weekdays, faculty members generally round with the service team on patients. The days are filled with either clinic or surgery, with all residents expected to get a fair mix of each. Operations at UCI are performed in our main OR center or in our outpatient surgical center and at the OR Ward at the LBVAMC. Evening rounds conclude the days' activities and again are performed by the entire team. These rounds occur usually between 5:30 PM - 7:30PM. The residents attend any meetings or lectures scheduled for that specific day.

Our aim is to promote healthy lifestyles for the residents, and while academic pursuits are encouraged, expected, and mandatory, we also recognize that outside activities contribute to a resident's general sense of well being. Currently, our residents participate actively in The Pacific Chorale Choir Group, surfing, martial arts, and other activities. Often, residents meet socially outside of the hospital, as time permits.

Residency Match
Resident matching is completed each fall. We customarily interview 30-40 candidates in order to generate our residency matching list. The total number of residents for the training program is 10 (3-2-3-2).

Interested medical students who would like to contact individual residents in our program are encouraged to do so via e-mail, available on this web site through the UCI directory.