The Residents Collection by Post-Graduate Training Year
Post-Graduate Training Year One
Within our field, the PGY-1, or intern year, has undergone significant changes over the last decade. Prior to 2007, the PGY-1 would spend their year dedicated to general surgery. In fact, the resident was a member of the general surgery department. Those entering our field became “otolaryngology residents” only in the PGY-2 year. After 2007, PGY-1s became members of the otolaryngology residency from day one, but still spent most of their time in other Departments. The structure of specific disciplines in which PGY-1 were to get experience has evolved under the American College of Graduate Medical Education (ACGME) and Otolaryngology Residency Review Committee (RRC). Beginning July 2016, PGY-1 will now spend 6 months on the Otolaryngology service, with the other 6 months dedicated to specific fields intended to broaden the working knowledge needed by an Otolaryngologist.
Despite the evolution in specific experiences, the PGY-1 year has always been about the first stage of application of medical knowledge in patient care. In medical school, students learn the “how” and “why” of disease and begin to understand the treatment, but it is as a PGY-1 where the true active therapeutic role-playing begins. This is the time when others will refer to you as an Otolaryngologist, with some assumptions of specialist knowledge and skills.
The PGY-1 collection focuses on articles, which highlight some important physiologic concepts in our field, but also begin to outline some of the cases in which the Otolaryngologist first begins to learn the trade. The otolaryngologists share the patient’s airway with colleagues in other specialties, but he or she is usually considered to be physician who can, if all else fails, establish an airway. Therefore, from the earliest stage, Otolaryngologist should be familiar with the thought processes and techniques essential to having a full armamentarium of techniques at their disposal to secure the normal and abnormal airway. Several article to begin building that skillset are included.
General
Head & Neck
Laryngology
Otology
Pediatric
Plastics & Reconstruction
Rhinology
Post-Graduate Training Year Two
The second year of training remains part of the early stages of knowledge building and application of concepts to patient care. The PGY-2 resident begins to build confidence in the evaluation of patients in the clinic, on the floor, and in the emergency room. Articles chosen for this section are not necessarily meant to include procedures to be mastered at this stage, but rather introduced and built upon in later years. Topics in this section include some office-based procedures as well as more advanced techniques or extension to procedures introduced in articles in the PGY-1 section. Concepts in management of facial injuries, soft and bony, are discussed. Surgical interventions, which stem from the first oropharyngeal surgery learned, tonsillectomy, are included to begin building a repertoire for management of obstructive sleep apnea.
General
Head & Neck
Laryngology
Otology
Pediatric
Plastics & Reconstruction
Reconstruction
Rhinology
Sleep Medicine
Post-Graduate Training Year Three
The middle year of training is one of transitions. In this year, earlier skills and techniques are reaching a point of early mastery, while more advanced techniques are being introduced. This year mandates a greater understanding of surgical neck anatomy, as dissections for benign and malignant pathology is introduced. Otologic and endoscopic techniques begin to develop in earnest. More advanced facial fracture repair techniques and some facial plastic and reconstructive topics are presented. The resident in this year is transitioning from the junior resident role of learning and doing a task based on direction from others, to the senior role of deciding a course of action and developing options in care.
General
Head & Neck
Laryngology
Otology
Pediatric
Plastics & Reconstruction
Rhinology
Sleep Medicine
Post-Graduate Training Year Four
This early senior experience demands that the resident have a good grasp on basic otolaryngology surgical skills, but also to have developed the ability to offer alternative techniques to a particular clinical situation. Refinement of routine endoscopic techniques is necessary in this year. In many programs, this is the year where large head and neck resections are part of the experience, but also the introduction of concepts and skills for reconstruction and reduction of morbidity are initiated. PGY-4 residents begin to teach junior residents those early basic surgical skills, and to guide them through the initial cases. The student begins to become the teacher.
Head & Neck
Laryngology
Otology
Pediatric
Plastics & Reconstruction
Rhinology
Sleep Medicine
Post-Graduate Training Year Five
The chief year allows for most residents to mature their clinical acumen. Many options must be available to deal with a clinical problem, and the chief must be skilled at several. PGY-5 residents may identify areas of the specialty in which they feel more or less competent. The individual maturing of those skills is important, and thus some flexibility in training is required. The procedures listed in this section require advanced knowledge and skills only possible through solid understanding of basic techniques. Many of these are procedures that will not be mastered in this year, but ones which a fellowship or active clinical practice time may be required to achieve. However, familiarity with these techniques allows the graduating resident to care for complex issues, and to know what options may be available to treat these conditions in referral centers.
Head & Neck
Laryngology
Otology
Pediatric
Plastics & Reconstruction
Rhinology
Sleep Medicine
