Otolaryngology (ENT)

Otolaryngology is the second oldest surgical subspecialty. According to the Laryngoscope figures, there are slightly over 10,000 board certified Otolaryngologists practicing in the United States.

The surgical procedures are diverse and challenging. They range in complexity from tonsillectomies & adenoidectomies and ear tube placements to microsurgery of the ear, major head and neck tumor surgery, endocrine surgery (i.e. thyroid, parathyroid), anterior skull base and sinus surgery, sleep surgery, treatment of various vocal cord pathologies—including treatment of the professional voice, and facial plastic and reconstructive procedures. The specialty encompasses all age groups and both sexes. The pathologies treated by otolaryngologists include congenital, neoplastic, inflammatory, traumatic and degenerative. Otolaryngology offers a wide variety of practice options. One can practice in both academic and community settings, operate a lot, or a little, or not at all. As there are few true Otolaryngology emergencies, the overall lifestyle of Otolaryngologists is quite good.

Most Otolaryngology residency programs are 5 years and include a research block ranging from 3-6 months. There are a few programs that offer longer research blocks, making the total residency program 6-7 years (Oregon, Hopkins, Mass Eye and Ear Infirmary). Programs take between 1-5 residents per year, with an average of 2-3 per year. There are only a handful of programs in the country with 5 (Jefferson, Baylor, UCLA, Hopkins).

Post-residency training is becoming increasingly popular, but not entirely necessary to gain an academic appointment. The fellowship options following residency include head and neck surgical oncology (with or without training in microvascular surgery and reconstruction), facial plastics and reconstructive surgery (ranges from cosmetic surgery of the face and neck, cleft and craniofacial anomalies, orthognathic surgery, facial trauma, and reconstruction after cancer surgery), pediatric otolaryngology, rhinology/sinus/skull base, laryngology, and otology/neurotology. Fellowships range from 1-2 years and can include time for research opportunities.

Currently, all residencies require one year of internship, which is directed by a program’s Otolaryngology department and incorporated into the residency training track. Applicants do not need to apply for a separate preliminary position. The rotations during the internship year typically include 6 months of otolaryngology, 1 month of anesthesia, 1 month of neurosurgery, 1 month of surgical ICU/critical care, and 3 months of general surgery rotations often including plastic and endocrine surgery (Specific rotations may vary based on the program).

Otolaryngology is one of the most competitive specialties and continues to become more competitive each year. In 2017, there were 331 applicants applying for 305 residency spots, 14 unfilled spots in the main match. The mean USMLE scores of matched applicants were 248 for Step 1 and 252 for Step 2. Most applicants apply to 40-60 programs with the average number of interviews being around 8 for matched applicants. To be a competitive applicant, you must have done consistently well in preclinical classes, third-year rotations, USMLE I, and have pursued a research interest. One does not have to be AOA (only 39% of those who matched were). It definitely helps to have research experiences, especially in something related to Otolaryngology, and it is not too late to begin a clinical project in third year. Although not necessary, many applicants even take time off during medical school to pursue meaningful research, especially authorship on a paper. As the field becomes more competitive research is becoming a more important aspect of the application.

1. Mentor: Find a mentor within the department early. All of the attendings in the department are great. Try to set up a meeting with Dr. Guardiani or Dr. Taylor to express your interest in the field. 
2. Research: 2. Research: Try to get involved with a research project within the department as this helps you get to know people in the department. This is something that will be asked about a lot on interviews. There is a range of both clinical and basic science projects going on. Dr. Hertzano has a basic science labs. The rest of the faculty are always actively involved in clinical research, case reports, etc. Be proactive and willing to put in the time to make substantial progress on these projects. However, if you have strong research in other specialties, it is almost as valuable as having ENT research especially if you have publications in these projects. That being said it is good to be active in some kind of ENT research. Research mainly shows programs that you have experience of some kind and are motivated to continue research in residency.
3. Personal Statement: Many faculty members including Dr. Guardiani and Dr. Will with feedback and guidance on their personal statement. Take advantage of this help.
4. Sub-I: Try to do your Sub-I as early as possible and prior to any away rotations. It helps to have your home rotation first. You may consider switching out one of the 1-month rotations at the end of MSIII for your Sub-I which will free up the critical July-Aug-Sept months for away rotations.
5. Away Rotation: The feeling on doing away rotations is mixed. Most programs are now recommending that students plan to do 1-2 away rotations if possible. Dr. Taylor usually recommends 2 away rotations. Programs like to see that you have done well and are liked at an institution other than your home medical school. Some programs even favor away rotators, guarantee an interview, and rank them highly in the match. If you are not geographically restricted, use your away rotations to show that you are willing to go anywhere in the country. As you will see on the interview trail, most programs generally invite applicants from the same region You will also often get asked about your away rotation experience on the interview trail. There are two schools of thought on selecting places to rotate at: one is to go to a program in a place that you really could see yourself going to and are competitive with numbers wise. The second is to go to a big name, top tier program in order to get LORs from people well known in the field. Doing one of both is optimal. Although it should be worth mentioning that the “big name” programs do NOT usually offer every away rotator an interview. The key to doing well on away rotations is to work hard, be friendly and enthusiastic, and always know your patients. You should also show that you work well with your fellow rotators. Away rotations are also helpful for you to figure out what sort of program you like (large or small, with or without fellows).
6. LORs: This is a specialty that likes to see all 4 LORs from faculty members within the field. However, if you worked closely with an attending from another department on research then you can include it, especially for programs that are more “research” oriented (i.e. T32 research track positions). Dr. Taylor and Dr. Guardiani will write a combined letter. You should try to get a second letter from another faculty member in the department. Also, get letters from faculty members on your away rotations. You can try to get "big names" in the field or program such as directors/chairmen, but it is very important that your letter writer has had adequate opportunities to get to know you so they can appropriately attest to your personality and skills. ENT is a small field with a tight-knit community so often times you are offered an interview simply because someone knew your letter writer. It also becomes a common talking point on interviews when the interviewer personally knows your letter writer.
7. Interviews: Try to do a mock interview before interview season starts. Dr. Vakharia offers to do one through the Trauma ICU rotation or you could ask one of the ENT faculty (Dr. Taylor usually offers to do them). As of 2019, the Maryland ENT department also interviews their students and away rotators at the end of their rotation as a way to practice early on.The majority of ENT interviews are held in December and January (check Otomatch). Try to take one of the months off and a light rotation for the second. The typical structure of the interview day is: continental breakfast, followed by welcome and overview of the program and department either by Chairman and faculty and/or residents. Then half the group will tour the facilities and half will interview. Lunch will be served and the groups will switch for the afternoon. Social events with residents and faculty are usually held the night before or the evening after the interview day. Interviews are “speed dating” style. Expect 6-12 interview sessions ranging from 10-20 minutes each. Sometimes there will be multiple faculty or residents in the room. Try to meet as many residents and faculty as possible to get the overall vibe of the program.

Previously, each institution required a program-specific paragraph (PSPs) of interest. These PSPs have now largely fallen out of favor, but can still be used in very specific circumstances if you have a particular attachment to a program (family, etc.). In many instances, a generic paragraph may do more harm than good. Start researching programs earlier and see if anything really sticks out that makes the program unique.

Your friendly Otolaryngology chairman and/or program director:

Chairman: Rodney Taylor, MD 
Program Director: Elizabeth Guardiani, MD 

There are a few web-based resources that can be helpful. Otomatch and Headmirror are two sites that are well known amongst Otolaryngology applicants. They both contain forums for otolaryngology applicants, so read them with many grains of salt. Many of the opinions on these medical forums can be quite skewed, but they are very helpful when trying to plan interview dates as many programs overlap.

DO NOT HESITATE TO ASK THE RESIDENTS AND ATTENDINGS QUESTIONS ABOUT THE PROCESS!!!  

Last Revision: February 17, 2020