I. GENERAL SUMMARY
Members of the Resident Staff assume responsibilities under faculty supervision for the care of patients on the inpatient service as well as in the outpatient clinic at levels consistent with their training and experience. Members of the Resident Staff also participate in the medical education program of the Hospital and the Johns Hopkins University School of Medicine.

II DETAILED DESCRIPTION

INTERN YEAR (PGY1)

The intern year consists of 5 months of General Surgery rotations, a 1 month Surgical Intensive Care Unit rotation, Emergency Medicine rotation, Neurosurgery rotation, Anesthesiology rotation and a 3 month rotation on the Head and Neck Service. During the Head and Neck Surgery rotation, an introduction to the organization of the Johns Hopkins Head & Neck Services is given. In addition, basic skills for outpatient assessment, care of H&N inpatients and airway management are taught.

SECOND YEAR (PGY2)

1. Research: Six months of protected research time is provided for all residents. Some have an extended 24 month research opportunity with clinical training extended into PGY-6 to complete RRC requirements. Prior to the rotation, residents must identify must identify a mentor and a project and write a proposal which is reviewed and approved by the faculty. The Residents works directly under the supervision of the mentor, but is expected to demonstrate initiative in direction of the research, the execution of experiments and the analysis of results. A written summary of results in publishable form is required at the end of the rotation. No clinical responsibilities are undertaken in this rotation.

2. General OHNS at Greater Baltimore Medical Center: under the supervision of full and part-time faculty, responsibilities are similar to those of PGY 3 residents at Johns Hopkins Hospital, described below.

THIRD YEAR (PGY3)

Third year residents rotate through 3 services at JHH, and one at GBMC. On all rotations, residents spend two days per week in outpatient clinic and three in the operating room. Inpatient ward responsibilities, night call and emergency ward coverage are interspersed on a rotating schedule. In the outpatient clinic, residents work under the supervision of full time faculty fellows and senior residents. They perform history and physical examinations on new patients, formulate a working differential diagnosis, and then present the patient to the supervisor. The faculty member then repeats the H&P, discusses the case with the resident, and a plan for further work-up or treatment is formulated jointly. The resident then assists in the execution of the plan. Follow-up patients are evaluated and managed in the same way. Simple office procedures such as biopsy under local anesthesia and flexible fiberoptic laryngoscopy are performed under the direct supervision of the faculty.

In the operating room, PGY 3 residents participate in routine surgical procedures such as tonsillectomy and myringotomy and tubes with graduated proficiency and degree, always under the direct supervision of the faculty member who is present in the operating room. The PGY 3 resident also assists in more complex cases such as neck dissection and mastoidectomy. The resident is responsible for postoperative care in the recovery room or intensive care unit.

On the inpatient ward, the PGY 3 resident shares every fourth night call and participates in daily ward rounds for postoperative and non-operative inpatient care. All activities are performed under the supervision of the chief resident and faculty, but routine procedures such as intravenous access and blood drawing, and routine management decisions may be made with appropriate levels of independence. The resident is responsible for writing an admission history and physical note and discharge summary for each patient. The fundamentals of routine and complex postoperative care are mastered.

1. Pediatric Otolaryngology: Congenital, infectious, neoplastic and traumatic diseases of the upper aerodigestive tract, special sense organs, head and neck are emphasized. The resident is expected to master pediatric endoscopy an tonsillectomy.

2. Head and Neck Oncology: Diagnosis and management of benign and malignant neoplasms of the upper aerodigestive tract, head and neck are the focus. The resident is expected to master simple soft tissue procedures such as sub-mandibular gland excision and begin to learn the more complex surgical anatomy of the neck, larynx and skull base.

3. Otology: The diagnosis and management of disorders of the ear and temporal bone including hearing loss and imbalance, as well as neoplasms of the lateral skull base are emphasized. The PGY 3 resident is expected to master simple audiometric and vestibular testing methodology, cortical mastoidectomy, and tympanoplasty approach.
4. General Otolaryngology: Rhinology, including septoplasty and endoscopic sinus surgery are major emphases of the rotation.

FOURTH YEAR (PGY4)

Residents in this year are given greater independence, typically working directly under the supervision of faculty members without the intermediate overnight of a chief resident. Responsibility and opportunity in the operating room is afforded commensurate with experience and demonstrated capability, affording the resident exposure to more complex procedures. First call in-house night call responsibilities persist, but with reduced frequency, permitting more time for participation in decision making in the care of patients.

1. Facial plastics and reconstructive surgery: The diagnosis and management of deformities of functional and cosmetic significance due to trauma, congenital, postoperative, infectious, or neoplastic cause are emphasized. The resident works with full-time faculty at Johns Hopkins Hospital 3 days per week, and with part-time faculty at a free standing surgicenter 2 days.

2. General Otolaryngology at GBMC: The PGY 4 resident serves as a junior "chief" resident on the head and neck oncology service working with several part-time faculty members on major head and neck oncological procedures. The resident also supervises the junior house staff in the postoperative care of these patients together with the chief resident (PGY 5) and the faculty. The resident is introduced to the performance of major cases such as laryngectomy, neck dissection and composite resection during this rotation.

3. General Otolaryngology at Bayview: The PGY 4 resident works with one chief resident under the oversight of the full-time faculty to manage this inpatient and outpatient service. Night call from home is divided by the two residents. Graduated independency in formulating a differential diagnosis, and executing a treatment plan under faculty supervision is afforded.

FIFTH YEAR (PGY5)

This is the chief resident year. On each rotation, the resident serves as the team leader, assigning daily duties to the junior house staff, overseeing routine postoperative patient management, ward rounds, and night-time emergencies. In the operating room, all but the most complex cases (reserved for fellowship training such as microvascular free tissue transfer or cerebellopontine angle surgery) are to be mastered. In the outpatient clinic, the resident is expected to accurately recognize and diagnose all common and many unusual conditions, formulate an accurate differential diagnosis, a complete plan for work-up, and a treatment recommendation with discussion of all valid alternative. Clinic evaluations and surgical procedures are supervised by full-time faculty who are present or immediately available at all times. Second call night coverage is the responsibility of the chief resident, supervising the first call resident, with the backup of the faculty on call.

All residents are required to participate in didactic sessions held on a weekly or annual schedule. They must take a home instruction course and the In-service Exam sponsored by the American Academy of Otolaryngology-Head and Neck Surgery

III. OUTLINE OF ROTATIONS

Application Process

Dear Applicant:

Thank you for your interest in our program. All students wishing to apply to this program must apply through the Electronic Residency Application Service (ERAS) sponsored by the Association of Academic Departments of Otolaryngology - Head and Neck Surgery.

To complete application, go to the following link http://www.aamc.org/eras
Once at ERAS website, click on "Residency & Osteopathic Internship Applicants" for a complete description of the application process.

Each year, the Johns Hopkins Otolaryngology Residency Training Program receives approximately 400 applications from which about 40 applicants are chosen to interview to fill the 4 positions. All applications are reviewed and interviews for prospective candidates are arranged on the basis of their medical school record, research experience, extracurricular activities and letters of recommendation. There is no minimum score requirement, however, competition is exceptionally high, with many more outstanding applicants than openings each year. Applicants are ranked on the basis of high moral, ethical and professional qualifications by the Resident Selection Committee for final selection in the Otolaryngology Matching Program.


Deadline for applications: In order for an application to be considered it must be submitted to ERAS in time to be received in the Otolaryngology Department at Hopkins by October 3, 2008.

Interviews are scheduled during the months of December 2008 and January 2009 and you will be notified by mail if you are invited to interview.
For additional information,

please contact
Christine Stansbury
at cstansb1@jhmi.edu
or by phone at (410) 955-1932.
Sincerely,
Paul M. Flint, M.D.
Program Director, Residency Program
pflint@jhmi.edu