Resident Rotations

The Otolaryngology-Head and Neck Surgery Resident Training Program at Johns Hopkins provides residents at levels PGY-1 through PGY-5 with the opportunity to be involved in the diagnosis and treatment of a wide variety of common and rare ear, nose and throat clinical problems. We offer two tracks designed to meet the resident's long term goals in either a research or clinical setting. 

Learn more about the overall goals common to all of the residency programs.

Rotations at a Glance

Post Graduate Year Rotations
PGY-1 OHNS Intern 3 months: General Surgery rotations
1 month: Neurosurgery rotation
1 month: Anesthesia rotation
1 month: Plastic Surgery rotation
6 months: Otolaryngology rotations 
PGY-2 OHNS Assistant Residents 12 month clinical rotation, of which: 3 months: Pediatric OTO - JHH
2-3 months: Night float - JHH
3 months: Otology - JHH
3 months: Sinolaryngology/Head & Neck Surgery
PGY-3 OHNS Assistant Residents 24 month: T32 research track (2 residents each year)
6 months: 5-year track (2 residents each year)
6 months: GBMC and/or Bayview 5-year track (2 residents each year) 6 months of 24 will be ACGME accredited
PGY-4 OHNS Assistant Residents 12 month clinical rotation, of which: 3 months: Facial Plastic & Reconstructive Surgery - JHH
3 months: Sinus & Laryngology - JHH
3 months: General OHNS – Bayview or GBMC
3 months: Head & Neck Oncology – JHH
PGY-5 OHNS Chief Residents 12 month clinical rotation, of which: 3 months - Head & Neck Oncology- JHH
3 months - Otology - JHH
3 months - Head & Neck Oncology – GBMC
3 months - Facial Plastics/Elective/Suburban
PGY-5+ OHNS Chief Residents 6 months - Senior subspecialty rotation - JHH
6 months - optional fellowship

Rotations in Detail

Intern Year (PGY1) Rotations

  • General surgery rotations (three months, including one month on a surgical intensive care unit)
  • Neurosurgery rotation (one month)
  • Plastic surgery rotation (one month)
  • Anesthesiology rotation (one month)
  • Otolaryngology rotations (six months), primarily head and neck oncology, which covers an introduction to the organization of the service. Basic skills for outpatient assessment, care of head and neck inpatients, and airway management are also taught.

Second Year (PGY2) Rotations

Second year residents rotate through three services at the Johns Hopkins Hospital (JHH) and one at Johns Hopkins Bayview Medical Center.

  • Pediatric OTO – JHH (three months)
    • Congenital, infectious, neoplastic, and traumatic diseases of the upper aerodigestive tract, special sense organs, and head and neck are emphasized. The resident is expected to master pediatric endoscopy and tonsillectomy.
  • Night float – JHH (about three months)
  • Otology – JHH (three months)
    • 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 2 resident is expected to master simple audiometric and vestibular testing methodology, cortical mastoidectomy, and tympanoplasty approach.
  • Sinolaryngology/Head & Neck Surgery (three months)
    • Diagnosis and management of benign and malignant neoplasms of the upper aerodigestive tract, and head and neck are the focus. The resident is expected to master simple soft tissue procedures such as submandibular gland excision and begin to learn the more complex surgical anatomy of the neck, larynx and skull base.

On all rotations, residents average around 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.

Outpatient Clinic

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.

Operating Room

In the operating room, PGY 2 residents participate in routine surgical procedures such as tonsillectomy and myringotomy tubes with graduated proficiency and degree, always under the direct supervision of the faculty member who is present in the operating room. The PGY 2 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.

Inpatient Ward

On the inpatient ward, the PGY 2 resident has 1-3 day calls each week and 4-5 night/weekend calls each month at The Johns Hopkins Hospital and has homecall responsibilities every 4 nights while at Bayview and GBMC. They participate 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 laryngoscopy, rigid nasal endoscopy, 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.

Third Year (PGY3) Rotations

  • Research (six months): Residents who matched into the R25 research track have an extended 24-month research opportunity (six months are ACGME-accredited) with clinical training extended into PGY6 to complete RRC requirements. Before the research rotation, residents must identify a mentor and a project and write a proposal, which is reviewed and approved by the faculty. The resident works directly under the supervision of the mentor but is expected to demonstrate initiative in the direction of 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.
  • General otolaryngology at Greater Baltimore Medical Center (GBMC) or Johns Hopkins Bayview (six months): Residents work under the supervision of full- and part-time faculty. Responsibilities are similar to those of PGY4 residents at JHH.

Fourth Year (PGY4) Rotations

  • Facial Plastic & Reconstructive Surgery – JHH (three months)
    • The resident works with full-time faculty at JHH three days per week, and with part-time faculty at a free-standing surgery center two days. This rotation offers exposure to diagnosis and management of deformities of functional and cosmetic significance due to trauma, congenital, postoperative, infectious, or neoplastic causes.
  • Sinus & Laryngology – JHH (three months)
    • The resident works with full-time faculty of the Sinus and Laryngology divisions. The sinus division offers exposure to diagnosis and management of common sinonasal and anterior skull base pathology. The laryngology division offers exposure to diagnosis and management of common laryngological disease, including voice, airway, and swallowing disorders.
  • General OHNS – Bayview/GBMC (three months)
    • The PGY 4 resident assumes a chief resident role under the oversight of the full-time faculty to manage this inpatient and outpatient service. Night call from home is divided with the PGY 2 resident. As the chief resident on this service, the PGY 4 resident develops proficiency in teaching junior residents intraoperatively and in general patient care.
  • Head & Neck Oncology – JHH (three months)

PGY4 residents are given greater independence, typically working directly under the supervision of faculty members without the intermediate oversight of a chief resident. Responsibility and opportunity in the operating room is afforded commensurate with experience and demonstrated capability, allowing 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.

Fifth Year (PGY5) Rotations

This is the chief resident year. On each rotation, the resident serves as the team leader, assigning daily duties to the junior house staff, and overseeing routine postoperative patient management, ward rounds, and night-time emergencies. The rotations include:

  • Head & Neck Oncology- JHH (three months)
  • Otology – JHH (three months)
  • Head & Neck Oncology – GBMC (three months)
  • Facial Plastics/Elective/Suburban* (three months)

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 alternatives. 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.