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Program Structure

Clinical Sites

UCI Medical Center (UCIMC)is an approximately 400 bed tertiary medical center ranked among the top 50 hospitals for Ear, Nose, and Throat in the nation by US News and World Report.  The brand new state-of-the-art university hospital now has operating rooms with cutting edge technology including advanced intraoperative monitoring and integrated digital HD technology.  The 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 has primary care and specialty clinics on site, which provide primary, secondary, and tertiary care services for the region. UCIMC is easily accessible, situated at the junction of several major freeways.

The UCIMC outpatient Otolaryngology clinic (Pavilion II) is fully equipped with state of the art and technologically advanced equipment, including videostroboscopy, several video towers capable of flexible and rigid endoscopy with image and video capture, and high quality microscopes for detailed otologic examinations and procedures. There is also an operating room situated within the outpatient clinic for use in procedures, predominantly facial plastic/reconstructive procedures, under conscious sedation. Plans are underway to upgrade this suite for general anesthesia capability.

The UCIMC clinical rotations are both service (multiple attendings) and mentorship (single attending) oriented. One senior resident (PGY4 and 5) will be assigned to Otology / Neurotology, while the remainder will be divided into “services” consisting of faculty members of multiple subspecialties, including Head and Neck, Rhinology, Laryngology, and Facial Plastic and Reconstructive Surgery. PGY5 residents will rotate as the “chief” resident to develop administrative and leadership skills.

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 in the clinical and operative setting, led 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.

Kaiser Lakeview and Sand Canyon Medical Centersare the hub for the Kaiser rotation, which provides exposure to an integrated HMO setting.  Two 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 have been completed.  

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

Faculty Supervision

Dr. Armstrong (department chair and program director), Dr. Bhandarkar (associate program director), 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 faculty are dedicated and committed to the education of the residents. Each resident receives lectures and one on one teaching every week. Thorough pre-operative evaluation, sound medical/surgical judgment, and nuances of post-operative care to optimize surgical success are stressed. 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 all faculty operative cases at UCI Medical Center and Long Beach VAMC. At the affiliated hospitals (Kaiser and CHOC), the number of cases exceeds resident availability and generally provides the residents an opportunity to tailor their experience.

Program Outline

The training program philosophy strives to develop increasing levels of responsibility through the five years of training as follows:

Year 1

  • Basic surgical skills, sterile technique, handling of tissue, fluid and electrolyte physiology and disorders, basic wound care, and basic patient management.
  • Rotation schedule includes anesthesia, emergency medicine, neurosurgery, plastic surgery, general surgery, and three months rotation on the Otolaryngology service.

 

Year 2

  • 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.
  • 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.
  • Clinical rotations: UCIMC (9-10 months), CHOC (1-2 months), LBVAMC (1 month)

 

Year 3

  • The surgical experience expands in the PGY-3 year. Basic endoscopic sinus surgery is undertaken as well as preliminary otologic surgical experiences, extended septoplasty, uvulopalatopharyngoplasty, neck dissection, microlaryngoscopy, and laser laryngoscopy.
  • Four months of the PGY-3 year are devoted to research.
  • Clinical rotations: CHOC (3 months), Kaiser (3-4 months), UCIMC (1-2 months)

 

Year 4

  • More advanced head and neck cancer, otologic, sinus, and laryngology procedures are emphasized at UCIMC.  At Kaiser there is a strong focus on thyroid surgery, endoscopic sinus surgery, and general otolaryngology procedures.
  • Research project(s) executed in the PGY-3 year are written up and presented at major national conferences generally during the PGY-4 year.  Clinical research project(s) are also either completed or extensively worked on during this time period.
  • Clinical rotations:  UCIMC (7 months), Kaiser (3-4 months), LBVAMC (1-2 months)

 

Year 5

Chief resident year – focused on leading team of residents

  • Extended expertise to the entire surgical spectrum of the specialty performing major skull base and other head and neck cancer resections and reconstruction, all aspects of otologic surgery, full endoscopic and non-endoscopic sinus surgery, advanced laryngology procedures, as well as facial plastic and reconstructive surgery including aesthetic facial surgery.
  • Faculty-supervised resident clinic which may involve more junior residents to increase supervisory experience for the chief
  • Clinical rotations: UCIMC (7-8 months), LBVAMC (2 months), and Kaiser (2-3 months)