So you wanna be an ENT?  Or at least you might be interested in how I was trained to be an ENT doctor?  In today’s post, I’ll talk about how a person goes from high school graduate to fully trained otolaryngologist (that’s the official name of my specialty).

Well, from start to finish, it usually takes a minimum of 13 years for Americans to go from high school graduation to completing ENT residency.  That (long) amount of time can be divided into 4 years of college, 4 years of medical school, and 5 years of ENT residency training.  Some folks will further subspecialize by doing fellowships which add an additional year or two after their residencies.

The first step is getting through college and doing well enough to be accepted into medical school.  Premed students can major in whatever they want, but they all must complete at the very minimum 1 year each of biology, general chemistry, organic chemistry, and physics.  People who decide on a career in medicine after graduating from college can complete special premed post-baccalaureate programs where they can complete these required classes in a 12-18 month period before applying to medical school.

Once you are in medical school, you’ll spend 4 years there.  Traditionally, the first two years were spent in the classroom learning the basic science foundations of medicine and then the final two years working and learning on the hospital wards.  Many medical schools are mixing things up more in recent years and getting their students to see patients much earlier than in the past.

At my medical school, Emory University, the curriculum was still fairly traditional when I was there.  The first two years were fairly grueling and required a lot of studying.  The third year was my favorite year of medical school, when I rotated through internal medicine, surgery, OB/Gyn, pediatrics, psychiatry, family medicine, and various other rotations.  The fourth year is actually the easiest year of med school- most of your time is spent applying for residency and doing elective rotations.

In March of their fourth year, all medical students find out where they will be spending the next 3-7 years on residency match day.  I was fortunate to have matched in ENT at VCU medical center in my home state of Virginia.

It is interesting that even though newly-graduated doctors learn a TON of stuff in medical school, they are totally unprepared to practice medicine.  This is why we all have to spend the next few years in residency training.  Residencies are as short as 3 years (internal medicine, pediatrics, among others) and as long as 7 years (neurosurgery).  Most surgical specialties are 5 years, including ENT.

The first year of residency is also known as the internship year.  The main goal of the surgical internship is to learn to manage the common problems of surgical patients in the hospital and to start learning the basics of surgery (suturing and minor procedures).  As an intern, most of your time is spent answering pages from nurses, taking care of routine issues, and doing paperwork.  Although it is a terrifying transition from student to intern, the job gets pretty easy after a few months.  It is mostly grunt work, and there are plenty of people above you in the hierarchy to call when there are more complicated problems.

During my intern year, I spent most of my time rotating through various surgical rotations including general surgery, trauma, neurosurgery, plastic surgery, and surgical oncology.  I also spent time in the emergency room and on the anesthesia service.

After completing intern year, I had 4 more years of residency training devoted entirely to otolaryngology (ENT).  Throughout the residency, I usually spent about half of each week seeing patients in the office and half in the operating room.

In the office, I would typically see a patient and then present that patient’s story and exam findings as well as my preliminary diagnosis and plan to my boss (the “attending physician”). The attending would then go see the patient as well and determine the final plan.  As I progressed through residency, I would get more and more autonomy.

In surgery, I would typically do procedures that were suitable for my level of training and sometimes assist more senior residents on more complicated surgeries.  We were always supervised by an attending physician, who (depending on our skills and their trust in us) could be scrubbed in next to us or out in the surgeon’s lounge with a coffee.

In the first years of residency, the main surgeries I learned were smaller procedures such as ear tubes, tonsillectomies, adenoidectomies, septoplasties, and laryngoscopies.  As my training progressed, I moved to more advanced procedures such as endoscopic sinus surgery, neck mass excisions, and microlaryngeal excisions.  In my final year, I routinely performed major cancer resections, cochlear implants, thyroidectomy, and parotidectomy, as well as plastic and reconstructive procedures.

The road is long but overall, I enjoyed my time in training.  I continue to learn in practice and I plan to keep on learning for the rest of my career.