Residency versus Fellowship in Otolaryngology: What is Practiced and Referred after Graduation?

A second option would be to create a surgical preceptorship in a localized center of excellence. An interested and qualified resident could spend one or two months at that center to accumulate adequate experience. This would obviate creating the exclusivity of neurotology fellows to perform stapedectomy.

In some large areas of the country, depending on the nature of training and core competencies, there may be very few people performing stapedectomies. But if it can be demonstrated that a resident has been given a sufficient volume of experience, then that should be acceptable. I would not like to see it fall into the realm of just fellowship-trained otologists, Dr. Pensak said.

The Broader Question

All those interviewed for this article believe that the current educational regime and qualifications for residency training will need to be modified.

But to what extent?

Dr. Ruckenstein suggested that otolaryngology as a specialty will need to consider whether an analysis of the nature of these studies should be extended to other surgical procedures in addition to stapedectomy: those procedures that are rarely done in training or can fall under a general otolaryngology umbrella or subspecialist purview. Should attention be given in fuller force to asking whether our residents are receiving adequate training to do any number of specific surgeries? Dr. Ruckenstein asked. To some extent we do that already. That’s why subspecialties exist. But once the qualifications for a subspecialty are established, they tend to be viewed as set in stone. Should we be more fluid in our analysis of what constitutes training in the subspecialties?

Changes and Mechanisms for Change

Another element that must be included in this exploration is the residency work-hours restraints.

By law, residents are not permitted to stay in the hospital over a certain amount of hours, said Dr. Fried, so even if a resident would like to perform a certain number of particular cases or a wider array of cases, that might not be possible.

There is also a movement on a federal level to constrict work hours even further.

If that comes to pass for all surgical specialties, Dr. Fried continued, the number of procedures that an individual will perform will be fewer. Yet training to proficiency is critical. If a resident can learn to do a procedure after five times, he shouldn’t be required to do it 15 times. The boards of our societies are going to need to modify what they feel are benchmark numbers that a resident is to perform. It will be more imperative than ever to train the individual as an individual.