Upcoming ACGME Otolaryngology Changes Put Greater Emphasis on Surgical Training

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In an effort to strengthen surgical training for otolaryngology residents, the Accreditation Council for Graduate Medical Education (ACGME) graduate medical education requirements will change as of July 1, 2016. Residents in their first postgraduate year (PGY-1) will now spend six months (up from one to three months in current curricula) in otolaryngology-specific rotations; the remaining six months will focus on patient-based skill development in topics such as airway management, interdisciplinary care coordination, and peri-operative care of surgical patients.

Residents will learn these patient-based skills through rotations chosen from nine non-otolaryngology specialties, including anesthesia, general surgery, neurological surgery, neuroradiology, ophthalmology, oral-maxillofacial surgery, pediatric surgery, plastic surgery, and radiation oncology.

Otolaryngology residents will now learn their basic surgical skills primarily from otolaryngology faculty, instead of general surgery faculty, and will be overseen closely by otolaryngology faculty the entire first year, according to a summary and impact statement of the requirement revisions from the ACGME Program Requirements for Graduate Medical Education in Otolaryngology. The other years of the otolaryngology residency program will not be affected by these changes.

“We believe the new standards will provide appropriate opportunity for first-year otolaryngology residents to develop non-operative skills, will enhance their training in surgical skills specific to otolaryngology, and will allow greater flexibility in later years of resident training,” said John R. Potts, III, MD, the senior vice president for surgical accreditation for the ACGME, in a released statement. Besides shifting greater responsibility for basic surgical training to the otolaryngology program, the changes will also give residents “earlier exposure to otolaryngology, thereby increasing flexibility later in resident training,” said Dr. Potts.

These are all welcome changes, because the general consensus has been that first-year otolaryngology residents weren’t learning the fundamental surgical skills, said Randal S. Weber, MD, professor and chair of the department of head and neck surgery at The University of Texas MD Anderson Cancer Center in Houston. “When they came to otolaryngology and the head and neck service, they often didn’t have the skills needed to progress more rapidly in skill acquisition,” he said. “This change will give residents a more focused education to prepare for otolaryngology. The expectation is that, for the first-year resident, the necessary basic surgical skills will be taught to them and [will] better prepare them for the ensuing years of training.”

Education Follows Profession’s Evolution

The modifications reflect changes both in medical education and in practice, noted Dr. Weber. “We talk about the way things used to be: Many years ago in my training, we used to do two years of general surgery and three or more years of otolaryngology,” he said. “There was a lot of time spent in the operating room, where the fundamental educational experience was in general surgery, and residents learned surgical skills such as how to tie blood vessels, surgical anatomy, tissue handling, and so on.”