This rotation was a great month of learning something completely new which turns out to be very relevant to our practice as anesthesiologists!
I would show up in clinic around 7:45 a.m., snag a computer in the resident room and choose a patient who was listed on the board. You split up the patients with the ENT residents one at a time, as they are roomed by nurses, and the residents will usually take the more complicated cases or post-operative cases. Ideally you should try and select cases with concerns such as “hoarseness” or “dysphonia” or “dysphagia” or anything that suggests a possible laryngeal lesion which requires laryngoscopy. However you will see (and clear out) a few ears this month as well, it’s just part of the clinic! You’ll also likely see plenty of thyroids, a variety of head and neck cancer cases, hearing issues or vertigo, and even loss of taste and smell associated with COVID-19.
You’ll take a history, do a brief physical exam, formulate an assessment and plan and then go chat with an ENT attending who is nearby. They’ll discuss the plan with you briefly, and then you’ll both go back in to see the patient and close out the encounter. Notes are fortunately very short and sweet so you don’t spend an excessive amount of time on that. Each encounter takes about 20 minutes with delays primarily due to grabbing a Spanish interpreter on the phone or waiting for the attending to wrap up in another room. Over time you’ll start to see things repeatedly and get better anticipating the attendings’ management plans, so it moves faster. Overall the nurses and residents are streamlined and efficient, so you spend the morning working through patients. You can take a lunch break when you’re at a good break point, and if there are still a few patients to see you finish that up with the residents and then usually get to go home no later than 3-4 p.m.! This plus the lack of weekends makes it overall a very relaxing and enjoyable month.
The opportunity for frequent scoping is great because you start to get an understanding on how to use a fiberoptic scope. Don’t worry, you aren’t expected to be a pro when it comes time to do your first fiberoptic intubation as a CA1! It just helps to have held a scope and to understand it’s mechanics before that. The ENT attendings and residents are very kind, forgiving and patient when you’re learning to scope so it’s a very low-pressure environment.
This is a flexible month, and if you’re interested in checking out the OR from their perspective, the ENT team is usually open to this. They are the specialty closest to us in terms of involvement with the airway, and I even ended up getting some intubation tips from them when I first started my CA-1 year! All in all this is a great month for us during our intern year, and ends up feeling more relevant (and less stressful) than another month of wards.