Otolaryngology—Head and Neck Surgery

Residency & Fellowship

Overview

Our residency and fellowship programs provide comprehensive training in all aspects of this diverse field with extensive hands-on surgical experience, the development of clinical decision-making skills, and exploration of and participation in the frontiers of research. The development of high ethical standards in the practice of our specialty is also within the scope of our training programs.

The activities of the Otolaryngology Division are aimed to deliver professional, high-quality patient care in a courteous and compassionate manner; to encourage an environment which will stimulate acquisition of knowledge by all staff members, residents, medical students and referring physicians; and to perform research which will further the horizons of our knowledge and enable us to become better physicians. We strive to accomplish these goals in a pleasant, mutually enjoyable atmosphere.

Faculty

Clough Shelton, MD, Professor and Division Chief, Otology and Neurotology

Jeremiah Alt, MD, Assistant Professor, Sinus and Rhinologic Surgery

Luke Buchmann, MD, Assistant Professor, Head and Neck Oncologic Surgery

Kathryn Colman, MD, Assistant Professor (Clinical), Pediatric Otolaryngology

Marc Error, MD, Assistant Professor, General Otolaryngology

J. Fredrik Grimmer, MD, Assosicate Professor and Resident Program Director, Pediatric Otolaryngology

Richard Gurgel, MD, Assistant Professor, Otology and Neurotology

Jason Hunt, MD, Associate Professor, Head and Neck Oncologic Surgery

Katherine Kendall, MD, Associate Professor, Laryngology

Jeremy Meier, MD, Assistant Professor, Pediatric Otolaryngology

Harlan Muntz, MD, Professor & Fellowship Director, Pediatric Otolaryngology

Richard Orlandi, MD, Professor, Sinus and Rhinologic Surgery

Albert Park, MD, Professor, Pediatric Otolaryngology

Marshall Smith, MD, Professor, Laryngology and Pediatric Otolaryngology

Michael Stevens, MD, Professor (Clinical), Taste and Smell Disorders

P. Daniel Ward, MD, Assistant Professor, Facial Plastic & Reconstructive Surgery

Bryce Williams, DDS, Assistant Professor (Clinical), Oral and Maxillofacial Surgery

Kevin Wilson, MD, Assistant Professor, Allergy and General Otolaryngology

We have open positions for three more faculty positions in Pediatric Otolaryngology, Head and Neck Oncologic Surgery, and General Otolaryngology.

The majority of information about our training programs are found in the Resident Handbook and Fellowship Program Description. Further inquiries may be directed to the Program Director or Coordinator.

How to Apply

Otolaryngology - Head and Neck Surgery residency programs participate in the National Resident Matching Program (NRMP), using the Electronic Residency Application Service (ERAS). This service collates, standardizes and distributes all application materials for those applying. ERAS will provide you with an application and information packet that describes the application process and timetable.

We suggest that you follow these basic guidelines so that your application can be completed in a timely fashion:

It is critical for you to establish contacts that can provide letters of recommendation as early as possible in the application process. It is recommended that you work towards completion of your basic application form in the late spring or early summer of your third medical school year. During the summer months you should attempt to obtain letters of recommendation to support your application.

The deadline for applications for our program is September 30th. All materials must be received by that date. Incomplete applications will not be considered.

Otolaryngology is a 5-year program; the PGY-1 year is a categorical internship that includes rotations in General Surgery, Critical Care, Anesthesiology, Neurosurgery, and Emergency Medicine, among others.

The University of Utah Otolaryngology program is very competitive. The mean step 1 score for interviewed applicants in the 2012 match was 246.

Questions about applying to our program should be directed to the Program Coordinator.

Interviews for the 2014 Match will be held on Saturday, December 14th, and Monday, December 16, 2013. We will purchase a lift ticket for applicants who wish to join our residents for skiing on Sunday, December 15th.

Educational Activities

In addition to clinical experiences, regularly scheduled didactic teaching conferences are an integral part of our residency. These conferences consist of lectures and discussions directed by the faculty members, visiting lectures by faculty of affiliated institutions, faculty from other residency programs across the nation, residents, and medical students. Each resident is expected to prepare and present a scientific lecture related to a clinical or research topic on a twice-yearly basis.

Additional regularly scheduled didactic sessions provide for additional educational opportunities and include: weekly inservice review, morbidity and mortality conference, tumor board, pathology conference, radiology conference, journal club, facial fracture plating course, head and neck imaging course.

A hands-on temporal bone dissection course is conducted yearly, and a head and neck cadaver dissection course is offered on a biannual basis.

The residents also participate in a monthly city-wide Otolaryngology-Head and Neck Surgery conference as well as the quarterly Utah Society of Otolaryngology-Head and Neck Surgery meetings.

During the Otolaryngology residency, the division funds attendance for the PGY-2s at the Annual Meeting of AAO-HNS. Residents with posters or podium presentations at main otolaryngology conferences are funded to attend the meetings as well.

The residents participate in the comprehensive Home Study course offered by the American Academy of Otolaryngology-Head and Neck Surgery and also are required to sit for the annual in-service examinations also sponsored by the American Academy of Otolaryngology. The residency program is proud of the scores obtained by the residents on this annual exam, and boasts a 100% pass rate on the national board certification at graduation.

Rotation Schedule

Otolaryngology-Head and Neck Surgery is a five-year training program. The primary training institution is University of Utah Hospitals and Clinics. Other training institutions are Primary Children's Medical Center (PCMC), Veterans Affairs Medical Center (VAMC), LDS Hospital, and Intermountain Medical Center.

We accept three residents per year for a total of fifteen residents. Clinical rotations provide the residents with a diverse, comprehensive exposure to all aspects of Otolaryngology-Head and Neck Surgery.

For one month during PGY2 and for four months during PGY3, residents have research rotations. The PGY2 rotation is to make all necessary preparations for the four-month PGY3 rotation including submission of grant applications. Residents are expected to complete one basic science and one clinical study. Additionally, all residents are encouraged to participate in on-going faculty research projects and to generate their own research ideas and proposals. Projects should be suitable for presentation at national meetings as well as for publication. Podium and poster presentations at national conferences are supported and funded by the program.

 PGY Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
5 FROG FROG FROG FROG HNL HNL HNL HNL FROG FROG FROG FROG
4 VAMC VAMC VAMC VAMC PCMC PCMC PCMC PCMC HNL HNL HNL HNL
3 FROG FROG FROG FROG RES2 RES2 RES2 RES2 FROG FROG FROG FROG
2 VAMC PCMC RES2 VAMC PCMC HNL VAMC VAMC PCMC PCMC HNL HNL
  • FROG - Facial Plastics, Rhinology, Otology and General Otolaryngology at UH
  • HNL - Head and Neck/Laryngology Service at UH
  • VAMC - Otolaryngology service at VAMC
  • PCMC - Pediatric Otolaryngology at Primary Children's Medical Center
  • RES2 - Clinical and Lab Research at UH/VA

The intern year consists of one month on the HNL service, one month of Research didactics and prep for the RES2 rotations, and one month each of SICU, Emergency Medicine, Neurosurgery, Anesthesiology, Plastics, Pediatric Surgery, and four other General Surgery rotations.

The 2013-2014 Resident Handbook for the Division of Otolaryngology is found below. All residents are expected to review the handbook at least annually, and are held accountable for abiding by the contents and meeting the goals and objectives listed within. Any suggestions for edits or additional information to be included in the handbook should be directed to the Residency Coordinator and/or Program Director.

Residency Handbook

Medical Students

MSIVs from LCME-accredited institutions are welcome to complete a one-month rotation with us. Please send your Curriculum Vitae and copy of your USMLE Step 1 score to Stephanie Ehlert (801-585-6580) for review. We will inform you when you have been pre-approved, at which time you will formally apply through the Student Affairs office. We will arrange the start date to meet your schedule requirements. Schedule requests will be granted on a first-come, first-served basis. Please note that Student Affairs does not begin to process applications until April 1st, and that UofU student schedule requests are handled before applications from external students.

Pediatric Otolaryngology Fellowship

Program Director: Harlan Muntz, MD (harlan.muntz@imail.org)

Fellowship Coordinator Contact: Kelli Hall (Kelli.hall@hsc.utah.edu

The Pediatric Otolaryngology fellowship is a new one year program, accepting the first fellow in July, 2013. The fellowship period is July 1 through June 30. Applicants must have completed or be in the process of completing an accredited residency program in Otolaryngology—Head and Neck Surgery. Non-U.S. residents must be eligible for a Utah State medical license as well as a J-1 visa sponsored by ECFMG. Candidates apply through the SF Match program. The applications are screened and invitations are offered for interviews with the Pediatric Otolaryngology faculty. All candidates are ranked by each faculty member and from this average the faculty ranks the fellow applicants. This is submitted to SF Match. The applicants also rank order their choice in institution and the decisions are finalized by the matching program.

Goals & Objectives:

The Pediatric Otolaryngology fellow will perform at the PGY-6 level.  The entire one-year fellowship will be spent at PCMC. Consultations may be done at the University of Utah Hospital as requested.  PCMC teaching service is composed of full-time physicians with University of Utah faculty appointments.  The Pediatric Otolaryngology fellow is expected to be an educator, assisting in training of junior residents, and medical students rotating on the service.  The fellow will take part in the didactic schedule for the University of Utah residents, as well as that for PCMC.

The overall goals of the Pediatric Otolaryngology fellowship are to:

1)      Become competent in the diagnosis and management of the tertiary care pediatric patient, including the development of leadership and administrative skills.  The fellow is to develop skills in the multi and interdisciplinary care of patients.

2)      Continue to build on the foundation of general knowledge in otolaryngology and pediatric to allow in depth understanding of the complex pathophysiology and treatment for tertiary care in this population.

3)      Become competent in advanced surgical techniques in the pediatric patient.

4)      Become competent in teaching skills to physicians, students, allied health professionals and families.

5)      Become competent in the methods of scientific investigation, critical review of the literature, and research process from conceptualization to manuscript preparation.

During the year, a comprehensive, mentored exposure to the care of the pediatric otolaryngology patient will be accomplished.  The six attendings will provide both general and focused education in special areas of pediatric otolaryngology.  The didactic teaching is informal and structured around patients, outpatients, surgical visits, and floor consults.

Patient Care:

1)      Develop competency in outpatient, inpatient, consultation and surgical services and procedures.

2)      Develop competency in developing a diagnosis and treatment plan for complex pediatric otolaryngologic problems.

3)      Develop advanced surgical skills to become primary surgeon on all tertiary cases.

4)      Become proficient in laryngotracheal reconstruction, pediatric sinus surgery, cochlear implantation, surgery of chronic ear disease, pediatric facial trauma, airway evaluation and treatment, microtia repair, aural atresia repair, cleft lip and palate repair, correction of velopharyngeal insufficiency, removal and treatment of vascular anomalies.

Medical Knowledge:

1)      Understand the peculiarities of the pediatric patient with otolaryngologic issues.

2)      Understand chronic ear disease, chronic and acute sinusitis and it complications, cleft-lip and palate, velopharyngeal insufficiency, common craniofacial syndromes, congenital and acquired hearing loss, vascular malformations, airway abnormalities, and airway physiology.

Practice-Based Learning and Improvement:

1)      Develop teaching skills through interaction with residents, nurses, and referring physicians.

2)      Develop systematic teaching tools such as lectures.

Interpersonal and Communication Skills:

1)      Develop communication skills for families from different socioeconomic and cultural backgrounds.

2)      Develop communication skills for discussing cases with referring physicians.

3)      Develop skills for effective and timely medical records.

Professionalism:

1)      Demonstrate compassion, integrity and respect for others from a diverse population.

2)      Demonstrate responsiveness to patient needs above self-interest.

3)      Show respect for privacy and autonomy.

Systems-Based Practice:

1)      Develop understanding of the health care systems and the impact on delivery.

2)      Demonstrate sound decision making to deliver cost effective and safe patient care.

3)      Demonstrate understanding of continuous of quality improvement.

 

During the fellowship year the following rotations will be required:

1) University Hospital NICU

a. The University Hospital NICU is of lower acuity than the PCMC NICU. During this rotation, the fellow will be required to assist in all consultations to develop expertise in flexible endoscopy of the neonate. Additionally, the fellow will develop judgment in the decisions for transfer to a more tertiary setting.

b. Children born at University Hospital who have an acute airway emergency will be seen by the fellow. The fellow will demonstrate mastery of the assessment and treatment of the newborn with acute respiratory distress.

2) Cleft and Craniofacial

a. The fellow will be required to attend the monthly Craniofacial Team meeting. The team focuses on feeding, speech, dental, and hearing as well as the functional and aesthetic and genetic aspects of the care of the child with a facial deformity.  The fellow will demonstrate understanding of the importance of team care by participating in the team’s health care decisions and activities.

b. The fellow will be required to attend an endoscopy clinic once a month to become competent at the endoscopic evaluation of velopharyngeal insufficiency as well as understanding nasalence testing. 

c. The fellow will be participate in all cleft-related procedures, including palatoplasty, repair of the cleft lip, and speech surgeries to develop the skills needed to become a competent cleft surgeon.

3) Aerodigestive

a. The understanding of the complexities of the aerodigestive anatomy and physiology are important for a pediatric otolaryngologist. The fellow will be required to attend the monthly Aerodigestive conference and be responsible for presenting pediatric otolaryngology patients in that setting. The conference brings together pediatric otolaryngology, gastroenterology, pulmonary and speech specialists. The fellow will develop an understanding of how both pulmonary and GI issues affect the airway and the treatment decisions. The fellow will develop an understanding of the team approach to care.

b. The fellow will be required to participate in all airway reconstruction procedures. These will include but not be limited to laryngotracheoplasty, sleeve resection with primary anastomosis, slide tracheoplasty, endoscopic repair of laryngeal cleft and supraglottoplasty. The fellow will develop competence in each of these procedures.

c. Tracheotomy and ventilator management will be focused on in this rotation. These complex patients are cared for by a team that includes pulmonary, respiratory therapy, rehabilitation and pediatric otolaryngology. Additional consultations from social work, nutrition, GI, and wound care are obtained as needed. The fellow will participate to learn management of tracheostomy complications. Additionally, the fellow will be required to learn the basics of ventilator management.

d. The fellow learn the basic assessment of the child with sleep apnea. This will include understanding polysomnography, sleep endoscopy, and cine MRI evaluations of the airway. The fellow will learn the fundamentals of the medical management using CPAP. The fellow will be involved with and become proficient in the surgical management of the child with sleep apnea including adenotonsillectomy, expansion pharyngoplasty, tongue reduction surgery, supraglottoplasty, and mandibular distraction.

4) Head and Neck

a. Vascular malformations are common in the head and neck. The best approach to care is that of a team. The fellow will be required to attend and present patients at the monthly Vascular Anomalies Conference, attended by dermatology, pediatric otolaryngology, interventional radiology and other subspecialties as needed. The fellow will learn the evaluation and management strategies in these children. This will include medical management protocols with steroid and propranolol.  The fellow will participate in the decisions between sclerotherapy and surgical resection. The fellow will be participate in all major resections of vascular malformations.

b. The fellow demonstrate understanding of the anatomy and surgical treatment of branchial cleft and thyroglossal duct cysts and fistula and will gain experience in their excision.

c. The fellow will develop an understanding of infectious processes in the head and neck, including both common and rare diseases that present with head and neck masses. The fellow will develop an understanding of the approach to assessment and treatment including imaging, antibiotics, and surgical management including resection and drainage.

d. The fellow will develop an understanding of the more common cancers in the child that present in the head and neck. This will include the evaluation of abnormal lymph nodes, assessment with imaging, diagnosis with both excision and fine needle aspiration, and resection where appropriate.

e. The fellow will learn the pathology and assessment of thyroid disease in the pediatric population. This will include the assessment of the thyroid mass and the medical and surgical management of thyroid disease.

5) Pediatric Sinus Disease

a. The fellow will develop expertise in the assessment and medical management of the child with chronic rhinosinusitis.  In those children who are surgical candidates, the fellow will develop the skills of endoscopic sinus surgery in the pediatric population.

b. The fellow will develop the understanding of cystic fibrosis-related sinus disease and its surgical management.

c. The fellow will develop the understanding of image-guided sinus surgery and will demonstrate competency in operating the system.

d. The fellow will develop an understanding of the indications for surgical intervention in acute complicated sinus infections and the techniques needed to surgically treat these diseases.

e. The fellow will develop an understanding of the evaluation of the child with neutropenic fever and invasive fungal sinusitis. This will include the surgical assessment of the disease as well as the surgical management of the disease.

6) Otology

a. The fellow will be required to attend the multidisciplinary Hearing Assessment Clinic. This will focus on congenital hearing loss and understanding the etiology of deafness. The fellow will interact with genetics and audiology in assessing the patient and counseling families.

b. The fellow will be required to participate in the cochlear implant team. The fellow will develop expertise not only in the surgical aspects of cochlear implantation but also the selection process for candidates, postoperative mapping, and the integration of the child into the mainstream.

c. The fellow will become proficient in the surgical management of cholesteatoma including revision cholesteatoma surgery.

d. The fellow will become proficient in ossiculoplasty.

7) Research

a. The fellow will be required to complete at least one research project (basic science, translational or clinical). The fellow will be informed in January prior to the fellowship about ongoing projects but will also be encouraged to develop other projects of interest.

b. At least one publication-ready manuscript must be completed before the end of the fellowship year.

 

The curriculum includes training in all aspects of pediatric otolaryngology, with dedicated rotations in NICU consultations, cleft and craniofacial surgery, aerodigestive, head and neck oncology, sinus disease and otologic disease and hearing loss. Outpatient clinic and inpatient surgery and postoperative care occurs daily, and participation in regular interdisciplinary team meetings dedicated to assessment and management of complex patients in each of these areas is required. Additionally, the fellow will be required to complete a research project and prepare a publication-ready manuscript.

 

By the end of the fellowship, the fellow will have demonstrated competency in complex congenital abnormalities of the head and neck, childhood tumors, pediatric sinus surgery, advanced techniques for pediatric sleep apnea, mandibular distraction, cleft lip and palate, auricular reconstruction, cochlear implantation, Bone Anchored Hearing Aid, surgical removal of vascular anomalies, laryngotracheal reconstruction, laryngeal reinnervation, airway endoscopy including microlaryngeal surgery, bronchoscopy, laser excision of tracheal lesions, complex airway foreign bodies, endoscopy for velopharyngeal incompetence and voice, and flexible endoscopic evaluation of swallowing.

 

The fellow will have demonstrated competency in all areas of general management of pediatric otolaryngology patients including outpatient assessment, history taking, physical examination, formulation of differential diagnoses and treatment plants. The fellow will demonstrate the unique interpersonal and communication skills required to deal with the families of pediatric patients, including awareness of and sensitivity to cultural concerns, financial obligations, and counseling techniques.

 

Full-time faculty members who will participate in the program are:

Harlan Muntz, MD, Professor & Program Director, Pediatric Otolaryngology

J. Fredrik Grimmer, MD, Assistant Professor, Pediatric Otolaryngology

Jeremy D. Meier, MD, Assistant Professor, Pediatric Otolaryngology

Albert H. Park, MD, Professor, Pediatric Otolaryngology

Clough Shelton, MD Professor & Division Chief, Otology & Neurotology

Marshall E. Smith, MD, Professor, Laryngology and Pediatric Otolaryngology

The fellowship will be at the Primary Children’s Medical center. A small portion of the program will require the fellow to care for children at the University Hospital Neonatal Intensive care Unit. The fellow will also participate in educational activities sponsored by the University of Utah’s Otolaryngology—Head and Neck Surgery Division.

Regular didactics include weekly Ground Rounds, monthly Morbidity and Mortality Conference, bi-weekly Cleft Team Meeting, monthly Pediatric Radiology Case Conference, bi-weekly Hearing Assessment Team Meeting, monthly Trach-Vent Team Meeting, monthly Vascular Anomalies Conference, monthly Pediatric Otolaryngology Interesting Case Conference, and monthly Aerodigestive Team Meeting. The fellow may also participate in other Otolaryngology and interdisciplinary conferences/meetings as deemed appropriate.

Textbook: Pediatric Otolaryngology – Principles and Practice Pathways (2nd edition)

July – General Pediatric Considerations (Chapters 1–7) – Mentor: Muntz

August thru September – Otology (Chapters 8–21) Mentor: Park

October thru December – Nose and Sinuses (Chapters 22–30) Mentor: Meier

January thru February – Oral cavity (Chapters 31–41) Mentor: Grimmer

March thru April – Larynx and trachea (Chapters 42–55) Mentor: Muntz

May thru June – Neck (Chapters 56–60) Mentor: Grimmer

 

The fellow will be primarily hospital-based, assisting in the care of the hospitalized patients in consultation and on the Pediatric Otolaryngology service and patients seen at the PCMC clinics. There will be flexibility in the schedule to accommodate the educational needs of the fellow. The fellow will be mentored in the care of the tertiary complex pediatric patient in the outpatient and hospital setting, receiving input from the pediatric otolaryngology faculty as well as interdisciplinary training from the associated faculty members included in the faculty listing and others on staff at the hospital.  This will include participation in the multidisciplinary clinics and focused care for complex inpatients. The fellow will attend the more complicated cases in the OR and assist in some less complicated cases to insure competency and ability to train residents. The fellow will be expected to dedicate time to developing teaching skills in OR, hospital and clinic. Research is expected. One half-day per week will be dedicated to this need with a required publishable paper at the end of the time period. Active mentorship in research will be provided by the co-investigators. The core fund of knowledge will be emphasized by attendance at the otolaryngology residency lecture series and additionally by a focused review of the pediatric otolaryngology literature and as indicated attendance at other rounds within the hospital and University setting. Exposure beyond this will be at the national meetings for pediatric and general otolaryngology. 

The faculty will be involved with the fellow on daily morning rounds. This is a time for in-depth discussion of the patients as well as the fundamental issues of pathophysiology related to each case. Mentoring during these times includes a focus on professionalism, caring approach to family and child, understanding and implementation of system informatics and resources to optimize patient care, and teaching skills directed at resident, medical and nursing student as well as others in the team.

In the operating room, mentoring will focus on the surgical pathology, technical aspects to optimize care, new technology, and efficiency both individually and as a part of a health delivery system. The faculty will direct focus to each of the core competencies. The faculty will also be responsible for defining the focused reading in their specific areas of expertise.  

One half-day each week will be free for research activities. This day may be used for meetings with the research mentors. Additional research time will be made available during the week as needed to complete projects. Each of the faculty has academic days that may also be used for these activities.

The fellow will be supervised in clinic, OR and research by a faculty member or other appropriate professional.  All OR cases will be attended by a faculty member. A balance will be achieved to assist in developing autonomy. The attending physician is responsible for evaluation of each in-patient on a daily basis. This will be done in concert with the fellow and residents.

Because of the short nature of the fellowship, a quarterly formal face-to face-evaluation will be done with the Program Director with input from each of the faculty members. The discussion will be based on the electronic evaluation system including both numeric and free-text responses.  Additionally, any needed verbal response from the faculty will be obtained. This information will be discussed with the fellow and will be kept on file by the Program Coordinator. Additionally, the faculty has made a goal to have a culture of immediate feedback. This will be done as informal discussions in the course of the day to encourage the fellow in areas of strength and to assist in improving limitations.

A formal evaluation of the fellow will be conducted on a quarterly basis. This will be completed by all faculty members. The evaluation will focus on each of the core competencies. The accumulated data will be discussed formally with the fellow by the Fellowship Director, Harlan Muntz, MD. As needed corrective action will be taken to assure development of expertise in each of these areas. Flexibility will be afforded to achieve the necessary case volumes and clinic encounters to accomplish these goals.

 

Contact Us

Emily Bird
Program Coordinator
Emily.bird@hsc.utah.edu

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