Residency Program Overview
Otolaryngology-Head & Neck Surgery is a broadly based discipline involved in the diagnosis and management of disease occurring above the clavicles and largely outside the orbit and cranial cavity. As such, it encompasses many systems and involves a very broad area of medical practice, including communication disorders, hearing loss, neurotology, skull base surgery, head and neck surgery, endoscopy, facial and reconstructive surgery and allergy in all age groups. The faculty has a broad range of skills with leaders represented in virtually all sub-disciplines. Very close relationships exist, including cross-appointments, with a number of other disciplines such as radiation oncology, pathology, and certain of the basic sciences. The discipline is vital, changing and growing. It is very exciting to be a part of this specialty.
This residency program is for 5 years.
Program length of training does not exceed the Royal College or College of Family Physicians of Canada standard.
This Otolaryngology - Head & Neck Surgery program at the University of Toronto consists of 1 year of Surgical Foundations training followed by 4 years of specialty training at University of Toronto teaching hospitals.
In core surgery, 13 blocks are in rotations undertaken in general surgery, neurosurgery, plastic surgery, emergency medicine, internal medicine, medical imaging, anesthesia, and critical care medicine. These rotations provide an important knowledge base to complement the core otolaryngology training. 7 months of clinical otolaryngology and 4 months of otolaryngology research comprise the remainder of the 2 year core training. Otolaryngology rotations for PGY1 residents are usually provided at the University Health Network (UHN), the Hospital for Sick Children (HSC), Sunnybrook Health Sciences Centre (SHSC), and St. Michael's Hospital (SMH). PGY2 residents also have a 1 month otolaryngology rotation at North York General Hospital (NYGH). The PGY2 4-month research block is undertaken with the supervision of a clinical or basic science researcher after formal proposal and discussion/approval of the project by the Director of Research for our Department and the Program Director.
The PGY3 year involves 12 months of clinical otolaryngology at University of Toronto teaching hospitals (usually SH, HSC, SHSC, and/or UHN). PGY3 residents spend a total of 2 weeks in the Division of Anatomy at the University of Toronto learning from anatomy professors, dissecting cadaver specimens, and teaching head & neck anatomy to first year medical students.
The PGY4 year involves 10 months of clinical otolaryngology at University of Toronto teaching hospitals (usually SH, HSC, THP, SMH, SHSC, and/or UHN). The PGY4 resident is the senior resident at THP and HSC. PGY4 residents have a 3-month block that consists of a facial plastic surgery rotation, elective rotation, sleep medicine rotation, and head & neck pathology rotation.
The PGY5 year involves 12 months of clinical otolaryngology at University of Toronto teaching hospitals (usually UHN, SH, SMH, SHSC, and MGH). The PGY5 residents are the senior or chief resident during each rotation. They have an unparalleled exposure to all aspects of otolaryngology-head & neck surgery and by the end of their year are expected to function at the consultant level.
The graded responsibilities of residents are clearly outlined to them by the Program Director and the site co-ordinators/hospital chiefs during their orientation sessions at each new rotation.
Since July 1, 2008 all University of Toronto residents entering PGY1 are required to complete the web based PGCorEd* core competency modules as part of their residency program certification. These modules provide the foundation for non-clinical roles for the RCPSC and CFPC Programs. These modules are focused for PGY1 & PGY2 trainees. Failure to complete the modules may constitute professional misconduct and/or prevent promotion to the next PGY level.
A.T.L.S. Training: Certification in Advanced Trauma Life Support (A.T.L.S.) is mandatory traininng provided and funded by our Department for all PGY1 residents.
Otolaryngology - 7 months
All PGY-1 residents participate in the Surgical Foundations course within the Department of Surgery. PGY1 residents participate in a unique hands-on surgical skills training program on a weekly basis during the academic year.
Otolaryngology - 4 months (research)
This is a year of clinical otolaryngology. Trainees have ten months of rotations at University of Toronto Teaching Hospitals, as well as 1 month of elective. In addition, PGY3 residents have a unique opportunity by spending 2 weeks of dedicated time in the anatomy laboratory and teaching head & neck anatomy to first year medical students.
PGY4 & PGY5
Two years of clinical otolaryngology - head & neck surgery at University of Toronto teaching hospitals including a minimum of 3 months of community otolaryngology (Michael Garron Hospital & Trillium Health Partners). A 3-month block comprising of a pathology rotation, a 1-month facial plastic & reconstructive surgery rotation, a sleep medicine rotation and a 1-month elective are included in PGY4. Residents in their PGY4-PGY5 years generally spend 3 month rotations at the University Health Network, Sinai Health, the Hospital for Sick Children, Sunnybrook Health Science Centre, Michael Garron Hospital, and Trillium Health Partners.
There is a great deal of flexibility in choosing electives anywhere residents wish. However, residents must submit to the Program Director, a written request detailing the nature of the elective, the proposed dates, a set of objectives and the name, affiliation and address/telephone/e-mail of the supervisor.
The University of Toronto teaching program is not only a leader in the education of residents, but also in the education of postgraduate fellows. There are a large number of clinical and research fellowships offered for advanced training. However, it is made absolutely clear that residents have first priority for any learning experience, including the operating room. The fellows are considered unique to our program in bringing outside experience and knowledge. Our residents have found them to be excellent teachers and have formed lasting friendships. We consider the fellows a uniquely positive addition to our training program. Prospective candidates are encouraged to speak with our current residents about the positive impact our fellows have had on their education.
Our program provides a full range of adult and pediatric care over seven institutions. General otolaryngology exposure is integral and available in all teaching hospitals, particularly at St. Michael's Hospital, Michael Garron Hospital and Trillium Health Partners Hospitals. The bulk of otolaryngology care in these three institutions can be defined as "general otolaryngology".
In addition to general otolaryngology, the following institutions also provide sub-specialty training as follows:
UHN: Head & neck surgery/reconstruction, otology/neurotology and skull base surgery
SH: Head & neck surgery emphasizing endocrine surgery, rhinology and sinus surgery
SMH: Laryngology, rhinology, endocrine head & neck surgery, skull base surgery
HSC: Paediatric otolaryngology
SHSC: Otology/neurotology, skull base surgery, head & neck surgery/reconstruction
MGH: Sinus surgery, pediatric otolaryngology, facial cosmetic surgery
THP: Otology, sinus surgery, paediatric otolaryngology
NYGH: Otology, sinus surgery, laryngology, paediatric otolaryngology
SJHC: General otolaryngology
Didactic and Practical Skills Courses
There is a substantial program of didactic and practical skills courses arranged for residents during their 5 year residency. During the PGY1 year, residents attend the Surgical Foundation lecture series given weekly by the Department of Surgery. PGY2 residents usually take the Royal College Surgical Foundations examination in the first half of their year, which is a pre-requisite to taking the final Royal College exam in Otolaryngology-HNS. In addition, PGY1 residents attend a prep camp in July and refresher course in September at the Surgical Skills Centre, Sinai Health. The curriculum covers the full range of basic surgical skills (airway management, suturing, bone plating, lasers, etc.). At the end of the program in the spring of each year, PGY1 residents undergo a practical skills assessment exam and are graded against residents in all of the other surgical specialties.
PGY2 to PGY4 residents have protected academic time each Friday morning from 9am to 12pm during the academic year for core lectures. This is a 3 year cycle of lectures given by faculty within and outside our Department as required. The lectures cover all aspects of otolaryngology management as well as specific lectures on the 7 CanMEDS roles, ethics, and epidemiology/critical appraisal. At the end of each block of lectures, residents write a 3 hour exam in the same format as the final Royal College exam (short answer). In addition to core lectures, residents have 2 temporal bone drilling sessions in the Surgical Skills Centre during core lecture time.
PGY3 residents spend the equivalent of 2 weeks in the Division of Anatomy. They receive didactic head & neck anatomy lectures and interactive seminars from Division of Anatomy professors. Residents dissect cadaver specimens and are demonstrators (teachers) for first year University of Toronto medical students. Where possible, otolaryngology faculty participate to show residents surgical anatomy. Residents write an anatomy exam at the end of their experience.
PGY4 residents participate in a fellowship study course organized by our Department each academic year. The lectures are held on Mondays for 2-3 hours and again cover the major topics in otolaryngology-head & neck surgery. The course is revised each year with input from the most recent graduates and the current PGY5 residents.
Residents are invited and encouraged to attend the 8-10 continuing education courses held each year organized by our Department. Residents in their PGY4 year are sponsored to attend the annual American Academy of Otolaryngology-Head & Neck Surgery meeting or the Annual Canadian Otolaryngology Review Course. Wherever possible, residents are encouraged to attend scientific meetings related to otolaryngology-head & neck surgery.
Practice exams are an integral part of our training program. In addition to a practice Surgical Foundations exam, PGY1 practical surgery skills exam, and core lecture exams, our residents write the National In-Training exam (NITE) each year. The National In-Training exam questions are submitted by otolaryngology faculty across the 13 Canadian training programs and all PGY2-PGY4 residents across the country take the exam. Results are tabulated by resident year and sent to each resident and program.
Practice oral exams are an integral part of the training program. The PGY1, PGY2, PGY3, and PGY4 year will usually undergo 2 sessions with 4-5 examiners each year (i.e., 8-10 practice oral exams) and the PGY5 residents will undergo 3-4 sessions with 4-6 examiners each year (i.e., 20-30 practice oral exams). After each exam, residents are sent their marks for each station compared with their peer's marks. More importantly, residents are given specific written comments from the examiners regarding their performance. The PGY5 residents in particular have found these practice oral exams an invaluable experience and tremendous preparation for the final Royal College exam.
One of the mandates of the University of Toronto Department of Otolaryngology - Head & Neck Surgery is to train the community and academic leaders of tomorrow. An important aspect of our training program is to foster clinical and basic science research. In his capacity as the Director of Research for our Department, Dr. Alain Dabdoub oversees the research agenda in collaboration with 4 PhD researchers and 8 research laboratories.
A dedicated 4 month research block takes place in the PGY2 year through a mentorship program; research projects are presented at our annual Percy Ireland Academic Day during the spring of each year. Trainees who are interested in pursuing a career in academic otolaryngology are encouraged to take advantage of the clinician scientist program through the University of Toronto. Some residents pursue advanced degrees (e.g. clinical epidemiology, surgeon scientist, education, health economics) during their residency training but this is not a requirement of our program.
There are numerous weekly academic teaching sessions, hospital rounds, quality assurance rounds (M & M rounds), and grand rounds during the academic year. Residents are responsible for preparing hospital based rounds and PGY2-PGY4 residents give departmental grand rounds once per year. Residents also prepare and present at journal club with articles focused around a particular subject or theme and include the teaching of clinical epidemiology and critical appraisal.
The University of Toronto Otolaryngology-Head & Neck Surgery Program is fully integrated. Affiliated hospitals are:
- Sinai Health (SH)
- St. Michael's Hospital - Unity Health Toronto (SMH)
- Sunnybrook Health Sciences Centre (SHSC)
- University Health Network (UHN) - Toronto General Hospital, Toronto Western Hospital, Princess Margaret Hospital
- Hospital for Sick Children (HSC)
- Michael Garron Hospital (MGH)
- North York General Hospital (NYGH)
- St. Joseph's Health Centre (SJHC)
- Trillium Health Partners (THP)