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Department of Anesthesiology

Day in the Life: PGY-1 at ENT Clinic

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Ashely

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By Ashely Chang Wetzig, M.D.

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My ENT clinic rotation was actually my very first rotation of intern year, and it was a great rotation to start with. I showed up at 7:30 a.m. each morning and began seeing patients around 7:45 - 8 a.m. along with 2-3 ENT residents. The day usually ended between 4-5 p.m., and sometimes earlier. The patients varied in their complaints, from foreign objects stuck in ears to epistaxis to dysphagia and head and neck cancers. As an anesthesia intern, I tried to see as many chief complaints of dysphagia and hoarseness since that usually meant getting the opportunity to use the fiberoptic laryngoscopes to scope patients. This allowed me to become more comfortable with maneuvering scopes and becoming more familiar with airway anatomy. 

Each patient visit lasted between 10-20 minutes (depending on use of the phone interpreter), and afterwards, I would present the patient to the ENT attending running clinic that week. We would then go back into the patient's room together, and the attending would either supervise me scoping if the visit required it or wrap up the visit if not. During an average day, I would have 5-7 minutes afterwards to finish my note and place orders in Epic. On busy days, I would start my notes after each visit and then finish them at the end of the day. 

Another unique aspect of this rotation is the opportunity to work closely with ENT residents and attendings who are very knowledgeable when it comes to learning about and mastering the airway. They make you feel included as an off-service intern, and even offer opportunities to scope patients on the floors with them and join them in the OR to watch tracheostomies. This rotation offers a refreshing break from inpatient medicine and is flexible enough for you to seek out opportunities that meet your interests.

will-jones/

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By Will Jones, M.D.

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ENT clinic was definitely one of the high points of intern year and a unique opportunity afforded to us as anesthesia interns at Baylor. The primary goal of the rotation is for us to get comfortable with upper airways, specifically the nasopharyngeal airway. The clinic gets many, many consults for swallowing difficult and hoarseness, which means lots of practice with flexible fiberoptic nasopharyngolaryngoscopy to evaluate the larynx and the cords. There are also numerous post-laryngectomy patients, so you’ll definitely get comfortable with trach monitoring and management, and maybe even perform a few in clinic trach exchanges.

The day starts around 8 a.m. when the team arrives to the clinic. Patients will start getting roomed and its off the races. Being a surgical subspecialty clinic, things tend to move very quickly, which I personally enjoyed. The morning continues as you pick up patients, take a quick H/P or post-op assessment, scope them if indicated, staff with either the attending or one of the ENT chiefs, and move on to the next patient. Notes are also quick and succinct. That continues to about 12:30 p.m. when there’s a break for lunch and then starts again for afternoon clinic around 1 pm. I would say on most days, clinic was done around 2-3 p.m. The ENT residents will usually head to the ORs after clinic to finish up some cases. They were more than happy to have us join them in the OR if it was something we thought would be helpful. I personally wanted to scrub on a tracheostomy placement to see what was happening on the other side of the curtain. A good anesthesiologist should always know some of the basic steps for the case on the table in order to stay prepared – especially when that case involves the airway!

The rest of the afternoon after clinic finished is yours to use as you see fit. It’s a great rotation to start studying for Step 3 if needed. Also, no call!

I really enjoyed my time in the ENT clinic – fast paced, procedural, pertinent to future practice, great experience for future nasofiberoptic intubations. Truly such great opportunity we have at Baylor Anesthesia.