ENT careers and skills evening with SCRUBS Not just tonsils, wax & snot ENT careers and skills evening with SCRUBS Nottingham University Medical School September 2017

AIMS Overview of the specialty Subspecialties Career path for ENT Getting involved in ENT as an undergrad SFOUK

ENT – What’s it about? Neonates to elderly Routine surgery to highly complex Multidisciplinary Medical & surgical ENT aka otorhinolaryngology EN Tcovers a broad range of diseases patients of all ages - from a baby with airway obstruction, through to an elderly man with throat cancer. The skills needed to manage patients are therefore diverse. Medical skills are required for accurate diagnosis and non-surgical management of conditions. Surgical skills range from microscopic surgery for middle ear conditions, through endoscopic surgery for nasal conditions to more traditional open surgery for head and neck cancer. Due to the diversity of the case load, otorhinolaryngologists – head and neck surgeons work closely with a range of professionals including audiologists, speech and language therapists, oncologists, endocrinologists, dermatologists, neurosurgeons, maxillofacial surgeons and plastic surgeons. Ex utero intrapartum treatment

ENT – What’s it about? ENT has lots of variety ENT surgeons manage non-surgical care of their patients More clinics than other surgical specialties – carry out procedures and medically manage patients Good gadgets in clinic and theatre ENT see more children than any other surgical specialty apart from paediatric surgeons. ENT surgeons also manage all the non-surgical care of their patients (as there is no sister medical specialty). Consultants have on average four clinics a week and can deal with a variety of problems. Audiology, allergy, sleep disorders, voice pathology, balance disorders, and rhinological disorders can all form part of a clinic workload. ENT examination is specialised and uses lots of gadgets. These range from a simple head mirror and torches to a microscope for examining ears.

ENT – What’s it about? More separate surgical procedures than other specialities Operations can last minutes to 10+ hours Range of cancer and benign surgery Surgery that helps improve communication and works with the senses Despite a common perception that ENT deals mainly with wax, snot, and spit, it is not widely realised that ENT has more separate surgical procedures than other surgical disciplines. An operation can be as short as 1 min (inserting a grommet) or as long as 12 hours (major head and neck resection with reconstruction). Advanced technology forms an integral part of the modern ENT surgeon's collection - from the use of laser surgery in laryngeal lesion excision to cochlear implants for hearing restoration – forward thinking speciality Common procedures undertaken include tympanoplasty, mastoidectomy, endoscopic sinus surgery, thyroidectomy, rhinoplasty and salivary gland surgery. Tertiary referral centres undertake cochlear implantation, resection of head and neck cancers, skull base surgery and complex airway surgery

ENT - Elective vs Emergency Generally busy day time with elective work Emergency work ranges from common conditions (epistaxis, FB) to dramatic and life threatening Usually registrar and consultant non-resident on calls  ENT departments can be busy during the daytime when elective work takes place and most emergency patients are seen.   Common elective procedures undertaken include tympanoplasty, mastoidectomy, endoscopic sinus surgery, thyroidectomy, rhinoplasty and salivary gland surgery. Tertiary referral centres undertake cochlear implantation, resection of head and neck cancers, skull base surgery and complex airway surgery Emergency work ranges from common conditions such as head and neck infections, epistaxis and removal of foreign bodies through to the urgent treatment of airway obstruction and penetrating neck trauma. Out of hours work is generally quieter than other surgical specialties, but emergencies can be dramatic and life threatening. The lifestyle that ENT offers makes it attractive to women and flexible trainees. Private practice work is available, but there is variation between regions.

ENT – Subspecialties Otology, neurotology, and base of skull surgery Rhinology Laryngology Head and neck surgery Facial plastic surgery Paediatric otolaryngology Like most surgical specialties, ENT is becoming more sub specialised

ENT – Otology Treatment of ear disease, improving hearing and balance Toys! Microscopes, endoscopes, drills, hearing implants Otologist performs surgery on: external ear e.g. for stenoses or cosmesis middle ear e.g. for hearing or cholesteatoma inner ear e.g. for hearing or balance Skull base surgery e.g. acoustic neuroma & CSF leaks

ENT – Rhinology Treatment of all aspects of nose and sinus disorders Including infection, inflammatory conditions and tumours Management of epistaxis to septoplasty/rhinoplasty to trans-sphenoidal hypophysectomy, Facial plastics – skin cancer surgery and facial skin flaps, and cosmetic surgery Dynamic– endo-nasal management of skull base tumours Opposed to craniotomy through sphenoid sinus

ENT – Laryngology Treatment of diseases of the larynx and throat e.g. vocal Cord augmentation, and cancers The voice is a fundamental component of communication Patients often include teachers, singers, actors and politicians Injections, microscopic procedures, open procedures, laser surgery The voice is a fundamental component of communication – individual personality and social interaction Fast-growing technological advancements

ENT – Head & Neck Treatment of benign and malignant diseases of the H&N: larynx, lymph nodes, salivary, thyroid and parathyroid glands Simple to complex surgery e.g. cancer resections and flap Reconstruction Anatomy clearly demonstrated Multidisciplinary Trans-oral laser and trans-oral robotics - advancing function and quality of life advancing the post resection function and quality of life for patients

ENT – Paediatric Some ENT conditions are congenital Starts at birth! EXIT procedure – ENT surgeon in the delivery room Variety – H&N surgery, sleep, apnoea, airway surgery, tympanomastoid/cholesteatoma surgery… Reward of making a significant difference in the quality of a child’s life

Career path in ENT Results

What to do now Get in touch with your local friendly ENT department Talk to consultants – ask about projects Do an ENT SSC Arrange an ENT elective Try and secure an ENT job at foundation Join SFOUK! Discussion

D Demonstrates commitment to specialty SFOUK Demonstrates commitment to specialty SFOUK annual conference (September) - platform to present Eligibility to enter SFOUK Essay Prize ENT podcasts ENT elective information Student membership is only £20 Discussion

D SFOUK Discussion

WHAT TO DO NOW Not to early to plan ahead for national recruitment in ENT ST3 selection hosted by Yorkshire and Humber Deanery http://www.yorksandhumberdeanery.nhs.uk Discussion

Surgical training is changing… Discussion

Thank you Any questions?