Before you start (e.g. people to meet, preparation, etc.)

If you have time before your rotation starts, shadow a CF/CT/FY2 on call. M5 is the ENT ward and handover takes place in the M5 Doctors' Office at 8am and 8pm. This is about halfway down the ward.

Rota pattern

There are 4 types of shift. These are:

1. The on-call day from 0800-2000 2. Nights from 2000-0800 3. Emergency clinic which begins at 1330-1730 in clinic 10 4. Firm days from 0900-1700. These are your 'training' days. You can either attend theatre sessions or shadow a clinic. ENT theatres are usually 9 and 10. You should meet the SpR who is doing the list at 8am to see the patient pre-op with them. CF clinic / OPD, clinical fellow clinic takes place in clinic 10. The morning session begins at 9am and the afternoon session at 2pm. OPD is shadowing SpR's/Cons in clinic. There is also a specific skull base clinic which takes place on a Friday morning with the neurosugery team.

The typical patient (common cases/workup/investigations/surgical/medical issues/differential diagnoses/management plans)

You should familiarise yourself with the management of epistaxis, otitis externa, otitis media and acute tonsillitis. The ENT SHO should be able to aspirate quinsies and remove simple foreign bodies from the nose or ears.

Admission/discharge/patient turnover (e.g. routes of admission, admission clerking, typical patient stay, turnover, discharge issues, social, hospital@home, follow-up, etc.)

Admissions from patients referred to ENT by ED, post-op patients and referrals from other teams. You may also receive referrals from local GPs. You will have to give GPs advice and decide whether to review patients via A&E, Emergency ENT clinic (SHO run), or a general ENT referral. If you're unsure, speak to the SpR on call with you.

Important learning tools (e.g. resources, papers, books, seniors, hospital policies)

You will be very well-supported by the on call ENT registrar on this job. They are the best initial source of information if in doubt about any practical matters.

“ENT: An Introduction and Practical Guide” (CRC Press, 2011) is a very useful book that is edited by the department's very own James Tysome (consultant ENT surgeon).

Website: entsho.com

There is an Oxford Handbook for ENT and an American edition of this. Both are useful and quite concise.

Flexible nasendoscopy is a skill you will be taught quite early on. Technically it is relatively straightforward. However you would be well advised to have a look at the anatomy and common problems you could encounter, as at the beginning it will all look the same! - http://www.ghorayeb.com/Pictures.html is useful for pictures. - obviously follow the advice of the SpR/cons teaching you the skill, but to familiarise yourself prior to starting there are loads of videos on youtube. This one is OK - https://www.youtube.com/watch?v=Mek604eTA5I

Other important information (top tips, the reality, what you wish you'd known)

Your clinics will have a 'supervising consultant'. They are not phsyically present in the clinic at the same time. There is no senior 'de-brief' at the end. So unless you ask for help, the patients will only be seen by you.

It is therefore important - especially when you start off - to ask for help if you are unsure about anything (ENT is a bit of a 'niche' speciality after all). Obviously if you are concerned about anything you can call the consultant through switchboard. In reality the first point of call is usually a consultant or registrar in an adjacent clinic, there is nearly always at least one other clinic running alongside of yours. They are often very helpful and approachable. They are very understanding and expect you to discuss cases with them. If in the rare occasion you are unable to contact either the supervising consultant or another senior in clinic. Call the on call SpR.

Clinics will be a daunting prospect at first, and will take a lot of time. However you will learn a lot and and will get the hang of it by the end of the block.

The long day on call shifts (Monday - Saturday) are very busy, but nights are quieter.

There have been long-standing recruitment problems on the ENT rota, and a high attrition rate for clinical fellows. The rota has changed several times as a result (although the structure of individual shifts has remained unchanged). Multiple changes have been known to occur within a four-month FY2 rotation, so prepare to be patient and flexible…

There are monthly ENT mortality and morbidity meetings which SHOs are expected to present at.

There are excellent learning opportunities when you are on call. Overall, a good rotation for those interested in general practice, paediatrics or neurosurgery.