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If you are thinking of embarking on a career in surgery, otorhinolaryngology - head and neck surgery (usually referred to as ear, nose and throat or ENT surgery) is an exciting and challenging option.
ENT surgery is a unique specialty where a broad range of diseases will be encountered in patients of all ages: from a baby with a threatened airway, to an elderly man with extensive throat cancer. The skills needed to treat patients are also diverse, ranging from microsurgery to treat middle and inner ear conditions to major surgery of the head and neck. Rhinoplasty, grommet insertion, adenoidectomy and tonsillectomy are only part of a diverse range of surgical procedures.
A large part of an ENT surgeon's practice is outpatient-based, which is where many procedures are carried out and diagnoses are made. Surgeons will use the latest technology, such as rigid endoscopes, flexible fibre-optic endoscopes or microscopes.
The career path
In Foundation years 1 and 2, six four month jobs are undertaken which will usually involve medicine, surgery and number of other specialities. Many will do some ENT probably for four months during this time but many will not. During this time someone who is interested in a career in ENT surgery will apply for jobs in core surgical training. If successful they should take the MRCS part “A” as soon as possible. Core surgical training years 1 and 2 can either be within surgery in general where there will be a mixed set of jobs including such things as general surgery, accident and emergency, plastic surgery, neurosurgery and paediatric surgery and ENT, or they can be in themed posts which will generally have one year of ENT and one year between mixed surgical specialities allied to ENT.
During the CT 1 and 2, the prospective ENT surgeon would take the MRCS(ENT). This consists of part “A” a multiple choice exam in the principles of surgery and then part “B” an OSCE examination which is specifically ENT. The OSCE examination is the same one as those doctors in general practice and from overseas take when they are obtaining the diploma of Otolaryngology/Head and Neck Surgery (DOHNS).
Following successful completion of the MRCS (ENT) the candidate would be eligible to apply through national selection for higher surgical training in ENT. In Scotland the training is run through so no hurdle applies. In the UK there are approximately 30 jobs available per annum. Six years of higher surgical training specifically in ENT is undertaken. During this time the full spectrum of ENT surgery is covered. The intercollegiate FRCS in ENT is taken about two thirds of the way through this time. Following successful completion of the FRCS many people undertake fellowships before they obtain their CCT and become consultants. These fellowships can either be in the UK or overseas, and there are well established Head and Neck, cleft palate and cosmetic facial surgery fellowships that are advertised every year. There are also specific fellowships advertised by departments such as implantation otology, skull base, rhinology and paediatric ENT fellowships. As well as this there are many fellowships abroad which people undertake in centres of excellence and in the third world to enhance their experience and CV’s. During this time many people undertake research projects which will often lead to a specific sub-specialist interest. Once CCT has been granted and you are on the specialist register then you can apply for consultant jobs.
So in summary 2 year Foundation, 2 years Core Surgical Training (usually ENT themed) and 6 years higher ENT training with fellowships as subspecialties.
The career of a consultant ENT surgeon
The general otorhinolaryngologist
Doctors who train as ENT surgeons will either work in a district general hospital or a teaching hospital and can expect to see patients with a range of diseases. Some specialism does occur in larger hospitals and the development of a specialist interest is encouraged. At least one in three outpatients seen will be children and approximately one in eight of all patients will be listed for surgery. Patients are also treated medically with a wide range of therapeutic agents, which often means regular visits to outpatients.
The appeal of the practice is the wide variety of clinical cases. More complex cases are often referred to a specialist in an ENT practice at the nearest large hospital.
Specialisation
Specialisation means training and working primarily in one area of ENT practice. This is becoming the normal practice for a consultant ENT surgeon in a teaching hospital or a large district general hospital. Examples include:
Paediatrics, which may be divided into paediatric otology and audiology, and the treatment of airway and head and neck diseases of childhood.
Head and neck surgery, which is the treatment of benign and malignant disease of the mouth, tongue, pharynx, larynx and upper oesophagus and neck.
Otology, which is the treatment of middle and inner ear disease and may include cochlear implantation or skull base surgery.
What to do next
If you would like more information on how to embark on a career in surgery, contact the training department at the Royal College of Surgeons.
Also see the leaflet published by ENT.UK:
Otorhinolaryngology - Head and Neck Surgery (E.N.T) an Excellent Career Choice
This can be purchased at a cost of 45p Order Form
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