Mission

To train the next generation of Army Otolaryngologists who are compassionate leaders in their community, prepared to tackle our nation’s military medical challenges, and dedicated to lifelong earning and scholarly activity.

Vision

The Madigan Otolaryngology Residency Program will set the standard for ENT training by providing a diverse training environment that immerses residents in rigorous academics, complex pathology, and well-rounded surgical exposure. We foster a healthy and encouraging learning environment where everyone is equipped to develop into their full potential.

Aims

Our program aims are to:

• Graduate competent and compassionate otolaryngologists who will pass their board exams on the first attempt and provide exceptional care to the diverse population of America’s service members and their families.
• Produce knowledgeable otolaryngologists who are well-prepared to perform head and neck surgery, trauma, and complex airway management while deployed to combat zones or on humanitarian missions.
• Continue to improve and advance the field of otolaryngology-head and neck surgery through research, medical innovation, scholarly activities, and training of the next generation of surgeons.
• Promote the wellness of both residents and faculty, preventing burnout through teamwork and maintenance of a supportive learning and working environment.

We have a robust academic curriculum. Our residents participate in:

• Morning Report / Chief Resident led didactics (daily)
• Morbidity and Mortality (M&M) Conference (monthly)
• Head and Neck Tumor Board (bi-monthly)
• Trauma Video Teleconference (monthly)
• Journal Clubs (quarterly)
• Grand Rounds
• Academic Lectures (resident, faculty, and guest speakers)
• Audiology & Vestibular Primer - Basic Science Curriculum
• ENT 101 Curriculum

PGY-1: Broad clinical overview

• Six, 4-week blocks of ENT at Madigan
• Seven, 4-week blocks of Plastic Surgery (2 blocks), Oral & Maxillofacial Surgery, General Surgery, Anesthesia, and ICU at Madigan, and Emergency Medicine at Tacoma General Hospital

PGY-2: 12 months at Madigan

• Run the inpatient service and primary call team
• Master basic surgical skills, anatomy, and pathophysiology
• Begin an introduction to MultiCare Hospital system (Mary Bridge Children’s Hospital, Tacoma General, Good Samaritan)- cover cases when able

PGY-3: Midlevel Resident split between Madigan and Seattle

• 6 months at Madigan
• 1 month at Mary Bridge Children’s Hospital
• 2 months at Seattle Children's Hospital
• 3 months at Swedish Hospital – focusing on Head & Neck Surgery

PGY-4: Independent and complex Otolaryngic disease and surgery

• 3 months at Madigan
• 2 months at Swedish Medical Center – Head & Neck Surgery
• 3 months at Virginia Mason – Otology, Neurotology & Lateral Skull Base Surgery
• 2 months at Harborview Medical Center – run the Head & Neck Trauma Service in the region’s only Level I Center
• 2 months at Providence Medical Center – Head & Neck and Endocrine Surgery in addition to a mélange of ENT care within a Private Practice setting

PGY-5: Supervisor of the Otolaryngology Service- Develop and refine independent practice skills

• 12 months at Madigan Army Medical Center
• Run the inpatient and outpatient Otolaryngology service at Madigan with a special focus on planning a rigorous academic curriculum
• Able to cover key indicator and surgically complex cases at MultiCare Hospital System, and Swedish Medical Center

There are no elective rotations inherent in our curriculum. However, if a trainee desires a unique and fulfilling experience, we are open to entertaining/accommodating this if it is not disruptive to their experience (or the experience of other residents).

While at Madigan, residents take home call approximately every 3-4 nights depending on the number of trainees on service. Junior residents are paired with senior residents to facilitate teaching and assistance on call. Call slightly varies on each off-service rotation; however, trainees are always under the guidance and support of a Physician faculty.

Due to the abundance of military bases in the Pacific Northwest, residents at Madigan Army Medical Center care for active-duty service members from all military branches. Patients also include veterans (American Lake VA), retirees, and their family members.

During their training, all residents will be sent to:

• Basic Officer Leadership Course (if not already attended)
• Combat Casualty Care Course (C4)
• Madigan Capstone Field Training Exercise (FTX)

All residents will complete the following courses as a part of their training:

• Basic Allergy Course (American Academy of Otolaryngic Allergy)
• Iowa Basic Anatomy Course
• Iowa Advanced Head & Neck Cancer Reconstruction Course

Residents are also offered the opportunity to participate in the:

• Seattle Otology & Rhinology (SOAR) Course
• Pacific Northwest Advanced Airway Course
• University of Washington Facial Plastics and Rhinology Course

Residents participate in simulated learning in our department, the hospital morgue, and the Anderson Simulation Center throughout the year, including:

• Oral & Maxillofacial Trauma Course
• Temporal Bone Dissection Labs
• Rhinology & Anterior Skull Base Surgical Lab
• Facial Trauma Lab
• Cadaver Anatomy Labs
• Microvascular Lab
• Simulated “Mock” Oral Examinations

Didactic lessons on Leadership and Professionalism are integrated throughout the year within our department and hospital. Our residents are leaders and teachers to those more junior to them. Our trainees undergo an intentional model of graduated leadership. First, they assist. Then, they do.

Finally, they supervise and teach. This applies to everything we do: including clinic, surgeries, and taking call. Everyone is expected to guide those behind them, and our culture fosters a climate of stewardship. We emphasize integrity, lead by example, and ensure that our faculty and residents model good behavior.

Our program has robust research opportunities including clinical, retrospective, prospective, and basic science projects. Our faculty is experienced with intellectual property, and technology transfer, and has several patents for novel surgical devices and pharmaceutical drug design.

Residents are required to complete three, 1-month dedicated research blocks during their training (PGY-2, 3, and 4 years). Additional time can be considered to support clinical research projects. Trainees are required to submit a scientific manuscript to a peer-reviewed journal and participate in various research projects and opportunities to meet their graduation requirements.

Residents are encouraged (and funded) to present their research at regional and national meetings including, but not limited to the:

• Northwest Academy of Otolaryngology (NWAO)
• Combined Otolaryngology Spring Meeting (COSM)
• American Academy of Otolaryngology-Head & Neck Surgery Annual Meeting
• Association for Research in Otolaryngology (ARO)
• Society of Military Otolaryngologists (SMO)
• Various otolaryngology sub-specialty association meetings

Madigan Army Medical Center’s Department of Clinical Investigation (DCI) offers courses throughout the year to assist trainees in preparing protocols, writing manuscripts, conducting research, and learning biostatistics. Our trainees have access to clinician scientists within our department in addition to the abundant research opportunities within our affiliated rotation sites (including the University of Washington, Seattle Children’s, and Virginia Mason Healthcare Systems).

Each resident must develop and implement a quality improvement (QI) project as a graduation requirement. The hospital has several Process Improvement (PI)/Quality Improvement (QI) seminars throughout the year and several trainees sit on the hospital’s PI/QI Committee. Also, interested residents are encouraged to complete the University of Washington Patent Care, Quality and Safety Course.

Professional development is fostered in our culture. This includes bi-annual resident review, mentor/mentee development, Rater/Senior Rater OER counseling, recognition with military achievement awards, and lessons about operational military experiences.

Residents are presented with the opportunity to participate in the following professional military education (PME) courses:

• Military Vestibular and Rehabilitation (MVAR) Course
• Military Humanitarian Assistance Course
• Military Dive and Hyperbaric Medicine Course

Although most of the training is at our home institution, residents also have an integrated experience throughout the region that gradually immerses trainees into complex otolaryngic pathology to reinforce and grow their surgical abilities. This provides our residents with diverse exposure to world-renowned surgeons at phenomenal academic centers.

Trainees spend time in:

• Tacoma, Washington: Mary Bridge Children’s and Tacoma General Hospitals
• Puyallup, Washington: Good Samaritan Medical Center
• Seattle, Washington: Virginia Mason, Swedish, Harborview, and Seattle Children’s Hospitals
• Spokane, Washington: Providence ENT

Applicants are encouraged to rotate with us early in the academic year before the October application deadline. Spending time on our service allows you to meet our faculty, residents, and staff, while fully appreciating the wonderful opportunities our program and location have to offer. Coordinate a rotation by reaching out to our program leadership.

Medical students and graduate applicants will be expected to perform at the level of an intern. In the clinic, they will begin by following either the attending or a senior resident. Then, after a brief period, they are expected to see patients independently and present them to the attending or the senior resident. Students/applicants should have MHS Genesis access and will be expected to write a clinic note for otolaryngology patients. Students/applicants are expected to attend all academic conferences including Grand Rounds, Tumor Board, Case Presentations, Pre-Op/Post-Op Conference, Morbidity & Mortality (M&M) Conference, Trauma Conferences, and any other lectures, labs, and academic courses that occur during their rotation. They will participate in morning reports and chief resident-led didactics that incorporate daily readings. A short presentation will be given by the applicant at the end of the rotation on an Otolaryngology topic. Assistance with the presentation will be available through an appropriate faculty member.

Program graduates take the American Board of Otolaryngology-Head & Neck Surgery’s (ABOHNS) board exam. This exam is offered annually. To become fully board certified, applicants are eligible to take board certification exam after graduating. Information about this process can be found at the ABOHNS website.

All doctors are teachers. The scope and degree of residents serving as teachers increase throughout their training under the guidance of faculty. As stated above, each resident is expected to assist, then do, and then teach. This applies to managing consults, seeing/supervising clinics, performing operations, and working to provide independent ENT call coverage. Residents will also hone their written, oral communication, and presentation skills throughout their five years of training as they synthesize material and effectively teach others.

Senior residents are eligible to become Clinical Faculty through the Uniformed Services University (USU).

All the subspecialties within Otolaryngology are represented by our faculty. This includes:

• Facial Plastics and Reconstructive Surgery
• Head & Neck Surgery -Endocrine, Oncology and Microvascular
• Laryngology
• Otology, Neurotology and Lateral Skull Base Surgery
• Pediatric Otolaryngology
• Rhinology & Anterior Skull Base Surgery

After the first 6-months of training, residents select a faculty mentor. This faculty is specifically tasked with helping trainees navigate the stressors of residency while looking ahead and planning for their future career while balancing their life stressors. However, all faculty have a role in mentoring trainees. Sometimes these are task-based (e.g. Grand Rounds, Journal Club) and other times, faculty serve as role models and champions for their trainees.

The Pacific Northwest is an outdoor, foodie and cultural paradise! Although we pride ourselves on working hard, we ensure that everyone has time for self-care, family, and wellness. Throughout the year, we have many non-clinical activities. The residents have an annual Resident Retreat (correction…Resident “Attack” since we don’t retreat) every spring where they prepare to transition leadership to the new chief residents. We host a graduation dinner to celebrate the graduating chiefs and welcome the new interns. Our department has a summer BBQ at American Lake with the Otolaryngology, Audiology, and Speech Pathology services. Every Friday morning, the residents play sports before academics. Small groups of hiking, biking, sports, and ski events are sprinkled around the calendar.