Clinical Education

The USC Caruso Department of Otolaryngology – Head and Neck Surgery provides residents with education in the comprehensive evaluation and medical and surgical management of diseases and disorders of the ears, upper respiratory, upper alimentary systems, and related structures of the head and neck. Residents are given graduated responsibility in accordance with their level of training, and resident proficiency is documented throughout training. Our philosophy and training sites allow for early resident involvement in the surgical and medical care of our patients, such that our residents gain clinical skill and confidence in taking care of complex patients from the beginning of their residency through the end of their chief resident year.

During the PGY1 year, residents spend six months on the otolaryngology service, split evenly between Los Angeles General Medical Center and Keck Hospital. At Los Angeles General Medical Center, the interns share the responsibility of inpatient care, have their own patients in the ambulatory clinic, and assist during surgery. At Keck Hospital, there is a much higher inpatient volume, and the interns share the responsibility of the inpatient care with the senior residents and a physician’s assistant. They also assist in the operating room and the attending ambulatory clinics. The remaining intern rotations outside of otolaryngology are selected because of direct relevance to otolaryngology.

Los Angeles General Medical Center serves as the sponsoring institution and main site for resident education. The entire PGY2 and PGY5 year as well as three months of the PGY3 year is spent here. There are four resident teams, each run by a chief resident. The PGY2 residents rotate through each team, and a PGY3 resident rotates on one of the teams at all times. The chief resident runs the service and is responsible for the comprehensive management of patients pre-operatively, intraoperatively, and post-operatively. The PGY2 resident acts as the consult resident as well as running the tracheostomy service, while the PGY3 resident begins to perform surgeries such as tympanoplasty and septorhinoplasty independently. Each team alternates clinic and OR on a daily basis. Residents are supervised in clinic and in the operating room at all times. Most of our faculty staff cases at Los Angeles General Medical Center, so surgical cases are scheduled according to the expertise of the faculty covering the operating room for that day. We are able to offer all operations to our patients at Los Angeles General Medical Center, including endoscopic anterior skull base surgery, acoustic neuroma resection, microvascular free flap reconstruction, and in-office procedures such as injection laryngoplasty. Our department performs more than 90 percent of all thyroid and parathyroid surgery at all three of our sites, so our residents become very proficient in these operations by their chief resident year. Los Angeles General Medical Center recently accessed an Intuitive Surgical da Vinci Xi robot, and we offer transoral robotic surgery (TORS) to our patients, just as we do at Keck Medical Center of USC.

Our resident training at Los Angeles General Medical Center is one of the highlights and unique aspects of our program. We offer appropriate supervision (whether indirect or direct) by our faculty and allow residents to work independently according to their level of training. Junior residents learn how to manage patients and get access to the operating room early in their experience. This prepares them for the senior year of residency when they are managing complex patients independently, running a team, operating independently, and preparing for independent practice. This level of independence also prepares our residents as teachers, as the chief resident is responsible for a portion of the education of the junior residents and medical students. Our residents uniquely experience the longitudinal care of patients by spending the entire PGY2 and PGY5 years at Los Angeles General Medical Center, permitting them to follow the disease course of their patients over this time.

Keck Medical Center of USC serves as our tertiary/quaternary private hospital, where the residents receive a high volume of surgical training. Our interns learn to manage complex patients and begin to gain surgical skills performing procedures such as tracheostomies and closure of free flap donor sites. The Keck rotation is divided into two teams. The head and neck surgery service is covered by two PGY4 residents, while a PGY4 and PGY3 resident cover the otology, rhinology, laryngology, facial plastic surgery, and sleep surgery services. Our residents work one-on-one with faculty and learn the necessary skills to be prepared for their chief resident year at Los Angeles General Medical Center. The head and neck surgery service is a high-volume service, performing all aspects of head and neck surgery including microvascular reconstruction, TORS, skull base surgery, endocrine surgery, and sialoendoscopy. On the other service the residents are exposed to the highest level of care in rhinology, otology/neurotology, laryngology, and facial plastic surgery. Our rhinologists and otologists collaborate closely to perform endoscopic anterior skull base surgery and lateral skull base surgery, including acoustic neuroma resection. We have a robust laryngology division performing airway surgery, phonosurgery, and numerous in-office procedures. Our residents are exposed to numerous cosmetic procedures, reconstructive procedures for MOHS surgery defects, and facial reanimation surgery. Finally, we have a dedicated sleep surgeon, and the PGY3 resident spends a month focused solely on this service.

Children’s Hospital Los Angeles (CHLA) is a busy, stand-alone children’s hospital located a few miles from the USC campus. The PGY3 residents each spend three months at CHLA, sharing the rotation with a UCLA PGY3 resident. This rotation exposes our residents to a high volume of high-acuity pediatric patients. In addition to basic ear tubes and tonsil procedures, our faculty perform complex airway reconstruction, endocrine surgery, head and neck surgery, endoscopic sinus surgery, microtia repair, and chronic ear surgery. In addition, we perform a high volume of cochlear implants in connection with the Caruso Family Center.