NHG-AHPL OTORHINOLARYNGOLOGY RESIDENCY PROGRAM

ENT

Resident's Talk

NHG-AHPL Otorhinolaryngology from NHG Residency on Vimeo.

What is the specialty of Otorhinolaryngology (Ear, Nose and Throat) ?

The ORL or ENT is a specialty which has a good balance between medical and surgical management of patients.

Many ORL patients can be managed in the outpatient clinic, with the help of specialized diagnostic ORL instruments. Some patients will require surgical intervention, for example, head and neck cancer patients. Surgery is also carried out with minimally invasive techniques, for example in endoscopic sinus surgery of the nose, and microsurgery of the ear.

In an ORL department, the ORL specialists also have to work with many other para-clinical specialists. For eg. Audiologists help in the assessment and rehabilitation of hearing impairment, and vestibular therapists in recovery from vestibular problems. Speech and swallowing therapists are also crucial members of our ORL team dealing with problems in the head and neck.

In short, an ORL specialist looks forward to a career of always challenging and ever improving medical and surgical excellence. During the first 5 years of their career, our rigorous residency program hopes to give an aspiring specialist the best possible start to his career.

NHG-AHPL 5-year ORL Residency Program

Our program is based in Tan Tock Seng Hospital (TTSH) and Khoo Teck Puat Hospital (KTPH). We will provide you with the opportunity to learn and practice in various clinical, surgical, academic and research settings in your exciting journey towards becoming an ORL surgeon. It complements structured teaching and academic activities with on-the-job training to develop clinical skills. We expect you to assist and perform various operations under the close supervision of our experienced surgeons, which is essential in the training of all aspiring surgeons.

An example of clinical rotations for residents, Year 1 to Year 5 + Year 6

ORL Rotations

Rotation Guidelines

Year 1 – General Surgery (or other surgical orientated rotation) is necessary as a pre-requisite for the intermediate MMed examinations. Residents who have acquired this experience prior to residency may substitute an ENT, emergency medicine or anaesthesia posting as an alternative.

Year 2 onwards – After ORL residents have achieved a basic level of experience, they will have rotations into subspecialty teams, where they will have a greater subspecialty exposure. But it is important to remember that residents are expected to be interested in all subspecialties, and not to unduly focus on any one subspecialty during their residency.

Year 4 – When a resident is more senior, a Paediatric ORL rotation will be done as an external posting at KKWCH. Similarly, senior residents who wish to rotate to other hospitals for further ORL exposure, either in Singapore or in other countries, may apply to do this as an alternative rotation. Some elective rotations in the intermediate years of ORL may be to departments outside TTSH and KTPH, to widen exposure in paediatric ORL, general surgery, plastic surgery, or any other surgical related specialties.

Year 5 – Final year residents will have increased subspecialty rotations, as well as increased surgical exposure, as they prepare to exit the program and begin work as fully fledged specialists.

Year 6 or 7 – For those residents who have selected the clinician-scientist residency track, year 6 onwards will be the time allocated to additional research, with the aim of achieving an additional research qualification.

Besides training in ORL, you will also receive training in other skills such as communications, patient safety, evidence-based medicine and professionalism to complete your development as a clinician.

An example of a weekly schedule of work for a resident

ORL Weekly Schedules

Note:

- In addition, General ORL clinics run everyday. 2 Surgical OTs also run each day. Each night there is 1 MO/junior resident, 1 senior resident, and 1 consultant on night call.
- Regular protected time away from this schedule can be given research work.
- Apart from these formally conducted teaching sessions, we consider personal reading as a very important part of acquiring the knowledge required by a resident.

Resident assessments:

Summative assessments:

These are the tests and examinations our residents have to sit for.

MRCS pt 1-3, (A&B)
Annual ABO in-service examinations
MMed ORL
ENT JCST administered exit examinations
ABMS-i certification exams (developing)
MOC examinations (developing)

Several members of our staff are helping in the development of the last 2 summative assessments

Formative assessments:

We think it is equally important for residents to do well in formative assessments, viz. your normal work and academic performance, to be assessed every 6 months. We will also monitor your surgical case load and ability, and also assess how you work as part of the team, and with your peers.

Post-residency: Subspecialty Training and other Career Opportunities

Following successful exit from our residency program, we would wish that you, the now fully qualified ORL surgeon, would continue to pursue a career in NHG-AHPL. This would help you gain further experience and upgrade your skills. TTSH and KTPH are the 2 newest government restructured hospitals in Singapore, and the new infrastructure provides many opportunities for employment and growth.

For the ORL surgeon who wishes to sub-specialize, there are opportunities to obtain further fellowship training in otology, rhinology, head and neck surgery, laryngology, and facial plastic surgery. This will involve a fully paid duration of fellowship training in the surgeon’s subspecialty of choice, usually in an overseas centre. We will assist by making the necessary contacts and introductions to the relevant overseas centres.

We also expect our staff to become teaching faculty at the Novena Campus of the NTU-Imperial College Lee Kong Chian School of Medicine, which will begin in 2013. At present, many of our staff already teach at the NUS Yong Loo Lin School of Medicine and the Duke-NUS Graduate Medical School. And of course, the teaching of residents remains a constant for all members of both departments.

Lastly, for those so inclined to try private practice, the newly setup Novena Medical Centre, and upcoming Parkway Novena Hospital will also give opportunities for those who want to mix private practice with institutional practice.

In conclusion, ORL provides a good balance between medical and surgical management of patients, and the opportunity to do research and teaching. Very importantly, the nature of this specialty allows for the chance of a healthy work-life balance.

Faculty Members

Name	Designation and Department
Program Director:
Dr Chong Yaw Khian	Consultant, Department of ORL, TTSH

Associate Program Director:
Dr Stephen Lo	Consultant, Department of ORL, TTSH
Dr David Loke	Consultant, Department of ORL, KTPH
Faculty:
Dr Samuel Yeak	Head and Senior Consultant, Department of ORL, TTSH
Dr Paul Mok	Head and Senior Consultant, Department of ORL, KTPH
A/P Siow Jin Keat	Senior Consultant, Department of ORL, TTSH
A/P Mark Khoo	Senior Consultant, Department of ORL, TTSH
Dr Julian Lee	Senior Consultant, Department of ORL, TTSH
Dr Chong Yaw Khian	Consultant, Department of ORL, TTSH
Dr Jeeve Kanagalingam	Consultant, Department of ORL, TTSH
Dr Kenneth Oo	Associate Consultant, Department of ORL, TTSH
Dr Andrew Loy	Visiting Consultant, Mount Elizabeth Hospital
Dr Chan Siew Chee	Visiting Consultant, Gleneagles Hospital
Dr Nelson Chee	Visiting Consultant, Mount Elizabeth Hospital
Dr Ravi Sheshadri	Visiting Consultant, MD Specialist Healthcare, Paragon and East Shore Hospital
Dr Yuen Heng Wai	Visiting Consultant, Changi General Hospital
Dr Lucy Leong	Senior Specialist, Occupational Safety and Health Division, Ministry of Manpower