BALANCING PEDIATRIC OTOLARYNGOLOGY TRAINING FOR FELLOWS AND RESIDENTSAT A CHILDRENS-HOSPITAL

Objective: To determine the feasibility of presiding surgical, endosco pic, and patient contact experience of high educational value at a chi ldren's hospital sufficient for adequately training contemporaneously both residents in otolaryngology-head and neck surgery and fellows in pediatric otolaryngology. Design: Retrospective review of operating ro om case logs and assignment of cases based on arbitrary perception of inherent case complexity and skill and experience that are required to manage the case. Setting: Tertiary care children's hospital located i n a major metropolitan area. Main Outcome Measures: (i) Volume of surg ical and endoscopic cases assigned retrospectively to junior resident, senior resident, or fellow. (2) Sore on newly developed self-assessme nt skill list in pediatric otolaryngology. Results: During 1 year, the re were 3224 surgical and endoscopic procedures performed in the opera ting room. Of the total number of procedures, only 44 (1.4%) were desi gnated as being exclusively assigned for hands-on experience to a fell ow, but 380 (11.8%) were appropriate for both a senior resident and a fellow and therefore were apportioned in an alternating fashion. A sel f-assessment instrument has been developed to assess competency and co mfort in the management of otolaryngic disorders, both surgical and no nsurgical, in children. Conclusions: The volume and assortment of surg ical and endoscopy cases at a tertian; care children's hospital can pr ovide the basis for a rich, practical hands-on experience for resident s and fellows. Since few surgical or endoscopic casts require pediatri c fellowship training for mastery, becoming a pediatric otolaryngologi st depends on acquiring skills and competence that exceed the technica l skills acquired in the operating room.