Careers in ENT

For anyone considering a career in surgery, ENT is a fantastic choice. It is an interesting and varied specialty, and much more flexible than traditional surgical careers. There is a wide range of surgical procedures to master from the routine adenotonsillectomy and grommets to the highly complex skull base surgery.

The mixture of medical and surgical conditions and treatments sets it apart from most other surgical specialties and we treat all ages, including children. Emergency work ranges from the common (head and neck infections / abscesses, epistaxis, removal of foreign bodies) to more exciting situations (airway emergencies, neck stabbings). Once at Registrar level, on calls are usually done from home which adds to the �family-friendly� reputation of ENT and can be particularly attractive to female surgeons.

There is the opportunity to proceed with sub-specialist training within ENT:

• Rhinology: the management of sinonasal disease, the surgical removal of sinus malignancies and septorhinoplasty.



• Otology: diagnosis and management of impaired hearing, removing destructive diseases of the ear and implantable hearing devices.



• Neurotology / Skull base surgery: Ranges from the medical management of the dizzy patient to the image-guided surgical removal of skull base tumours.



• Head & Neck Surgery: the treatment of benign and malignant diseases including laryngectomy, thyroidectomy, neck dissection, salivary gland excision, and reconstructive surgery.



• Paediatric ENT: diagnosis and treatment of congenital abnormalities to highly complex airway reconstructive work.



• Facial plastic surgery: ranges from simple skin lesion removal to resection of malignancies and reconstruction of facial / nasal defects.

For those at medical student / Foundation level of training who are keen to pursue a career in ENT, it is always worth talking to your local friendly ENT team! When applying for your rotations, those with ENT as an option are obviously ideal, but other specialties with close overlap include Plastic Surgery, Neurosurgery, Paediatric surgery and Ophthalmology. A short rotation in any of these would be beneficial. The MRCS exam is changing to incorporate the Diploma of Otolaryngology-Head & Neck Surgery (DOHNS), for those seeking direct career progression.

The selection process into ENT at ST3 is highly competitive. The process is constantly evolving and National Selection is now a reality. The application form and person specification are subject to slight change each year. There will be six stations including portfolio review assessing career progression, generic interview assessing knowledge of the field, management scenario, one or two clinical scenarios, communication skills and a technical competence assessment. Marks from the stations will be ranked, and previously declared preferences will be taken into account.

Once through this bottleneck, trainees will embark on a 6-year training programme in general ENT as well as exposure to sub-specialist ENT as listed above. During this period trainees are expected to undertake audit as well as publish and present research projects. The option of studying for a higher degree is there, either as �time out� from training or on a part-time / distance learning basis whilst continuing normal clinical activities. The Part 3 �exit� exams are usually taken about 18 months before the predicted CCT date, after which many trainees travel to other centres to become trained in more specialised procedures. These fellowships can be undertaken pre-CCT, particularly if travelling abroad to centres of excellence eg Australia, Canada, Europe.

Post-CCT fellowships are becoming more common and are now being introduced formally in England, hopefully with the rest of the UK to follow suit shortly. These are advertised nationally and are appointed on merit at interview. They include Head & Neck, Skull Base, Airway & Voice, Rhinology & Advanced FESS and Cosmetic Surgery.

Consultant posts are in demand, and the current shortage of jobs is a concern in ENT as in many other specialties. However, there is a steady trickle of jobs coming through and moves are afoot to prevent this situation getting any worse.

ENT is a great career, and it is worth the hard work needed to pursue it.



Joanne Rimmer

Education & Training Committee Representative