Marshall Ge, Marta Kulich, Rodrigo Mondero, Peter Kim, Janet Choi, Alison Yu, Shane Zhou, Ido Badash
While no one in the USC Caruso Department of Otolaryngology – Head and Neck Surgery was the least bit surprised, it’s worth noting that earlier this year, the Otolaryngology Residency Program earned full reaccreditation. With flying colors, actually.
After a self-study process painstakingly documenting adherence to roughly 80 pages of requirements set by the Accreditation Council for Graduate Medical Education, and after a ruthlessly self-critical “SWOT” (strengths, weaknesses, opportunities and challenges) analysis, the program welcomed an ACGME site reviewer to the USC Health Sciences Campus late last year. The good news arrived in February.
“We had a glowing accreditation—both from the ACGME and the LAC+USC Graduate Medical Education Committee, which oversees all USC residency programs,” says Niels Kokot, MD, who has directed the Otolaryngology Residency Program since 2013.
Otolaryngology has been a part of USC medicine since 1933, and its residency program has a proud legacy, according to Kokot, who received his own training here between 2002 to 2007. Now an Associate Professor specializing in head and neck cancers, he joined the faculty in 2008 after a yearlong fellowship at University of Pennsylvania.
Under Kokot’s watch, and with the full backing of USC Caruso Department Chair John Oghalai, MD, the Otolaryngology Residency Program has recently undergone big changes. Traditionally known for producing rock-solid surgeons, it is retooling as a training ground for academic surgeon-scientists.
In the past seven years, the department has added six clinician-scientists and 13 basic scientists to its faculty. The USC Caruso Department of Otolaryngology – Head and Neck Surgery now boasts 55 faculty members, including 24 surgeons who, as attendings, devote much of their time and attention to training and mentoring the program’s 20 residents.
The improvements are tangible.
“We really have seen a change in the type of residents we’re recruiting and the quality of residents we’re getting,” Kokot says. “We used to be a small department that was very clinically oriented. Now some of the new faculty we hired are more research-minded, and we’re recruiting residents interested in academic careers. We’re still getting people who are excellent clinically. That’s always going to be a part of our program. But now they also are having a great experience on the research side.”
The faculty expansion has made the Otolaryngology Residency Program more robust in measurable ways. The USC Caruso Department of Otolaryngology – Head and Neck Surgery now ranks 10th among the nation’s 104 otolaryngology programs in terms of NIH funding. It currently places 28th in Doximity and 44th in U.S. News & World Report rankings, and Kokot expects to see those numbers continue to improve.
“We’re a small but very competitive specialty,” he says, of otolaryngology in general. The field naturally attracts a stellar pool of candidates. Forty percent of all residency applicants in otolaryngology are members of AOA (Alpha Omega Alpha Honor Medical Society) with board scores above the 90th percentile, excellent letters of reference, outstanding grades and substantial research experience already under their belts.
Nationwide, there were just 315 residency positions available in 2018. Last year, the USC Caruso Department of Otolaryngology – Head and Neck Surgery received more than 400 applications for its four PGY1 spots. The admissions committee—which, in addition to Kokot, includes faculty members Tamara Chambers, MD, Michael Johns, MD, and Eric Kezirian, MD—winnowed those applicants down to 36 serious candidates, whom they invited for interviews. In recent years, the majority of “matches” have come from the committee’s top 10 picks.
Among the department’s attractions is a training model that takes full advantage of the Keck School’s tight connection with LAC+USC Medical Center.
First-, second- and fifth-year residents spend the vast majority of their time at the 600-bed facility, one of the nation’s largest publicly funded hospitals, where they deliver emergency and urgent care services to about 20 patients a day and perform up to 40 scheduled surgical procedures a week. Residents also staff a large otolaryngology outpatient clinic at LAC+USC, where up to 100 patients are seen on a daily basis.
“Our residents get a great experience as the primary providers of otolaryngology care to the people of Los Angeles. And they get a lot of independence. Right away, they’re seeing their own patients,” Kokot says. “By the time they’re chief residents in the last year of training, they basically run the show, treating everyone that walks through the door in a subspecialty tertiary manner, with the oversight of the faculty.”
Third- and fourth-year residents mostly rotate through Keck Hospital and Children’s Hospital Los Angeles, working shoulder-to-shoulder with faculty surgeons in a high-volume “operating camp” for private patients. This experience prepares them, in their last year as chief residents at LAC+USC, to “spread their wings and become independent surgeons,” Kokot says.
The fourth year also includes a three-month block for focused research, on top of yearly research projects completed by all residents and presented at the Resident Research Symposium in June. Graduates finish the program with “a track record of publishing between three and eight papers, making them very competitive for top fellowship positions,” Oghalai says.
The evolution of the residency program is in line with sweeping changes across the department.
“When Dr. Oghalai came in three years ago, he presented a very clear vision of how to grow the department—by hiring new faculty and expanding our clinical sites,” Kokot says.
Oghalai is a very well-respected scientist with a stellar research background, Kokot explains. “He has been very successful at running labs and getting grants. As far as I can tell, he’s had NIH funding basically since birth,” Kokot says, with a grin.
“And he has been supportive of our efforts to make sure we’re running the best training program possible. He’s committed to optimizing resident education, and he has been gung-ho about growing the residency program.”
Plans are underway to increase the program complement from 20 to 25 residents. Oghalai and Kokot have applied for grants to support the proposed increase. The new spot may include an extra two years of research—effectively creating a residency and fellowship rolled into one.
Backing Kokot’s efforts is a team of passionate professionals, including Clinical Assistant Professor Tamara Chambers, MD, who serves as Associate Residency Program Director and Chief of Otolaryngology at LAC+USC, where she oversees all trainees. Program Administrator Kim Schultz provides yet another support system for the residents. She runs the logistical aspects of the educational program, including grand rounds.
Schultz calls the 20 residents “my focus and my pride and joy.”
Kokot welcomes this kind of emotional investment.
“Medicine is a team sport,” he says. “Our residents need the support of classmates, faculty and staff to help get through it.”
To promote camaraderie and peer support, Kokot and Chambers have created “residency families” mixing trainees from different class years. These mentoring-trees help junior residents navigate the hospital system.
The Residency Program also now includes a Wellness Committee spearheaded by Michael Johns, MD, which provides counseling services to help reduce stress and stave off burnout.
Residents meet every semester with a faculty mentor to discuss changing goals and career paths. They’re also assigned a research mentor; those interested in pursuing a subspecialty receive informal mentoring from faculty in that subspecialty. For fourth-year residents aiming for academic jobs, Kokot, Chambers and faculty advisors work hard to land research fellowships—writing letters and making phone calls to colleagues at other top programs.
“We’ve really tried to make all aspects of the residency better,” Kokot says.
— By Diane Krieger