Otolaryngology Curriculum

2 Purpose

The purpose of the curriculum is to produce, at certification, consultant Otolaryngology surgeons with the generic and specialty-specific professional capabilities needed to manage patients presenting with the full range of acute conditions and general elective conditions as well as to develop a special interest within Otolaryngology. Trainees are entrusted to undertake the role of the general Otolaryngology Specialty Registrar (StR) during training and are qualified at certification to apply for consultant posts in Otolaryngology in the United Kingdom or Republic of Ireland. This section of the curriculum defines the scope of practice of Otolaryngology, what has to be learnt, the levels of performance expected to complete training, how the curriculum is delivered and how it is assessed.

Patient safety and competent practice are both essential and the curriculum has been designed so that the learning experience itself should not negatively affect patient safety. Patient safety is the first priority of training demonstrated through safety-critical content, expected levels of performance, critical progression points, required breadth of experience and levels of trainer supervision needed for safe and professional practice. Upon satisfactory completion of training programmes trainees are expected to be able to work safely and competently in the defined area of practice and to be able to manage or mitigate relevant risks effectively. A feature of the curriculum is that it promotes and encourages excellence through the setting of high-level outcomes, supervision levels for excellence, and tailored assessment and feedback, allowing trainees to progress at their own rate.

Training is divided into three phases, and the second two phases are covered in this curriculum. The first phase refers to core surgical training or the first two years of surgical training (indicative) for run-through trainees (core equivalent) and is covered by the separate core surgical training curriculum. In the second phase trainees must achieve competence in the knowledge required in the generality of the specialty required for certification, and in the third phase they must continue the acquisition of general and emergency Otolaryngology technical skills to achieve technical competence. In addition, trainees must achieve competence in one area of special interest, defined as an advanced area of training in a particular area of the specialty. Service providers and patients benefit from consultant otolaryngologists who are trained in the generality of the specialty but who also have special interest skills to provide more specialist care. The curriculum ensures that trainees at certification, have both a special interest skill and good general emergency and elective skills.

Seven special interest areas are offered:

  1. Otology
  2. Rhinology
  3. Head and Neck
  4. Thyroid and Parathyroid
  5. Laryngology
  6. Paediatric Otolaryngology
  7. General Otolaryngology as a Special Interest

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK.

The Shape of Training (SoT) review1 and Excellence by Design: standards for postgraduate curricula2 provided opportunities to reform postgraduate training. The Otolaryngology curriculum will produce a workforce fit for the needs of patients, producing doctors who are more patient-focused, more general and who have more flexibility in their career structure. The GMC’s introduction of updated standards for curricula and assessment processes laid out in Excellence by Design requires all medical curricula to be based on high-level outcomes. The high-level outcomes in this curriculum are called Capabilities in Practice (CiPs) and integrate parts of the syllabus to describe the professional tasks within the scope of specialty practice. At the centre of each of these groups of tasks are Generic Professional Capabilities3 (GPCs), interdependent essential capabilities that underpin professional medical practice and are common to all who practise medicine. The GPCs are in keeping with Good Medical Practice (GMP)4. Equipping all trainees with these transferable capabilities should result in a more flexible, adaptable workforce.

All the shared CiPs are transferable to other surgical specialties and some may be transferable to non-surgical specialties. In addition, core knowledge and skills gained in any surgical specialty training programme are transferable for entry into Otolaryngology. Trainees who choose to move to or from a different speciality training programme having previously gained skills transferable to Otolaryngology, therefore, may be able to have a shorter than usual training pathway in their new training programme. While most of the specialty syllabus is not transferable because the knowledge and detailed technical skills are specific to Otolaryngology, some limited areas of the syllabus may be transferable e.g. Thyroid and Parathyroid surgery could be transferred to the Endocrine Surgery special interest within General Surgery. This flexible approach, with acquisition of transferable capabilities, allows surgical training to adapt to current and future patient and workforce needs and change in the requirements of surgery with the advent of new treatments and technologies.

Trainees enter Otolaryngology training via a national selection process at either phase 2 after core surgical training (CT1-2) or through the run-through programme from phase 1. Training is delivered in three phases, phase 1 (two years, of core surgical training or Otolaryngology themed run-through training), phase 2 (four years) and phase 3 (one or two years). Trainees who demonstrate exceptionally rapid development in knowledge, technical skills and acquisition of capabilities can complete training more rapidly than this indicative time. There may also be a small number of trainees who develop more slowly and require an extension of training in line with A Reference Guide for Postgraduate Foundation and Specialty Training in the UK (the Gold Guide)5. Trainees who opt for training less than full time (LTFT) have their indicative training time extended on a pro-rata basis.

Figure 1: Otolaryngology training pathway. Trainees can enter Otolaryngology training at phase 1, following the curriculum for core surgical training and running through without further selection into phase 2 of the Otolaryngology curriculum, or trainees can enter at phase 2, having successfully completed the curriculum for core surgical training and been successful at a national selection process into Otolaryngology training. Core surgical training is uncoupled from specialty training for the majority of trainees. The availability of posts is at the discretion of the statutory postgraduate medical education bodies.

Phase 1

Trainee can enter Otolaryngology training via a run-through programme at phase 1. They will follow an Otolaryngology themed two-year programme, following the core surgical training curriculum. The Intercollegiate Membership examination of the Royal Colleges of Surgeons; MRCS (ENT) (the MRCS part A plus the MRCS (ENT) OSCE) must be successfully completed before progressing to Phase 2.

Phase 2

During phase 2 trainees must gain the knowledge and clinical skills in general Otolaryngology to the level of independent practice expected at certification. Their technical skills, whilst well developed by the end of phase 2, will not necessarily reach the level expected for certification in the emergency and general elective competencies of the syllabus until the end of phase 3. At the end of phase 2 there is a critical progression point (see section 3.4) at which trainees must be able to demonstrate competencies in knowledge, clinical skills and professional behaviours commensurate with certification and become eligible to sit the Intercollegiate Specialty Board (ISB) examination in Otolaryngology.

Phase 3

In phase 3 trainees must further develop the technical skills in the elective and emergency aspects of the specialty and develop one of seven possible special interest areas as defined by the syllabus. A special interest is chosen after discussion with the Training Programme Director (TPD) and is based on the needs of the service, the preference of the trainee and the ability of the programme to support the trainee in that special interest. While programmes offer most or all of the special interest areas, either within the programme or by arrangement with a neighbouring programme, there is no requirement for any one programme to offer all the areas of special interest. There may be instances where there are more trainees in a cohort who wish to pursue an area of a specific special interest than a programme can accommodate, and the TPD may need to suggest a different special interest to some of these trainees.

Five of the special interest modules take an indicative two years to complete (Otology, Rhinology, Head and Neck, Paediatric Otolaryngology and Thyroid and Parathyroid), giving a total specialty training time of an indicative six years. Trainees undertaking Laryngology or General Otolaryngology as a special interest are usually able to complete this training in one year, subject to them also achieving the necessary technical skills in general and emergency Otolaryngology, giving an indicative specialty training time of five years. For all trainees the actual length of training may be shorter or longer than the indicative time according to the rate at which competencies are achieved.

Trainees do not necessarily spend all of phase 3 in placements in their chosen area of special interest as, by the end of phase 2, they are not required to have reached the level of technical skill in general elective and emergency Otolaryngology required by the syllabus for certification. Trainees may, therefore, need to undertake placements offering this training in phase 3. By the end of phase 3 trainees must be able to perform, independently to the standard expected of a day-one consultant, the procedures that are required to safely manage all patients presenting as emergencies, except those rare cases which need more specialised care - certification produces doctors with the knowledge and skills to stabilise and safely transfer these patients. At certification, trainees must also be able to manage a wide range of general Otolaryngology elective procedures in both children and adults, as described in the syllabus (appendix 2). On successful completion of phase 3, including successful completion of the ISB examination, trainees become eligible for certification and for recommendation to enter the specialist register.

1 Shape of training: Securing the future of excellent patient care

2 Excellence by design: standards for postgraduate curricula

3 Generic professional capabilities framework

4 Good Medical Practice

5 Gold Guide 8th edition