With much appreciated funding in the form of The Journal of Laryngology & Otology Travelling Fellowship, and at the kind invitation of Professor Clarence Sasaki, Chief of Otolaryngology, I visited the Yale otolaryngology department during May and June 2007 (Figure 1).

Fig. 1 Professor Clarence Sasaki and Mr Paul Nix.

This report aims to give a flavour of the department and how it functions, and of the experiences I gained there.

Yale Medical Center

Yale Medical Center, New Haven, is the principal teaching hospital of Connecticut and is situated approximately one and a half hours south of New York. The otolaryngology department sees approximately 15 000 out-patients and performs approximately 6500 operations per year. The key consultants and professors in the department are Professors Sasaki, Son, Ross and Leder and Assistant Professors Kveton, Karas, Michaelides, Friedman and Baum, supported by a dedicated team of clinicians, staff and 10 residents.

My experience of the department

On my first day, I met Professor Sasaki as he was presenting patients to the weekly tumour board meeting, akin to the UK head and neck multidisciplinary team meeting. It would be an understatement to say that he was an active man; not only did he run the tumour board meeting, along with Professor Son, but he also managed to fit in two other out-patient clinics and could be found in theatre four days per week!

I was very fortunate to be given a free rein within the department, and took full advantage of the opportunity to observe many aspects of otolaryngological practice at Yale.

A typical day began with patient rounds at 6.45 a.m. Each patient would be presented by the intern or residents to the rounding team, which included professors and otolaryngology residents. All charts and patient reviews had been prepared, from 5.30 a.m. onwards, by the juniors in the otolaryngology team. That made for a very early start. At the end of the round, the Chief Resident, Tom DellaTorre, would assign daily duties to the residents and medical students. Formal rounds occurred six days per week.

Nobody knew what I meant when asking about ‘theatre’, and I quickly became adept at the American terminology of the ‘OR’ (operating room). General OR started at 7.30 a.m. with two adult and one paediatric otolaryngology lists.

The 10 residents had an active teaching programme. Each was enrolled on a home study programme of the American Academy of Otolaryngology – Head and Neck Surgery, as well as having half a day of dedicated teaching per week. Hospital-based teaching occurred every Wednesday, and rounds would start at 6.15 a.m. on that day to maximise time. Teaching included resident presentations and input from the departments of pathology, radiology and oral surgery. Dedicated bi-weekly teaching time was also allocated to the temporal bone lab for the drilling of cadaveric temporal bones.

The department was also involved in a nationwide sinus simulator evaluation programme, termed ‘ES3’. At present, there are only three simulators in the USA, and their role in sinus training has yet to be defined.

In addition, the department held a weekly clinical radiology meeting.

The consultants and my experience of their practices

Obviously, in a department the size of Yale's, I was not able to closely scrutinise the work of all the consultants and clinicians. However, I hope the following gives a flavour of the work of the department which I did observe.

Private otolaryngology offices

During my visit, I also had the opportunity to visit private otolaryngology offices run by Drs Kveton and Toukoudes. The offices were situated in the penthouse suite of an office block, with panoramic views of New Haven and a large veranda for lunch time breaks. The otolaryngology equipment in this private office was extremely impressive, including a transnasal oesophagoscope (Figure 2), extensive audiology and vestibular equipment, and even an in-house cochlear implant team.

Fig. 2 Dr Tomas Toukoudes with a transnasal oesophagoscope.

Patients stepped out of a lift into an elegant waiting area, before being shown to one of three clinic rooms. This facilitated a fast and efficient through-put of patients. I was particularly interested in the transnasal oesophagoscopies regularly performed by Dr Toukoudes. The procedure was tolerated very well by the patient and recorded onto a K system for later, detailed viewing. At the time of my visit, Dr Toukoudes was using this only as a screening process. The practice also had facilities to perform out-patient laryngeal and pharyngeal biopsies, using a side port on a flexible nasal endoscope. Lunchtime was a welcome break from the busy private office schedule, and included my first American hot dog. This was cooked on the outside barbecue while I enjoyed the heat haze view of downtown New Haven.

Leisure time

When time permitted during my Fellowship, I explored the city of New Haven, dominated by the Ivy League campus of Yale University. The campus was modelled after Oxbridge and certainly reproduced the spectacular architecture of Oxford. I was also privileged to be invited to Mory's, a Yale alumni club and past haunt of a number of American presidents (Figure 3)

Fig. 3 Mr Paul Nix and Professor Doug Ross at Mory's, the Yale alumni club.

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At weekends, I took the opportunity to visit the surrounding area, including the magnificent sights of Boston and New York. Inevitably, I have a host of touristy photos with spectacular views from the Empire State Building, New York Metropolitan Museum … and even of afternoon tea at the Waldorf Astoria!