Our fifth episode features our resident lead, Dr. Travis Pickett, who is currently a PGY-1 at the University of Ottawa! We had a fun and informative discussion with Travis regarding life as a PGY-1, incorporating questions provided by our followers. Listen along to hear his thoughts on transitioning to residency, the highs and lows, and more!

Show Notes

Katie: Hey there and welcome to The Oto Approach, a podcast created by medical students for medical students, to teach you about all things otolaryngology. I'm your host, Katie, and today we are joined by Dr. Travis Pickett!

Travis Pickett is originally from Corner Brook, Newfoundland. He completed his undergraduate degree with an honours in biochemistry and a minor in chemistry. He completed his MD at Memorial University of Newfoundland where he was awarded the accolades of the Canadian Medical Hall of Fame Award, and the Chancellor's Award. He is also the co-founder of a 3D-Printing in healthcare company, PolyUnity, currently based in St. John’s, NL. His interests are in medical technologies as well as arts in medicine. He is currently completing his first year of residency training in Otolaryngology - Head and Neck Surgery at the University of Ottawa.

Thank you so much for joining us today Travis!

Dr. Pickett: Thanks for having me Katie, I really Appreciate it!

Katie: So Travis- I wanted to start by asking how you realized you were interested in otolaryngology in the first place. 

Dr. Pickett: Yeah, I guess my story is a little bit of a funny one. So a lot of people come into medicine knowing kind of what they want to do, most people don't. But for me, I didn't even know that surgery was an option, but I guess after my first year of medicine I shadowed surgery and I was like “Woah this is pretty cool.” It was from there that I was introduced to all the different varieties of specialties in surgery. It was my friend, Michael Bartellas, who actually introduced me to ENT he kind of showed me the different types of things that they can do and from there I just started looking into it a little bit more myself. I had some excellent mentors back in Newfoundland. Some of the surgeons there that I work with were great for just having me around and letting me help out. And then my interests were kind of solidified when I- when I thought about what you're really doing with the ENT. I really enjoy the fact that you're working with the special senses. You're working with people's ability to interact with the world around them, it's their voices, it’s their hearing, it's their faces, the way that people perceive the world and how people perceive them. That was a powerful and I felt like it was some somewhere where I really wanted to help make a difference  

Katie: Yeah, Absolutely. I think a lot of medical students are fascinated by work happening with the special senses, kind of like what you had mentioned. Would you say the breadth of the specialty is something that drew you to it as well?

Dr. Pickett: Yeah exactly, so you know, I was- I always had difficulty kind of picking what I wanted to do, it was never an easy decision for me. I'm a little bit indecisive. What I like about ENT is that it is so broad, there are so many different subspecialties in it, so it's still a little bit of choose your own destiny within residency as well. I still have a little bit of time to think about what type of discipline within ENT that I want to do, you know, there’s Laryngology, Head and Neck Surgery, Pediatric Otolaryngology, Facial Plastics, Rhinology, Otology. I mean it's just such a wide variety and every discipline is so different.

Katie: Yeah, wow. It seems like there are a lot of really unique avenues available to you. So of course you're a PGY1 in Ottawa right now. How have you been enjoying your first year as a resident?

Dr. Pickett: It's been good. I moved here in an interesting time, during the pandemic, so that definitely afforded its challenges as well, you know, a lot of the social aspects of residency that you- you come to enjoy, that I heard of in first year, right now probably haven't been the same. But what's good is that, you know, I have a lot of off service rotations in first year so I get to meet a lot of different people through these rotations and get to know people around the hospital, so that's been really helpful. Residency itself is always a steep learning curve for everybody, no matter what discipline you’re in, no matter what program you're in, it's always- it's always a change from medical school, but along the way you make friends, you get more independence and you enjoy yourself. 

Katie: Yeah, okay. So it sounds like you're having a pretty good time, despite what I'm sure have been some challenges due to the pandemic. Can you explain a little bit about what you mean by off Service rotations and what that looks like?

Dr. Pickett: So off service means you're covering a specialty that is not the residency that you are training in, essentially. So when I'm on service that would mean that I'm on ENT. Residencies are broken up into blocks throughout the year that are 4 weeks long each. And so in my first year I do 3 blocks of ENT and the rest are off service. So this could be a wide variety of things. So there are different surgical Specialties that we cover and non surgical Specialties. Interestingly, we do a palliative care rotation here in Ottawa, which is really valuable. But we do things spanning from neurosurgery to plastic surgery, trauma surgery, thoracic surgery. It's a really good variety.

Katie: Okay so it seems like you definitely have some nice variety there. That's really cool that palliative care has been incorporated into the program.

Dr. Pickett: Yeah, I think it's really important, you know, we in ENT, we have a lot of very sick patients sometimes, you know, the head and neck oncology population can be incredibly sick and we need to be able to have these difficult conversations with patients and their families and loved ones all the time so it was really really valuable. 

Katie: What was it like transitioning from medical school to residency?

Dr. Pickett: It's good. I mean the transition to residency is- it presented challenges for everybody right and like I said before I like it doesn't matter what program you're doing it doesn't matter what specialty you’re training in, you have this increased sense of responsibility now and at 3 a.m. when you're on call, you got to make decisions, right. You always have back up there, so what's supposed to be really nice is, you know, the rotations that I've been on I felt very supported in the decisions that I make. And overtime you start to become a little bit more independent. I remember, you know, first starting residency and putting in orders for Tylenol and getting really nervous about it, being like ‘Oh My God’ because you could finally sign off on things and that's a big change. But yeah, over time you just get more comfortable within your scope of practice and it's really good, it's a very collegial environment here in Ottawa I have to say I've really enjoyed it.

Katie: Would you mind just walking us through a normal day as a PGY1?

Dr. Pickett: Yeah, It depends on what rotation I'm on, but I can focus on I guess an ENT block. So again it depends a little bit if you're on pediatric ENT vs. adult ENT. So adult ENT, I'll typically wake up at around 5:00, I like to have a little bit of time in the morning before I go into work. Rounding would typically start at around 6:00 anywhere between 6:00 and 6:30. And from there you go to clinic or the OR depending on whatever you're scheduled for that day. You'll typically carry the Day pager, as a junior resident. So any consults that come in, any ward issues that come up, you’re responsible for handling throughout the day by the clinic or the OR. And then, you know, if any urgent consults come up you go see it, but typically you try to see any consults, you know, after your duties for the day are finished. Review through Senior residence when you have a chance. Round again at the end of the day, if you need to. And then head home. 

When we're on call for ENT, we cover 3 different sites, we cover the general campus, we cover the Ottawa Civic campus and we cover the Children's Hospital of eastern Ontario. So call kind of spreads you in all these different directions and that's a bit of a transition as well. But once you get used to it it's pretty good. So for call, what's nice for first year is we're always assigned a senior resident to work with, so anytime you have a consult you can review with them, anytime there's a procedure or an OR they can be there to help as needed and then in second year we start to senior call. 

Katie: Okay right, that makes sense. What have been some of the highlights for you so far?

Dr. Pickett: Yeah so, the biggest highlight is just really looking back and realizing how much you learn. So I guess I'm getting close to being done my first-year residency now and looking back on this year and realizing how much independence I've gained, how much I've learned, how much I've done. It’s pretty incredible to think about and to realize. So either passively or actively, you're learning a lot every single day, you're really getting involved in a lot of procedures, you're the person doing it, you’re hands on, whether it's in the OR or down to emerge- you're the one, kind of, do the procedures. All the friends that I've made along the way, maybe the social situation isn't as great here in locktown, but you know, I made a lot of friends and I’m going to hopefully continue to make a lot of friends throughout the next 5 years, it's been really good.

Katie: So when you say you're involved in procedures, what are some of the common procedures you'd be involved in as a resident and what's your role?

Dr. Pickett: Yeah it kind of depends on the- on the rotation every rotation kind of has it's like bread and butter Junior resident skills that you, that you get involved in. For ENT in particular epistaxis is something that we would get very comfortable with, in first year as Juniors. So learning all the different techniques of stopping epistaxis. Draining peritonsillar abscess, draining abscesses in general that would be things that we do in emerg fairly frequently. In the OR, tonsillectomies, like, we get to do readily, throughout first year. So I did two blocks of pediatric ENT, by the end of it I was doing tonsils fairly independently, which was great. Same thing with adenoids, myringotomy tubes and then any other larger procedures, you're there to assist on and if your first assist, you are there to help out throughout every step of the procedure.

Katie: So we've been chatting a bit about the interesting and fun aspects of residency. But obviously, there are going to be some challenges that come with that as well. What have been some of those challenges for you and how have you been able to overcome them?

Dr. Pickett: Hearing the call pager for the first time. I’ll never forget my first block that I was like really on call for with the thoracic surgery and it's technically home call, but I was so nervous that I just decided I was going to stay in the hospital, I just didn't want to go home in case something came up. And then I remember someone went into atrial fibrillation like in the middle of the night it was like 3:30 in the morning and I was like ‘Man, I can't call the fellow about this, I need to be able to handle this.’ And I know how atrial fib is managed, but when you're the person making the call, at 3:30 in the morning, you really want to make sure you're the one making the right call. The nurse called me from the Ward and I was like, ‘okay yeah sure great, just give me a minute’ and I ended up like just taking time and I remember like scrolling through Uptodate, all these resources online, like really just like trying to definitively decide on what my best management was going to be and I spent like 20 minutes just like researching what I was going to do before I called back and she was like, ‘okay thanks.’ So really just like gaining the confidence in your initial decisions, right. You know what you need to do it's just making sure you know you know. And I think that that's probably one of the biggest challenges, right, gaining the confidence in yourself but it comes with time and experience, you know, I don't get as nervous now on the pager goes off. It goes off a lot, it goes off all the time and you, after seeing how things could go right and how things can go wrong with things on the ward or in emerg, you start to get more comfortable with things that you can handle.

Katie: Yeah it definitely seems like developing confidence in your own abilities would be, kind of, an ongoing challenge during residency, for sure. So how do you balance your duties as a resident with other aspects of your life?

Dr. Pickett: Yeah, I mean I have a wide variety of interests, sometimes to a fault. But you just, you learn to make time for things that are important, you know, residency can be tough and it's important to learn how to make time for yourself during residency as well. You want to read around your cases and stuff as much as possible, but I try my best not to take work home with me. If I'm off for a weekend, I'm off for a weekend kind of thing. And really just, you know, time management is everything you're going to have a lot of different duties, whether it's research presentations you need to give, different courses, ACLS, ATLS that you need to do on the side as certification for residency and so just learning to balance all those things is just super important, learning to triage what needs to be done now and what can wait.

Katie: So we kind of already touched on the breakdown of your rotations in your first year of residency, but how are things structured throughout the rest of your residency?

Dr. Pickett: Right so first years, is what I like to see it as, it's how you become a better specialist moving forward. So all the off service rotations that we do, are disciplines that, you know, that we as ENT will interact with in some way or another. So First Year is mostly off service with some introduction to ENT blocks. Second-year is when you really take a deep dive into ENT and so we just do one off service block as a senior ICU resident in second-year and then everything else is ENT. And it's kind of more broad Strokes ENT. We do a couple of subspecialty blocks in otology say, but then the rest is really like the broad select head and neck oncology, site-specific Junior resident and that kind of thing. 

Starting in third year and all throughout 4th year and 5th year, you're doing, you know, you're generally in see blocks but also like all the different subspecialties within ENT so laryngology, otology, facial plastics, rhinology, a little bit of everything, kind of scattered throughout. Our Royal college exam for ENT has been moved to the beginning of 50 year, so that's that's a bit of a recent change that's happened across Canada. So now instead of studying throughout the most of 5th year for the exam at the end of the year to finish residency, there's more time allotted near the middle and end of 4th year into the beginning of 5th year to study for the exam. And then what's nice about that is, that it allows you to focus the rest of the year on operating as a senior resident and really refining your skills before going off into your different paths, because at that point should you typically know where you'll be going after residency whether you'll be going into a fellowship or whether you'll be starting a practice. And so you can tailor your learning needs based on that. I kind of skipped over third and fourth-year a little bit, in terms of electives, so worth 4th students will typically do a lot of electives and whatever fellowship disciplined they’d like to do. Fellowship interviews and everything, typically happens, you know, in 4th year or 5th year and people find out, kind of, all throughout there.

Katie: That sounds pretty exciting. Are there any books or other resources that you found to be particularly helpful in your first year?

Dr. Pickett: Yeah, you know, for just quickly reading up on topics, I'll still typically use Pasha’s Otolaryngology. I bought a couple of other books so Landge Otolaryngology-Head and Neck Surgery published by McGraw-Hill, Cummings Otolaryngology, I purchase and that's kind of like a long-term resource that I will use throughout residency. ENT-Secrets can still be helpful as well, which I know a lot of medical students typically use. One resource that I use a fair amount for helping with call, would be an app called ‘MD on call’ that just helps you with some kind of general ward type things that may come up throughout. And as always UptoDate is always very useful and then reading around specific cases, I would always go back to the literature and look up best approaches.

Katie: Okay so we're coming to the end of our interview here, but I just wanted to ask if you have any advice for our senior medical student listeners about how to make the most of their PGY1 year?

Dr. Pickett: I think what's really important is, you know, it can be easy to get lost in the fact that you're not on your on your specialty rotation a lot of the times in PGY1, but I think it's important to see everyday is a learning opportunity, you're gathering skills that make you a better overall physician. This is, you know, one of the last times that you'll ever be doing things outside of ENT, that will contribute to your knowledge of being a better doctor. And, you know, it's important because we do interact with these specialties all the time, in many different ways and it's important to learn their perspectives, it’s important just to become collegial with other people throughout the hospital. If you make friends it makes your life easier, when you're on call, when you have to call people about certain things that you're not sure about, when you have to consult other services, it's nice to hear a friendly voice on the other end of the line. Yeah, enjoy everyday as much as possible, this is all I can really say, you know, the responsibility grows throughout residency, it doesn't go away and so you just build on your foundations of knowledge that you develop in PGY1 and become a better doctor overall.

Katie: Okay, That's great Travis, thanks so much for chatting with me today and for giving us kind of an inside view into what it's like being a first-year resident 

Dr. Pickett: Thank you very much for having me and if anybody ever wants they can reach out to me any time, I'm on any social media platform, if they have any further questions, happy to help.

Katie: Awesome thank you and thanks to everyone that turned into this episode. You can head over to our website at www.theotoapproach.com to learn more about the podcast and you can also find us on Instagram, Twitter, Spotify and apple podcast. Additionally I'd like to extend a special thanks to the Department of Surgery at the Saint John Regional Hospital for their generous support. See you next time.

We would like to extend our sincerest thanks to the Saint John Regional Hospital Department of Surgery within the Horizon Health Network for their generous support. Please head to our website at www.theotoapproach.com for our show notes, and to sign up for our newsletter to stay up to date with our latest episodes.