What gets you out of bed at 2 a.m.? An Interview with Dr. Kathryn Roth
In our 32nd episode, Dr. Kathryn Roth shares her journey to Head and Neck Surgery, reflects on the evolving field of otolaryngology, and offers practical advice for medical students on succeeding during rotations and building a sustainable career in surgery.
Show notes
Introduction
Hello 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, Emily Kraft, and today we're incredibly excited to be joined by Dr. Kathryn Roth, a distinguished Otolaryngologist, Associate Professor, and Director of the Undergraduate Medical Education Program at Western University in London, Ontario, Canada. Dr. Roth also serves as the Deputy Chair of the Cutaneous Oncology Multidisciplinary Clinic at the London Regional Cancer Program.
Dr. Roth completed her Otolaryngology – Head and Neck Surgery residency at Western University, where she now teaches residents and undergraduate students, and contributes to surgical education. Her clinical interests include skin cancer and facial reconstruction, thyroid and parathyroid surgery, salivary gland disease, and ultrasound-guided biopsy. She is the co-founder and director of the Emergencies in Otolaryngology Bootcamp and received the 2020 Schulich Leader Award for her contributions to medical education.
In this episode, we’ll explore Dr. Roth’s journey into otolaryngology, why representation matters, the advantages of simulation training, and advice for medical students on their otolaryngology rotations.
Whether you're scrubbing in for the first time or starting to plan for residency, stay tuned - this conversation is full of insight, inspiration, and practical tips.
Interview
Host: Hello, Dr. Roth, and welcome to The Oto Approach Podcast. Thank you so much for being here with us today.
Dr. Roth: Thanks so much for having me. I’m excited about this initiative.
Training and Career Path
Host: Great. So can you tell us a little bit about your path to otolaryngology?
Dr. Roth: I’m on staff here now at Western University, and I’ve been on staff for 16 years, actually. I did my undergrad at Queen’s University, then I did my medical school at Western and my residency in otolaryngology also at Western. So I’m pretty homegrown.
But then I branched out and went to Sydney, Australia, for my head and neck microvascular fellowship. I have a focus now in my practice that’s a lot of skin cancer and facial reconstruction, and that came from that time in Australia because of the volume of aggressive skin cancer that we see there.
So I brought that back to Canada as kind of a subspecialty niche, I guess, in melanoma and skin cancer.
Undergraduate Medical Education
Host: That’s a really interesting training journey, especially your experience in Australia. Shifting to your education work, what does your role as Undergraduate Medical Education Director look like?
Dr. Roth: As a small department, we actually cover many administrative roles over our careers. I was the CPD—Continuing Professional Development—Director for a number of years, and then I moved into the Undergraduate Medical Education role.
In that role, we coordinate the large-group teaching sessions that you would all be very aware of in first and second year, as well as a lot of small-group teaching. We’ve really tried to create a more active learning environment within the curriculum.
It can be difficult, I know, because class sizes are large now, and we also have a distributed education link with Windsor as well. So a lot of that teaching is done in a larger setting, but we are trying to bring the anatomy to life.
We always scope one student—one lucky volunteer each year gets to display their nasopharyngeal and oropharyngeal anatomy—which is always a big hit, actually. People like to see that.
And as you know—or maybe you don’t know yet, but you will know—a flexible nasal scope is actually not that uncomfortable. So it is something you could have done in front of people and it not be such a terrible experience.
So we try and bring in some patients as well, just to make the sessions more real for students before they’re actually working in the hospital setting.
Then once you arrive for clerkship, we have a clerkship lecture that’s focused mainly on emergencies in otolaryngology that you would see on call or working in emerge or as a primary care physician, so that you can have a general sense of the breadth of our specialty.
And of course, we have lots of teaching going on in all of our clinics and our ORs really across the city. I think that’s really the strength of our department. That’s where we really shine—is that one-on-one teaching in the clinical setting.
Discovering Otolaryngology
Host: That’s great. Thank you for sharing that. In terms of your experience getting into otolaryngology and head and neck surgery, would you be comfortable speaking a little bit to that?
Dr. Roth: Yeah, definitely. I actually thought I was going to do neurosurgery. That’s what all my research was in going into medical school and then during the first summer after medical school.
I was doing PCR on brain tumour specimens and working away in the neuropathology lab, and that’s definitely what I thought I was going to do.
But I had some opportunities to do clinical rotations and spend some time in the OR, and I guess I gravitated away from it a little bit, in part because I found some of the patient outcomes very difficult to reconcile with the amount of time and effort and expertise involved. Just a very difficult prognosis to grapple with.
I felt that over time it might not be as well suited to me. I don’t know that I could really conceptualize that at the time—I just knew it wasn’t exactly what I was looking for in terms of the surgical breadth as well as the type of problems we were dealing with.
So I switched gears after second year medical school and started to explore otolaryngology a little more seriously.
That was actually my first exposure to undergraduate teaching because I revamped the undergrad curriculum and created some online modules. And that was at a time when that wasn’t really that common.
Now you see it all the time, but back then it wasn’t really a thing as much. I’m old—the internet was just getting going.
So we did that, and it really helped me find my love of otolaryngology and understand how varied it was and what different types of patients you can see. You can see pediatrics, geriatrics, and everything in between.
I think that’s really where my interest grew, along with the variety of surgical skills.
And I don’t have to tell you that, Emily, because that’s probably one of the things that drew you to it as well. We have the endoscopic skills, the skills under the microscope, and then a lot of soft tissue work and reconstruction as well.
Although we’re head and neck regional experts, we’re not exclusively in the head and neck either, because a lot of our reconstructive techniques apply elsewhere in the body.
I just felt that it was a very rich specialty and that you could make an excellent career out of it.
I also did not gravitate toward ENT originally because I had actually been a patient first. I had been a patient of one of the otologists here in London and another otolaryngologist in Kingston.
I had surgery for cholesteatoma in my ear, and I had a middle ear surgery that damaged my facial nerve. I also had vestibular issues and a CSF leak after my first surgery.
So I had already experienced a very rare and unusual surgical complication from middle ear surgery, and I really didn’t think that I would want to deal with those kinds of things going forward.
But looking back on it, I suppose maybe it allowed me to understand the patient perspective in a way that I would never otherwise have been able to bring to the specialty.
So when I consent someone for a parotidectomy and I’m talking about working on their facial nerve, you can say it’s a rare complication, but if it happens to a patient, it’s 100% to them. It’s something they may be dealing with for the rest of their life.
So I take that surgical consent process very seriously. And obviously, you’re going to get a very meticulous nerve dissection out of me every single time as a result of my own lifetime experience with nerve injury.
So I guess I kind of resisted the specialty at first, but I also understood it very well, and ultimately I felt like I could maybe bring something to it over time. So that’s why I gravitated back.
AboutFace Initiative
Host: Thank you so much for sharing that. It’s definitely a very unique perspective. And I’m sure all the lucky students who get to train with you are appreciative of having that background, especially in terms of being meticulous about consent and the things that can go wrong in surgery.
Dr. Roth: We’ve recently started an initiative as well, which I think is really interesting, working with an organization called AboutFace.
We’re developing a curriculum for undergraduate medicine that includes teaching sessions and breakout groups looking at how we as a medical community speak to and interact with people with facial differences, and how we may bring biases into those interactions without even realizing it.
It’s been a very eye-opening and rich discussion. We’re actually hoping to publish those results. It’s definitely a first in the country for this kind of curriculum delivered to first-year medical students.
So there are opportunities throughout your career that you would maybe never have thought of that draw on previous experiences and that you can bring to teaching or to patient care as well.
Host: That sounds extremely interesting. And that’s going to be published after it’s completed?
Dr. Roth: Yeah. And actually, for any of you going to the Canadian Society of Otolaryngology meeting—CSO—there’ll be a booth there as well for this organization, so stop by and check it out.
We’re doing surgical training, and obviously we want to be technically excellent, but we also want to cultivate a certain bedside manner.
I think surgery in general gets a bad rap about that, but that’s never been true in my experience. I’ve always found people able to recognize the humanity in their patients and treat them with extreme compassion.
We want to relay that to medical students as well—that you can absolutely be in surgery and still practice with empathy. You don’t have to fit the stereotype of surgery, because honestly, when you scratch below the surface, that stereotype really isn’t how most people practice.
Diversity in Surgery
Host: And I think it’s great that students are going to be exposed to that right from first year, so when they’re making decisions about where they want to spend their time, they can take that into account and not get intimidated by the surgical stereotype.
Dr. Roth: I also think it’s great that we’re seeing broader representation in our specialty as well across many cultural backgrounds, racial backgrounds, and gender identities. It’s bringing a whole new level of understanding to our specialty.
And I think it’s really an excellent change that we’re seeing and one that’s representative of the populations we care for and the populations entering medical school.
You and I met through the Women in Otolaryngology group, but we’re seeing wonderful diversity across our specialty.
Host: What do you think is the driving force behind the increase in diversity and backgrounds that we’re seeing within the field?
Dr. Roth: Well, I think it starts at the medical admissions level as well.
I think those conscious or unconscious biases that may have driven admissions processes in the past are now being recognized for what they were. There are processes and training in place now to prevent that from propagating.
So we’re seeing it at the admissions level, and we’re also seeing it in the residency match process.
There’s still more work to be done, but it’s wonderful progress.
There were very few women when I went through training who were academic physicians in surgical specialties.
I recently attended a Women in Surgery event for an undergraduate group here at Western with my mentors and senior residents, and we honestly could count on one hand the number of women who were staff surgeons in London when I went through training.
There were three.
So I think once you have women in leadership positions, you naturally start to see that representation propagate over time.
ENT Emergencies Boot Camp
Host: Absolutely, I completely agree. It’s amazing to see people like yourself as academic surgeons and being able to take on so many leadership roles to help be that change and to shift the culture towards more inclusion.
Switching gears a little bit but still staying on the topic of education, would you be able to speak to the Emergencies in Otolaryngology Boot Camp that you help run every year?
Dr. Roth: Yeah, absolutely. It’s definitely a passion project. We’ve been hosting this annual Emergencies in Otolaryngology Boot Camp primarily for first-year residents, though some second-year residents attend as well, from programs across the country. It’s become a really lovely event on many levels.
For first-year residents, it’s the first course where you meet your national cohort. You get to celebrate matching into otolaryngology and meet the people who are going to become your colleagues.
And we always joke that what happens at boot camp stays at boot camp—kind of like Vegas.
Originally, the boot camp was started by Dr. Fung, Dr. Rotenberg, and myself. It’s now carried on by myself, Dr. Peng in pediatric otolaryngology, and Dr. Chris Chin at Dalhousie University.
We’ve continued it because we really feel it’s important to create a safe environment where residents can ask questions, practice skills, and make mistakes safely—for both patients and learners.
That’s really the goal: creating an environment where everyone is learning.
I’ve been running it now for 13 years, and there’s always something I learn as well.
We bring in colleagues from anesthesia, emergency medicine, and radiology, as well as speakers from across North America on topics like facial trauma and airway emergencies.
So the faculty also come away having learned something new.
We run skills stations in the morning where residents practice adult airway techniques, pediatric airway techniques, bronchoscopy and foreign body removal, epistaxis management, orbital decompression, tracheostomy techniques—including percutaneous tracheostomies—and tonsil bleed and cautery tonsillectomy scenarios.
There are lots of opportunities to practice these skills. Then we put everything together into more complex simulation scenarios where teams work together to save the fictional patient. And although the scenarios are simulated, they really do feel real in the moment.
Over the years, we’ve learned a lot about balancing complexity and cognitive load. We want the scenarios to be a little bit scary so learners understand what real emergencies feel like, but not so overwhelming that they can’t absorb the learning points.
I think over time we’ve created something where people are excited, engaged, and leave with a valuable experience.
And you’ll also see faculty from across the country joining us for teaching, so it’s become a very national event—and in some cases international, because we often have centres from the United States participating as well.
Simulation Training
Host: Wow, this sounds like an incredible initiative. I’m sure the residents find it really helpful to have hands-on experience with these procedures and scenarios before facing them in real life on call or on the wards.
Building off this, would you be able to speak to the effectiveness of simulation training and some of the publications you’ve been able to share based on this type of training?
Dr. Roth: Yeah, we’ve looked at a variety of things over the years—different models that we’ve used and the effects of those models.
I’ve also had several papers looking at the construction of the scenarios themselves and that balance between realism and cognitive load, and how important it is not to overload people, especially early in training.
There’s also a lot of literature looking at how to build complexity into training programs over time, so that learners revisit these scenarios later in residency and develop different skills from them.
Early on, you’re focusing more on technical skills and crisis management, whereas later you might focus more on leadership, efficiency, communication, emotional regulation, and logistics.
So there’s a lot of literature now on how simulation can evolve throughout training and continue building on those early experiences.
A Typical Practice Week
Host: It’s so interesting to hear that, and I love the idea of building complexity while also incorporating the more human aspects into training.
With everything you do in education, simulation, clinic, and the OR, I’m curious—what does a typical week in your practice look like?
Dr. Roth: Yeah, most Canadian academic centres divide their time across several areas.
Generally, I have one day a week of OR time, although that fluctuates a little bit. I also have a day set aside for academic work—research, administrative work, and educational work.
I have a day at the Cancer Centre with a multidisciplinary clinic there, and usually two full clinic days, one of which is generally procedures.
One clinic each month is also an ultrasound-guided needle biopsy clinic where we do FNAs using ultrasound on thyroids, parotids, and similar lesions, with the cytopathology tech present to assess adequacy.
So there’s variety even within the clinic days and procedure days themselves.
One of the unique things about otolaryngology is that there are many in-clinic procedures we can do.
My colleagues in rhinology are doing lots of in-clinic endoscopic sinus procedures, polypectomies, minor septoplasties—things that can all be done under local anesthetic.
We also do a lot of skin procedures and local flap reconstructions under local anesthetic as well.
So in many ways, you almost gain another operating day every week through procedural clinic work.
Advice for Medical Students
Host: That’s great.
For medical students coming into their ENT rotations who may feel intimidated by the specialty or overwhelmed by the amount of knowledge they need to know, what advice or tips would you give?
Dr. Roth: I would say: come in with an open mind.
There’s actually a lot of otolaryngology in primary care practice. Even if you think, “I’m not going into surgery,” you’ll find there’s overlap with neurology, neurosurgery, allergy and immunology, endocrinology, plastic surgery, and primary care.
There’s a lot of overlap because we’re a regional specialty. We handle both the medical and surgical care of the head and neck region, which is somewhat unique.
There are a few other specialties like that, but we don’t really have a direct “medicine counterpart” in the way neurosurgery has neurology or cardiac surgery has cardiology.
So I think even students who don’t envision themselves in the OR can still get a tremendous amount out of an ENT rotation.
One of the biggest things students should take away is demystifying the head and neck exam—particularly the oral cavity and oropharyngeal exam.
You want to learn how to palpate the neck and become comfortable recognizing normal anatomy so that you’ll recognize abnormal anatomy when you encounter it.
I think students can gain a lot from the rotation even if that’s not where they’re headed for a career.
And honestly, if you want to do well on the rotation, anatomy is key.
Students have opportunities to review upcoming OR cases and clinic lists ahead of time now through the electronic medical record, so you can prepare in advance for the types of things you might be asked.
Anatomy never changes, so that’s always fair game.
And the other thing is understanding how you would diagnose certain conditions and what complications you would discuss when consenting a patient for surgery.
Those are fair game in terms of both teaching and what students should hope to take away from the rotation.
Recommended Resources
Host: Thank you so much for sharing that. I think students are going to find that really helpful in terms of how to get the most out of their otolaryngology rotations.
In terms of anatomy, you mentioned that it’s one of the big foundational things students can focus on. Is there a specific resource that you recommend or that you’ve seen students use successfully?
Dr. Roth: No, not one specific resource.
I think just something detailed enough that you’ll recognize the surgical anatomy and understand how it compares to textbook drawings.
There are amazing resources available now that show real surgical anatomy, which is incredibly helpful.
From a physical exam standpoint, though, I still hear students being recommended Bates’ Guide to Physical Examination and History Taking, and I can’t say enough good things about that textbook.
As a medical student, I went through that book many times, and I know it made me a stronger physician overall.
Having a very solid foundation in clinical examination and history-taking skills gives you the tools you need to succeed regardless of specialty.
That may sound a little old school, but you’d be amazed at what you can find if you simply pay attention.
Over the years, I’ve diagnosed several things that weren’t what the patient originally came in for—but I’m very glad I didn’t miss them—including a brain tumour in a patient who came in for thyroid follow-up.
So I guess that brings me full circle back to wanting to be a neurosurgeon.
But I think the things you learn in medical school can become important in ways you never expect, and being able to examine the whole patient is incredibly valuable.
It also makes you a stronger team member.
Final Reflections
Host: Yes, absolutely. Thank you so much for sharing that advice. It feels really actionable and tangible—something medical students can work on regardless of their stage of training, including myself.
Dr. Roth: Well, it’s easy to get blinders on and think, “That’s not important to me because I’m going into whatever specialty.”
But the truth is, there’s also a lot of psychiatry and psychology involved in seeing patients in clinic—managing anxiety around surgery, around cancer diagnoses, and what comes afterward in terms of survivorship.
You gain something valuable from every rotation, including psychiatry, and it all ultimately shapes how you’ll practice medicine and care for your own patients.
Host: Absolutely. That’s such an important mindset to have and a great reminder to keep an open mind regardless of the field you’re in or the rotation you’re on.
Well, thank you so much, Dr. Roth. This conversation has been extremely informative and powerful.
We touched on so many different subjects, and the advice you shared has been incredibly helpful for myself and, I’m sure, for the students listening.
We also can’t thank you enough for your involvement in education initiatives and everything you do for the program.
Before we wrap up today, are there any final thoughts or words of advice you’d like to share?
Dr. Roth: Well, I think this was a great conversation too, and I really appreciate it.
I would especially encourage students to explore and really use this time to figure out what they want to do clinically and where their passions lie.
Take a look at people who are mid-career like me. Are they still passionate about their specialty and the care they’re delivering? If they are, that’s usually a pretty good indicator that it’s a fulfilling career choice.
Take every opportunity to explore and discover what you genuinely love and care about, because ultimately that’s what’s going to get you out of bed at 2 a.m. when you’re on call—the passion for it and the compassion for your patients.
Host: Thank you so much, Dr. Roth.
Dr. Roth: Thank you. I really appreciate it.
