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Badhey AK, Bose A, Teng MS, Tang A. National Survey of Otolaryngology Program Directors Regarding Recruitment Methods for Underrepresented in Medicine Residents. JOURNAL OF SURGICAL EDUCATION 2024; 81:1612-1617. [PMID: 39276705 DOI: 10.1016/j.jsurg.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 08/01/2024] [Accepted: 08/20/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To characterize Otolaryngology residency program strategies for recruiting underrepresented minorities in medicine (URiM) residents and their perceived effectiveness, and explore perceived barriers to recruitment. DESIGN We conducted a survey of Otolaryngology program directors (PDs) at the 122 accredited programs within the United States, utilizing a validated and previously published survey utilized within the OB-GYN literature. We solicited information regarding recruitment of underrepresented minorities in medicine (URiM) applicants, effectiveness of strategies, and perceived barriers in recruitment. SETTING A national survey of U.S. accredited residency programs in Otolaryngology in 2022-2023. RESULTS A total of 42 (34%) PDs responded. 55% of programs reported an increase in URiM residents, of which 18(43%) described an intentional change. Almost all PDs reported placing at least "some" significance in the recruitment of URiM residents (95%). Statistically significant differences were seen in recruitment methods between programs that saw an increase in URiM resident recruitment an those that did not. Additionally, Program Directors believed that increased face-face interaction with applicants were the most effective forms of recruitment. PDs found the biggest challenge to recruitment was a lack of diverse applicants (6.3/10) and faculty (5.8/10). This perception did not change when adjusted for programs that saw an increase in URiM trainee recruitment. CONCLUSIONS This study demonstrates the URiM resident recruitment practices and perceived effectiveness of these strategies within otolaryngology programs nationally. The results and analysis may provide programs who are looking to diversify their workforce with some effective and meaningful strategies to start the process.
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Affiliation(s)
| | - Arpan Bose
- UMass Chan Medical School, Worcester, MA.
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Miller ME, Witte D, Lina I, Walsh J, Rameau A, Bhatti NI. Development of Machine Learning Copilot to Assist Novices in Learning Flexible Laryngoscopy. Laryngoscope 2024. [PMID: 39363661 DOI: 10.1002/lary.31812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 09/07/2024] [Accepted: 09/17/2024] [Indexed: 10/05/2024]
Abstract
OBJECTIVES Here we describe the development and pilot testing of the first artificial intelligence (AI) software "copilot" to help train novices to competently perform flexible fiberoptic laryngoscopy (FFL) on a mannikin and improve their uptake of FFL skills. METHODS Supervised machine learning was used to develop an image classifier model, dubbed the "anatomical region classifier," responsible for predicting the location of camera in the upper aerodigestive tract and an object detection model, dubbed the "anatomical structure detector," responsible for locating and identifying key anatomical structures in images. Training data were collected by performing FFL on an AirSim Combo Bronchi X mannikin (United Kingdom, TruCorp Ltd) using an Ambu aScope 4 RhinoLaryngo Slim connected to an Ambu® aView™ 2 Advance Displaying Unit (Ballerup, Ambu A/S). Medical students were prospectively recruited to try the FFL copilot and rate its ease of use and self-rate their skills with and without the copilot. RESULTS This model classified anatomical regions with an overall accuracy of 91.9% on the validation set and 80.1% on the test set. The model detected anatomical structures with overall mean average precision of 0.642. Through various optimizations, we were able to run the AI copilot at approximately 28 frames per second (FPS), which is imperceptible from real time and nearly matches the video frame rate of 30 FPS. Sixty-four novice medical students were recruited for feedback on the copilot. Although 90.9% strongly agreed/agreed that the AI copilot was easy to use, their self-rating of FFL skills following use of the copilot were overall equivocal to their self-rating without the copilot. CONCLUSIONS The AI copilot tracked successful capture of diagnosable views of key anatomical structures effectively guiding users through FFL to ensure all anatomical structures are sufficiently captured. This tool has the potential to assist novices in efficiently gaining competence in FFL. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Mattea E Miller
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Dan Witte
- Perceptron Health, Inc, New York, New York, U.S.A
| | - Ioan Lina
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anaïs Rameau
- Department of Otolaryngology - Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| | - Nasir I Bhatti
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Torabi SJ, Hong EM, Patel RA, Nguyen TV, Huck NA, Khosravi P, Peter Manes R, Kuan EC. How Variable are Patient Comorbidity Profiles Among Practicing Otolaryngologists? Otolaryngol Head Neck Surg 2024; 171:1033-1041. [PMID: 38738928 DOI: 10.1002/ohn.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/08/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To determine whether certain groups of otolaryngologists (ORLs) are treating cohorts of patients with more comorbidities. STUDY DESIGN Cross-sectional population-based analysis. SETTING 2019 Medicare Provider Utilization and Payment Dataset. METHODS Each ORL's average Medicare hierarchical condition category (HCC) risk score, a comorbidity index calculated from a patient's comorbidities, was collected. These were stratified and compared by various physician characteristics, including practice region and rurality, years in practice, gender, subspecialty, and setting (academic vs community). RESULTS Among 8959 ORLs, the mean HCC risk score for Medicare patients was 1.35 ± 0.35. On univariate analysis, ORLs practicing in urban (compared to rural), ORLs in academic settings (compared to community), and early career ORLs all had a patient population with a higher HCC risk score (P < .001 for all). On multivariate analysis controlling for gender, rurality, graduation year, and region, rural setting was associated with decreased odds of having a high-risk patient population (odds ratio: 0.58 [95% confidence interval, CI: 0.48-0.71]; P < .001), while those more recently graduated has an increased risk (2000-2009: 1.41 [1.01-1.96], P = .046; 2010-2015: 2.30 [1.63-3.25], P < .001). In a separate subgroup analysis, subspecialty differences were seen and community setting was associated with decreased odds of having a high-risk patient population (0.36 [0.23-0.55]; P < .001). CONCLUSION There is variability in patient comorbidity profiles among ORLs, with those in urban settings, those more recently graduated, and those in academic settings treating a group with more comorbidities. As the comorbidity burden may increase the cost of practice and complications, these findings may have important implications for health inequity.
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Affiliation(s)
- Sina J Torabi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Ellen M Hong
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Rahul A Patel
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
| | - Theodore V Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Nolan A Huck
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Pooya Khosravi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - R Peter Manes
- Department of Surgery (Division of Otolaryngology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
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Naunheim MR, DeVore EK, Huston MN, Song PC, Franco RA, Bhattacharyya N. Increasing Prevalence of Voice Disorders in the USA: Updates in the COVID Era. Laryngoscope 2024; 134:3713-3718. [PMID: 38525993 DOI: 10.1002/lary.31409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders. METHODS The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence. RESULTS 29.9 million Americans (95%CI[28.3-31.5]) annually report a voice problem, representing 12.2% of the population (95%CI[11.7-12.8%]). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI[4.3-6.0%]) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI[50.9-55.1%]). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI[13.7-15.1] and [9.3-10.7], respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI[18.9-23.5%] and [11.1-12.1%], respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI[12.0-22.1] and [11.0-14.8], respectively). CONCLUSIONS Voice problems affect approximately 1 in 8 adults in the U.S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self-reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3713-3718, 2024.
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Affiliation(s)
- Matthew R Naunheim
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Elliana K DeVore
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, U.S.A
| | - Phillip C Song
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ramon A Franco
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Neil Bhattacharyya
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Lava CX, Hakimi AA, Parsa K, Nguyen TV, Chu EG, Reilly MJ. Factors Influencing Graduates of American Academy of Facial Plastic and Reconstructive Surgery Fellowships Career Choice of Academic or Private Practice: A 20-Year Review. Facial Plast Surg Aesthet Med 2024; 26:283-287. [PMID: 37582204 DOI: 10.1089/fpsam.2022.0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Background: Absence of published literature on facial plastic and reconstructive surgery (FPRS) fellows' pursuit of academic careers hampers informed decision making for those interested in the specialty, fellowship program directors, and leaders in the American Academy of Facial Plastic and Reconstructive Surgery. Objective: To examine career choices among FPRS fellows from 2000 to 2019 and identify factors linked to academic or private practice employment after fellowship. Methods: Data from 796 fellows were analyzed, including gender, medical school, residency program, fellowship program, fellowship year, and degrees, to categorize them based on academic or nonacademic career placement. Logistic regression analyses were conducted to explore the association between demographic factors and academic career placement. Results: Forty-three percent (n = 345) obtained academic positions, with significant associations found between academic placement and additional advanced degrees, completion of fellowship training in the northeast, and residency training at an institution offering FPRS fellowship. Conclusion: Although fellows in FPRS predominantly pursue private practice, the decision to pursue academia is influenced by complex and multifactorial factors among graduates in the field.
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Affiliation(s)
- Christian X Lava
- School of Medicine, Georgetown University, Washington, District of Columbia, USA
| | - Amir A Hakimi
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Keon Parsa
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | | | - Eugenia G Chu
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Michael J Reilly
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Pozin M, Nyaeme M, Peterman N, Jagasia A. Geospatial evaluation of access to otolaryngology care in the United States. Laryngoscope Investig Otolaryngol 2024; 9:e1239. [PMID: 38525122 PMCID: PMC10960241 DOI: 10.1002/lio2.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/25/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives This county-level epidemiological study evaluated the travel distance to the nearest otolaryngologist for continental US communities and identified socioeconomic differences between low- and high-access regions. Methods Geospatial analysis of publicly available 2015-2022 NPI records was combined with US census data to identify geospatial gaps in otolaryngologist distribution. Moran's index geospatial clustering in distance to the nearest county with an otolaryngologist was used as the core metric for differential access determination. Univariate logistic analysis was conducted between low- and high-access counties for 20 socioeconomic and demographic variables. Results Nationally, the average person was 22 miles from an otolaryngologist. 444 counties were identified as geospatially "low access" with increased travel distance in the Midwest, Great Planes, and Nevada with a median of 47 miles. 1231 counties in the Eastern United States and Western Coast were identified as "high access" with a 3-mile median travel distance. Areas of low access to otolaryngological care had smaller median populations (12,963 vs. 558,306), had smaller percent Black and Asian populations (2% vs. 11%, 1% vs. 5%, respectively), had a greater percent American Indian population (2% vs. 1%), were less densely populated (8 vs. 907 people per square mile), had fewer percent college graduates (20% vs. 34%), and fewer otolaryngologists per county (median: 0.01-20). Conclusion These findings highlight disparity in otolaryngology care in the United States and the need for otolaryngology funding initiatives in the Midwest and Great Plains regions. Level of Evidence Level 3.
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Affiliation(s)
| | - Mark Nyaeme
- Carle Illinois College of MedicineUrbanaIllinoisUSA
| | | | - Ashok Jagasia
- Carle Illinois College of MedicineUrbanaIllinoisUSA
- Department of Otolaryngology‐Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
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Hoskins M, Bhanja D, Piper M, Strausser SA, Mansfield K, Zheng A, McNutt S, Goss M, Lighthall JG, Burns AS. Training Program Factors Most Important to Women When Selecting an Otolaryngology Residency. Laryngoscope 2024; 134:600-606. [PMID: 37551878 DOI: 10.1002/lary.30877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES The aim of the study was to determine factors that female resident physicians find most influential when choosing an otolaryngology residency program. METHODS A three-part survey was sent to current female otolaryngology residents via email evaluating the importance of 19 characteristics impacting program choice. The 19 factors were scored from 1 (least important) to 5 (most important). The participants also ranked their personal top five most influential factors. Data were analyzed using descriptive statistics. RESULTS One-hundred and fifty of 339 contacted residents participated. Most were aged 30-39 (63%), white (70%), and married (43%). Eighty-five percent had no children, and 52% did not plan to have children during residency. The highest scoring factors derived from Likert scale ratings included resident camaraderie (4.5 ± 0.8), resident happiness (4.4 ± 0.8), and case variety/number (4.4 ± 0.8). The lowest scoring factors were number of fellows (2.9 ± 1.1), attitudes toward maternity leave (2.7 ± 1.3), and maternity leave policies (2.4 ± 1.2). The top five most influential factors and the percentage selecting this were resident camaraderie (57%), resident happiness (57%), academic reputation (51%), case variety/number (47%), and early surgical/clinical experience (44%). Gender-specific factors were infrequently selected. However, 51 (34%) ranked at least one gender-specific factor within their top five list. CONCLUSION Non-gender-related factors, like resident camaraderie and surgical experiences, were most valued by women. Conversely, gender-specific factors were less critical and infrequently ranked. Ninety-nine residents (64%) rated exclusively gender-neutral characteristics in their top five list of most influential factors. Our data offer insight into program characteristics most important to female otolaryngology residents, which may assist residency programs hoping to match female applicants. LEVEL OF EVIDENCE NA Laryngoscope, 134:600-606, 2024.
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Affiliation(s)
- Meloria Hoskins
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Debarati Bhanja
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Molly Piper
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Sarah A Strausser
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Kirsten Mansfield
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Amy Zheng
- Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Sarah McNutt
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Madison Goss
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
| | - Amy S Burns
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
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McCrary HC, Meeker M, Farlow JL, Seim NB, Old MO, Ozer E, Agrawal A, Rocco JW, Kang SY, Bradford CR, Haring CT. Demographic and Academic Productivity Trends Among American Head & Neck Society Fellows Over a 20-Year Period. JAMA Otolaryngol Head Neck Surg 2023; 149:987-992. [PMID: 37561525 PMCID: PMC10416085 DOI: 10.1001/jamaoto.2023.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/08/2023] [Indexed: 08/11/2023]
Abstract
Importance Historical data reveal that, compared with women, men are more likely to pursue a head and neck surgical oncology fellowship, but little is known about possible gender differences in academic productivity. Objective To assess demographic trends and academic productivity among American Head & Neck Society (AHNS) fellowship graduates. Design, Setting, and Participants This cross-sectional study used electronically published data from the AHNS on fellowship graduates in the US and Canada from July 1, 1997, to June 30, 2022. Scopus was used to extract h-indices for each graduate. Exposure Scholarly activity. Main Outcomes and Measures Main outcomes were changes in demographic characteristics and academic productivity among AHNS graduates over time. Data analysis included effect size, η2, and 95% CIs. Results A total of 691 AHNS fellowship graduates (525 men [76%] and 166 women [24%]) were included. Over the study period, there was an increase in the number of programs offering a fellowship (η2, 0.84; 95% CI, 0.68-0.89) and an increase in the absolute number of women who completed training (η2, 0.66; 95% CI, 0.38-0.78). Among early-career graduates pursuing an academic career, there was a small difference in the median h-index scores between men and women (median difference, 1.0; 95% CI, -1.1 to 3.1); however, among midcareer and late-career graduates, there was a large difference in the median h-index scores (midcareer graduates: median difference, 4.0; 95% CI, 1.2-6.8; late-career graduates: median difference, 6.0; 95% CI, 1.0-10.9). A higher percentage of women pursued academic positions compared with men (106 of 162 [65.4%] vs 293 of 525 [55.8%]; difference, 9.6%; 95% CI, -5.3% to 12.3%). Conclusions and Relevance This cross-sectional study suggests that women in head and neck surgery begin their careers with high levels of academic productivity. However, over time, a divergence in academic productivity between men and women begins to develop. These data argue for research to identify possible reasons for this observed divergence in academic productivity and, where possible, develop enhanced early faculty development opportunities for women to promote their academic productivity, promotion, and advancement into leadership positions.
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Affiliation(s)
- Hilary C. McCrary
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Molly Meeker
- The Ohio State University College of Medicine, Columbus
| | - Janice L. Farlow
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Nolan B. Seim
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Matthew O. Old
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Enver Ozer
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Amit Agrawal
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - James W. Rocco
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Stephen Y. Kang
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
| | - Carol R. Bradford
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
- The Ohio State University College of Medicine, Columbus
| | - Catherine T. Haring
- Department of Otolaryngology–Head and Neck Surgery, The Ohio State University, Columbus
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Alarfaj AA, Al-Nasser S. Evaluating Gaps in Otolaryngology Training: An In-Depth Needs Assessment in Saudi Arabia. Healthcare (Basel) 2023; 11:2741. [PMID: 37893815 PMCID: PMC10606914 DOI: 10.3390/healthcare11202741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The landscape of otolaryngology training in Saudi Arabia is undergoing transformation due to the expansion of medical colleges and increased overseas medical scholarships. However, concerns persist regarding the satisfaction and adequacy of surgical education. This study aims to assess gaps in otolaryngology training through an in-depth needs assessment. METHODS A cross-sectional study was conducted among 85 otolaryngology-head and neck surgery residency graduates in Saudi Arabia between 2019 and 2021. Participants completed a validated questionnaire assessing deficiencies, importance, and competence in different subspecialty areas. Data were analyzed using descriptive statistics, median comparisons, and Kruskal-Wallis tests. RESULTS Participants identified deficiencies in training across domains, with significant variations in specific subspecialties among different regions. Dissatisfaction with clinical discussions, research training, access to simulation labs, and training in emerging subspecialties was evident. CONCLUSION The study highlights challenges within otolaryngology training, emphasizing the need for continuous evaluation and adaptation to ensure high-quality and comprehensive training. Addressing these gaps is essential to produce well-rounded otolaryngologists capable of meeting the evolving demands of modern healthcare.
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Affiliation(s)
- Abdullah A. Alarfaj
- Otorhinolaryngology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Sami Al-Nasser
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh 11481, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), Riyadh 11481, Saudi Arabia
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Vasan V, Cheng C, Lerner DK, Signore AD, Schaberg M, Govindaraj S, Iloreta AM. Letters of recommendations and personal statements for rhinology fellowship: A deep learning linguistic analysis. Int Forum Allergy Rhinol 2023; 13:1971-1973. [PMID: 36896816 DOI: 10.1002/alr.23153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Vikram Vasan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christopher Cheng
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David K Lerner
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anthony Del Signore
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Madeleine Schaberg
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alfred Marc Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sim ES, Belsky MA, Konanur A, Yan A, Shaffer AD, Williams K, Martsolf GR, Chi DH, Jabbour N. Adherence to Tympanostomy Tube Clinical Practice Guidelines in an Advanced Practice Provider Clinic. Ann Otol Rhinol Laryngol 2023; 132:1110-1116. [PMID: 36412134 DOI: 10.1177/00034894221135282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE We compared adherence rates by attending otolaryngologists (OTOs) and advanced practice providers (APPs) to the 2013 American Academy of Otolaryngology-Head and Neck Surgery Foundation clinical practice guideline (CPG) for children with recurrent acute otitis media (RAOM) undergoing bilateral myringotomy and tympanostomy tube placement (BMT). METHODS Patients aged 6 months to 12 years old undergoing BMT for RAOM who had a pre-operative visit with an independent APP or OTO were reviewed. Patients satisfied CPG criteria if middle ear effusion was identified at the pre-operative visit (pre-op) or if they did not have effusion but met exception criteria based on their risk for developmental difficulties and contraindications to medical therapy. Adherence rates between APPs and OTOs were compared. Agreement between pre-op and time-of-surgery middle ear effusion identification was assessed. RESULTS Nine hundred twenty-three patients were included. Six hundred one patients were seen by OTOs and 322 by APPs. Middle ear effusion was identified at pre-op in 84% of APP patients and in 76% of OTO patients (P = .005). Eight percent of APP patients and 11% of OTO patients met exception criteria (P = .138). Overall, 87% of OTO patients and 92% of APP patients met either CPG or exception criteria for BMT (P = .037). A logistic regression model demonstrated that pre-op provider type did not significantly impact rates of agreement between pre-op visit and time-of-surgery middle ear effusion identification. CONCLUSIONS Independent APP-led clinics can reliably and effectively deliver evidence-based care for prevalent conditions such as RAOM at similar rates of adherence to CPGs as OTOs.
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Affiliation(s)
- Edward S Sim
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael A Belsky
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anisha Konanur
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annie Yan
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | | | - David H Chi
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Noel Jabbour
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Fenton D, Hamzat I, Dimitroyannis R, Nordgren R, Saunders MR, Baroody FM, Baird B, Shogan A. Assessment of Demographic Changes of Workforce Diversity in Otolaryngology, 2013 to 2022. JAMA Otolaryngol Head Neck Surg 2023; 149:628-635. [PMID: 37261840 PMCID: PMC10236323 DOI: 10.1001/jamaoto.2023.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 06/02/2023]
Abstract
Importance Given the growth of minoritized groups in the US and the widening racial and ethnic health disparities, improving diversity remains a proposed solution in the field of otolaryngology. Evaluating current trends in workforce diversity may highlight potential areas for improvement. Objective To understand the changes in gender, racial, and ethnic diversity in the otolaryngology workforce in comparison with changes in the general surgery and neurosurgery workforces from 2013 to 2022. Design, Setting, and Participants This cross-sectional study used publicly available data from the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges for 2013 to 2022, and included medical students and trainees in all US medical residency programs and allopathic medical schools. Main Outcomes and Measures Average percentages of women, Black, and Latino trainees during 2 intervals of 5 years (2013-2017 and 2018-2022). Pearson χ2 tests compared demographic information. Normalized ratios were calculated for each demographic group in medical school and residency. Piecewise linear regression assessed linear fit for representation across time periods and compared rates of change. Results The study population comprised 59 865 medical residents (43 931 [73.4%] women; 6203 [10.4%] Black and 9731 [16.2%] Latino individuals; age was not reported). The comparison between the 2 study intervals showed that the proportions of women, Black, and Latino trainees increased in otolaryngology (2.9%, 0.7%, and 1.6%, respectively), and decreased for Black trainees in both general surgery and neurosurgery (-0.4% and -1.0%, respectively). In comparison with their proportions in medical school, Latino trainees were well represented in general surgery, neurosurgery, and otolaryngology (normalized ratios [NRs]: 1.25, 1.06, and 0.96, respectively); however, women and Black trainees remained underrepresented in general surgery, neurosurgery, and otolaryngology (women NRs, 0.76, 0.33, and 0.68; Black NRs, 0.63, 0.61, and 0.29, respectively). The percentage of women, Black, and Latino trainees in otolaryngology all increased from 2020 to 2022 (2.5%, 1.1%, and 1.1%, respectively). Piecewise regression showed positive trends across all 3 specialties. Conclusions and Relevance The findings of this cross-sectional study indicate a positive direction but only a modest increase of diversity in otolaryngology, particularly in the context of national demographic data. Novel strategies should be pursued to supplement existing efforts to increase diversity in otolaryngology.
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Affiliation(s)
- David Fenton
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Ibraheem Hamzat
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | | | - Rachel Nordgren
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Milda R. Saunders
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Fuad M. Baroody
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Brandon Baird
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Andrea Shogan
- Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medicine, Chicago, Illinois
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Batool S, Burks CA, Bergmark RW. Healthcare Disparities in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:1-14. [PMID: 37362031 PMCID: PMC10247342 DOI: 10.1007/s40136-023-00459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review The purpose of this review is to summarize some of the recent research studies on healthcare disparities across various subspecialties within otolaryngology. This review also highlights the impact of COVID-19 pandemic on disparities and proposes potential interventions to mitigate disparities. Recent Findings Significant healthcare disparities in care and treatment outcomes have been reported across all areas of otolaryngology. Notable differences in survival, disease recurrence, and overall mortality have been noted based on race, ethnicity, socioeconomic status (SES), insurance status, etc. This is most well-researched in head and neck cancer (HNC) within otolaryngology. Summary Healthcare disparities have been identified by numerous research studies within otolaryngology for many vulnerable groups that include racial and ethnic minority groups, low-income populations, and individuals from rural areas among many others. These populations continue to experience suboptimal access to timely, quality otolaryngologic care that exacerbate disparities in health outcomes.
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Affiliation(s)
- Sana Batool
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
| | - Ciersten A. Burks
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
| | - Regan W. Bergmark
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women’s Hospital and Dana Farber Cancer Institute, 45 Francis Street, Boston, MA 02115 USA
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Hicks CW, Plichta JK, Santry HP. Long road ahead for diversity efforts in surgery. Am J Surg 2022; 224:257-258. [PMID: 35397921 PMCID: PMC9838556 DOI: 10.1016/j.amjsurg.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Caitlin W. Hicks
- Department of Surgery, Johns Hopkins Hospital, 600 North Wolfe
Street - Halsted 668, Baltimore, MD, 21287, USA
| | - Jennifer K. Plichta
- Department of Surgery, Duke University Medical Center, DUMC 3513
919.681.9156, Durham, NC, 27710, USA
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Miller RH, Gurgel RK, McCrary HC. Graduating Otolaryngology Residents' Ideal Practice Expectations: A Longitudinal Analysis. Otolaryngol Head Neck Surg 2022; 167:472-478. [PMID: 34982583 DOI: 10.1177/01945998211069505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior literature has indicated that the number of trained otolaryngologists required to meet the need of our growing population may be insufficient. Therefore, identifying trends in the subspecialty composition of future otolaryngology practices will elucidate workforce needs. STUDY DESIGN One-page anonymous questionnaire. SETTING The survey was completed by examinees at the conclusion of their American Board of Otolaryngology-Head and Neck Surgery oral examination from 2011 to 2019. METHODS Data included age, gender, fellowship, practice type, and ideal future practice components. RESULTS A total of 2286 examinees were included: 58.1% were male and 57.2% completed a fellowship. Ideal practice specialties included general otolaryngology (19%), rhinology (15%), head and neck (13%), and pediatrics (11%). General and pediatric otolaryngology had a negative correlation over time (r = -0.81, P = .01, and r = -0.75, P = .03, respectively). An overall 45% of graduates reported 1 ideal practice area (r = 0.61, P = .10), with a statistically significant decline in the number of ideal practice areas over time (r = -0.79, P = .018). Men more commonly reported allergy, head and neck, otology, rhinology, and sleep medicine as part of their ideal practice (P < .05), while women more commonly reported pediatric otolaryngology (P < .05). There was a higher mean number of ideal practice areas among men than women (2.58 vs 2.1, P < .001). CONCLUSION There is a growing trend for more specialized otolaryngology practices. The data demonstrate a decline in considering general and pediatrics otolaryngology as part of practices, which portends a gap in access to comprehensive otolaryngology in the future.
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Affiliation(s)
- Robert H Miller
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Hilary C McCrary
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA
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Finding the Right Job: Locum Tenens and Private Practice. Otolaryngol Clin North Am 2021; 55:23-31. [PMID: 34823718 DOI: 10.1016/j.otc.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
When choosing a career path in otolaryngology, one might consider locum tenens as an opportunity to sample a practice or locale before deciding where to settle down. It may also be an excellent way to garner some new perspective and experience while between jobs or while unable to commit to a long-term position. Before deciding to pursue locum tenens otolaryngology, it is important to consider logistical and lifestyle factors. When deciding on an assignment, one must consider the proposed work schedule, call obligation, patient acuity, and reimbursement.
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Vohra V, Watley DC, Yan CH, Locke TB, Bernstein IA, Levy JM, Rowan NR. Predictors of academic career placement and scholarly impact in fellowship-trained rhinologists. Int Forum Allergy Rhinol 2021; 12:62-70. [PMID: 34309228 DOI: 10.1002/alr.22873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND As rhinology fellowship positions outpace the availability of academic rhinology jobs, it is increasingly important to identify characteristics that are associated with academic placement after fellowship completion. In this study, we evaluated the association of academic characteristics during training with current job placement and posttraining scholarly impact. METHODS Previous rhinology fellows were identified using publicly available data. Bibliometric indices, training institutions, graduate degrees, and job placement data were used in bivariate and multivariable regression analyses to assess for association with predictors and academic trajectory. RESULTS Data from 265 rhinologists, all graduating between 1991 and 2020, were included. Most surgeons (n = 185, 70%) held an academic position and 80 (30%) surgeons worked in a nonacademic setting; 93.2% had a Doctor of Medicine (MD) degree and 80.3% were male. Multivariable logistic regression indicated that a designation of MD, compared with Doctor of Osteopathic Medicine (DO; odds ratio [OR], 5.93; 95% confidence interval [CI], 1.97-21.9), number of publications during fellowship (OR, 1.19; 95% CI, 1.02-1.41), and h-index during training (OR, 1.25; 95% CI, 1.07-1.49]) were independently predictive of academic job placement. Meanwhile, number of primary authorships during fellowship (β = 1.47; 95% CI, 1.07-1.88]), h-index during training (β = 0.48; 95% CI, 0.25-0.71), and PhD (β = 4.16; 95% CI, 1.57-6.76) were associated with posttraining h-index. Medical school ranking; graduate degrees, including Master of Science (MS), Master of Business Administration (MBA), and Master of Public Health (MPH); and research metrics before residency were not associated with either academic placement or posttraining h-index. CONCLUSION The predictors of academic job placement in rhinology are unclear, but h-index during training, and research productivity during fellowship may serve as indicators of an academic career.
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Affiliation(s)
- Varun Vohra
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Duncan C Watley
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol H Yan
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Tran B Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Isaac A Bernstein
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Miller RH, McCrary HC, Gurgel RK. Assessing Trends in Fellowship Training Among Otolaryngology Residents: A National Survey Study. Otolaryngol Head Neck Surg 2021; 165:655-661. [PMID: 33618575 DOI: 10.1177/0194599821994477] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To summarize trends in otolaryngology fellowship applications, fellowships selected, and reasons for pursuing a fellowship. STUDY DESIGN One-page anonymous questionnaire. SETTING A survey was completed by examinees at the conclusion of their American Board of Otolaryngology-Head and Neck Surgery oral examination from 2011 to 2019. METHODS Data included age, gender, fellowship type, reasons for doing a fellowship, and type of practice that examinees will enter. Spearman correlation and Pearson chi-square tests were completed. RESULTS Over the 8-year study, 58% of the 2243 responding examinees did fellowships. The most frequently chosen fellowship was facial plastic surgery (25%), followed by pediatric otolaryngology (21%), head and neck surgery (19%), rhinology (13%), laryngology (9%), and neurotology (8%). The 2 most common reasons for doing a fellowship were desire for additional expertise beyond residency training (35%) and intellectual appeal (30%). Over the study period, the number of residents choosing to do a fellowship increased from 45.6% in 2011 to 61.5% in 2019, with a positive correlation between year and number of residents (r = 0.73, P = .036). When the data were stratified by gender, there were statistically significant differences in fellowship selection (P < .001), notably with women selecting pediatric otolaryngology at a higher frequency than men (30.9% vs 15.8%). CONCLUSION There is a statistically significant increasing trend of otolaryngology residents who choose to undergo further training in fellowship. These data from a large, long-term study will be valuable in planning for training and workforce needs in the future.
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Affiliation(s)
- Robert H Miller
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Hilary Caitlyn McCrary
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Utah, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Utah, USA
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