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Jacobson A, Mack D, Herrera G, Bowe SN, Highland KB, Patzkowski MS. Incidence of Surgically Managed Post-Tonsillectomy Hemorrhage Associated With NSAID Prescribing for Postoperative Pain Management. Mil Med 2024:usae194. [PMID: 38758073 DOI: 10.1093/milmed/usae194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/28/2023] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Tonsillectomy ranks high among the most common pediatric surgical procedures in the United States. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen, are routinely prescribed to manage post-tonsillectomy pain, but may carry the risk of hemorrhage. MATERIALS AND METHODS This retrospective, longitudinal, secondary-data analysis study compared the incidence of surgically managed post-tonsillectomy hemorrhage (sPTH) in pediatric patients prescribed ibuprofen at Brooke Army Medical Center (BAMC) after tonsillectomy compared to a similar cohort of pediatric patients at the Children's Hospital of Philadelphia (CHOP) not prescribed ibuprofen. Additional regression analysis examined predictors of sPTH at BAMC. RESULTS The odds of sPTH was lower in patients who were prescribed ibuprofen at BAMC, relative to patients who were not at CHOP (OR 0.57, 95% CI, 0.37, 0.87; P < 0.01). In a generalized linear model evaluating BAMC patient data, there was a lack of a relationship between reason for tonsillectomy (tonsillitis versus tonsillar obstruction), primary procedure (tonsillectomy-only versus tonsillectomy with adenoidectomy), and presence of a co-occurring procedure. CONCLUSIONS Post-tonsillectomy ibuprofen prescribing practices were not associated with an elevated risk of sPTH, relative to patients at CHOP not exposed to ibuprofen.
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Affiliation(s)
- Andrew Jacobson
- Department of Anesthesia, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234-6200, USA
| | - Douglas Mack
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TX 78234-6200, USA
| | - Germaine Herrera
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation, Inc., Rockville, MD 20852, USA
- Defense and Veterans Center for Integrative Pain Management, Bethesda, MD 20814, USA
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, TX 78234-6200, USA
| | - Krista B Highland
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
| | - Michael S Patzkowski
- Department of Anesthesia, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234-6200, USA
- Department of Anesthesiology, Uniformed Services University, Bethesda, MD 20814, USA
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Duggal R, Mehrabi S, Bryson PC, Bowe SN. Trends in Twitter Utilization Among Academic Otolaryngologists. Laryngoscope 2024; 134:1190-1196. [PMID: 37526319 DOI: 10.1002/lary.30916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/06/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To characterize Twitter utilization among academic otolaryngologists and evaluate the relationship between Twitter utilization and research productivity. METHODS Data were collected manually from accredited US otolaryngology residency programs from July-November 2021. Program and faculty demographics were documented, including citations and H-index for faculty and Doximity reputation and US News and World Report ranking for programs. Twitter metrics were also recorded. Descriptive analyses and multivariable logistic regression models were used to identify predictors of Twitter utilization. RESULTS Currently, 333 (16%) faculty and 70 (62%) programs have a Twitter account. Of these, 36 (11%) and 27 (39%), respectively, were created in 2020. The regression model indicates that for each 5 unit increase in H-index, the odds of having a Twitter account increase 22% (OR 1.22, 95% CI 1.10-1.34, p = 0.0009). The number of faculty with a Twitter account predicts the existence of program Twitter accounts (OR:1.49, 95% CI 1.01-2.19, p = 0.04). Finally, of the 323 faculty with a Twitter account and available Scopus profile, we found that the number of individuals with Twitter use out of proportion to their academic productivity was low (n = 8/323). CONCLUSION The H-index is a significant predictor of faculty Twitter accounts, whereas the number of faculty with Twitter is a significant predictor of program Twitter utilization. Although Twitter utilization is increasing, especially during the coronavirus pandemic, the findings indicate that there is ample room for growth, particularly amongst faculty with strong academic portfolios. LEVEL OF EVIDENCE NA Laryngoscope, 134:1190-1196, 2024.
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Affiliation(s)
- Radhika Duggal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shadi Mehrabi
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Fort Sam Houston, Texas, USA
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Bowe SN, Bly RA, Whipple ME, Gray ST. Residency Selection in Otolaryngology: Past, Present, & Future. Laryngoscope 2023; 133:S1-S13. [PMID: 36951573 DOI: 10.1002/lary.30668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/31/2023] [Accepted: 02/25/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVES To examine the otolaryngology residency selection process, including past experiences based on the medical literature and survey analysis of our present practices to generate recommendations for future selection system design. METHODS A mixed-methods study, including a scoping review and a cross-sectional survey, was completed. Four databases were assessed for articles on otolaryngology residency selection published from January 1, 2016 through December 31, 2020. A 36-question survey was developed and distributed to 114 otolaryngology program directors. Descriptive and thematic analysis was performed. RESULTS Ultimately, 67 of 168 articles underwent data abstraction and assessment. Three themes surfaced during the analysis: effectiveness, efficiency, and equity. Regarding the survey, there were 62 participants (54.4% response rate). The three most important goals for the selection process were: (1) to fit the program culture, (2) to make good colleagues, and (3) to contribute to the program's diversity. The three biggest 'pain points' were as follows: (1) Large volume of applications, (2) Lack of reliable information about personal characteristics, and (3) Lack of reliable information about a genuine interest in the program. CONCLUSIONS Within this study, the depth and breadth of the literature on otolaryngology residency selection have been synthesized. Additionally, baseline data on selection practices within our specialty has been captured. With an informed understanding of our past and present, we can look to the future. Built upon the principles of person-environment fit theory, our proposed framework can guide research and policy discussions regarding the design of selection systems in otolaryngology, as we work to achieve more effective, efficient, and equitable outcomes. LEVEL OF EVIDENCE N/A Laryngoscope, 133:2929-2941, 2023.
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft. Sam Houston, Texas, U.S.A
| | - Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Seattle Children's Hospital and Research Institute, Seattle, Washington, U.S.A
| | - Mark E Whipple
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, U.S.A
| | - Stacey T Gray
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
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Konuthula N, Epstein S, Wang X, Whipple ME, Bly RA, Bowe SN. Intersectionality of Race, Ethnicity, and Gender in the Otolaryngology Match From 2013 to 2019. Laryngoscope 2023; 133:2558-2563. [PMID: 36794674 PMCID: PMC10427733 DOI: 10.1002/lary.30592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/14/2022] [Accepted: 12/28/2022] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Racial, ethnic, and gender disparities in the otolaryngology-head and neck surgery (OHNS) match have been described individually, but not intersectionally. Intersectionality recognizes how multiple forms of discrimination (e.g., sexism, racism) can have a combined effect. The objective of this study was to analyze racial, ethnic, and gender disparities in the OHNS match using an intersectional approach. METHODS Cross-sectional evaluation of data from otolaryngology applicants from the Electronic Residency Application Service (ERAS) and of corresponding otolaryngology residents from the Accreditation Council for Graduate Medical Education (ACGME) from 2013 to 2019. Data were stratified by race, ethnicity, and gender. The Cochran-Armitage tests assessed trends over time in the proportions of applicants and corresponding residents. Chi-square tests with Yates' continuity correction were performed to evaluate differences between the aggregate proportions of applicants and corresponding residents. RESULTS The proportion of White men in the resident pool was increased compared to the applicant pool (ACGME 0.417, ERAS 0.375; Δ + 0.042; 95% CI 0.012 to 0.071; p = 0.03). This was also the case for White women (ACGME 0.206, ERAS 0.175; Δ + 0.031; 95% CI 0.007 to 0.055; p = 0.05). In contrast, there was a smaller proportion of residents compared to applicants among Multiracial men (ACGME 0.014, ERAS 0.047; Δ - 0.033; 95% CI -0.043 to -0.023; p < 0.001) and Multiracial women (ACGME 0.010, ERAS 0.026; Δ - 0.016; 95% CI -0.024 to -0.008; p < 0.001). CONCLUSION The findings of this study imply that White men have a persistent advantage, while several racial, ethnic, and gender minorities are disadvantaged in the OHNS match. Further research is necessary to examine why these differences exist in residency selection, including evaluation during the screening, reviewing, interviewing, and ranking stages. Laryngoscope, 133:2558-2563, 2023.
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Affiliation(s)
- Neeraja Konuthula
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sherise Epstein
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Xing Wang
- Seattle Children’s Hospital and Research Institute, Seattle, WA, USA
| | - Mark E. Whipple
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Randall A. Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children’s Hospital and Research Institute, Seattle, WA, USA
| | - Sarah N. Bowe
- Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Ft. Sam Houston, TX, USA
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Haischer-Rollo GD, Lu K, Drumm C, Fagiana A, Bowe SN, Aden J, Demarcantonio M. Superior Labial Frenulum Attachment Site and Correlation with Breastfeeding Outcomes. Laryngoscope 2022; 132:2498-2504. [PMID: 35234285 DOI: 10.1002/lary.30059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/25/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Current literature suggests that infant oral anatomy may impact breastfeeding outcomes. Our research seeks to evaluate superior labial frenulum (SLF) attachment site grade utilizing a modified existing system and investigate the correlation with breastfeeding outcomes. METHODS Two hundred and eight dyads were recruited from the nursery at Brooke Army Medical Center. The neonate's SLF and lingual frenulum were evaluated and photo-documented. Photos were assessed by blinded reviewers utilizing a modified Stanford SLF grade. Breastfeeding mothers completed surveys on attitudes and associated pain with feedings 24 h postdelivery, at 2 weeks and at 2 months. Categorical data were analyzed using chi-squared tests or Fisher's exact tests. Means and standard deviations were analyzed using analysis of variance or Wilcoxon's test. RESULTS At 2 weeks and 2 months, 86.8% and 72.8% were breastfeeding, respectively. At 2 months, SLF grade 1 newborn dyads had a significantly lower breastfeeding rate (50.0%) compared to SLF grade 2 (75.3%) and SLF grade 3 (85.7%) subjects (p = 0.0384). At 2 weeks and 2 months, there was no difference between SLF groups with regard to maternal breastfeeding attitudes or pain scores. There was no significant difference in terms of weight, referrals, or lingual-labial frenulectomy between SLF groups. CONCLUSIONS Our study shows no correlation between SLF attachment grade and breastfeeding outcomes to include length of breastfeeding, maternally reported confidence, maternal pain, or infant weight. Our findings do not support labial frenulectomy based on SLF grade alone and highlight the need for a more robust functional grading system. LEVEL OF EVIDENCE 2 Oxford Center for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653 Laryngoscope, 132:2498-2504, 2022.
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Affiliation(s)
- Gayle D Haischer-Rollo
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Khang Lu
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A.,Otolaryngology Department, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Caitlin Drumm
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Angela Fagiana
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Sarah N Bowe
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - James Aden
- Pediatrics Department/Neonatal Division, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A.,Graduate Medical Education Department, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, U.S.A
| | - Micheal Demarcantonio
- Otolaryngology Department, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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Bly RA, Whipple ME, Bowe SN. Racial and Ethnic Differences in Resident Selection-Reply. JAMA 2022; 328:1871-1873. [PMID: 36346416 DOI: 10.1001/jama.2022.16542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Randall A Bly
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle
| | - Mark E Whipple
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle
| | - Sarah N Bowe
- San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam Houston, Houston, Texas
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Smith DH, Case HF, Quereshy HA, Mecham JC, Bowe SN, Carlson ML, Cordero J. Geographic Distribution of Otolaryngology Training Programs and Potential Opportunities for Strategic Program Growth. Laryngoscope 2022. [DOI: 10.1002/lary.30361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/22/2022] [Accepted: 08/02/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Drew H. Smith
- Department of Otolaryngology‐Head and Neck Surgery Texas Tech University Health Sciences Center Lubbock Texas U.S.A
| | - Hannah F. Case
- Mayo Clinic Alix School of Medicine Jacksonville Florida U.S.A
| | - Humzah A. Quereshy
- Department of Surgery Case Western Reserve University/University Hospitals Cleveland Medical Center Cleveland Ohio U.S.A
| | - Jeffrey C. Mecham
- Department of Otolaryngology‐Head and Neck Surgery Mayo Clinic Arizona Phoenix Arizona U.S.A
| | - Sarah N. Bowe
- Department of Otolaryngology‐Head and Neck Surgery San Antonio Uniformed Services Health Education Consortium, JBSA‐Ft Sam Houston Sam Houston Texas U.S.A
| | - Matthew L. Carlson
- Department of Otolaryngology‐Head and Neck Surgery Mayo Clinic Rochester Minnesota U.S.A
| | - Joehassin Cordero
- Department of Otolaryngology‐Head and Neck Surgery Texas Tech University Health Sciences Center Lubbock Texas U.S.A
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8
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Flagg CA, Marinelli JP, Carlson ML, Kezirian EJ, Dion GR, Van Abel KM, Choby G, Hamilton GS, Bowe SN. Developing a Social Media Ontology Across Otolaryngology and its Subspecialties. Laryngoscope 2022. [DOI: 10.1002/lary.30345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Candace A. Flagg
- Department of Otolaryngology–Head and Neck Surgery San Antonio Uniformed Services Health Education Consortium, JBSA‐Fort Sam Houston San Antonio Texas U.S.A
| | - John P. Marinelli
- Department of Otolaryngology–Head and Neck Surgery San Antonio Uniformed Services Health Education Consortium, JBSA‐Fort Sam Houston San Antonio Texas U.S.A
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Rochester Minnesota U.S.A
| | - Eric J. Kezirian
- USC Caruso Department of Otolaryngology–Head and Neck Surgery Keck School of Medicine of the University of Southern California Los Angeles California U.S.A
| | - Gregory R. Dion
- Department of Otolaryngology–Head and Neck Surgery San Antonio Uniformed Services Health Education Consortium, JBSA‐Fort Sam Houston San Antonio Texas U.S.A
| | - Kathryn M. Van Abel
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Rochester Minnesota U.S.A
| | - Garret Choby
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Rochester Minnesota U.S.A
| | - Grant S. Hamilton
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic Rochester Minnesota U.S.A
| | - Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery San Antonio Uniformed Services Health Education Consortium, JBSA‐Fort Sam Houston San Antonio Texas U.S.A
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Malka RE, Marinelli JP, Newberry TR, Carlson ML, Bowe SN. Asynchronous learning among otolaryngology residents in the United States. Am J Otolaryngol 2022; 43:103575. [DOI: 10.1016/j.amjoto.2022.103575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/31/2022] [Indexed: 11/16/2022]
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Epstein S, Konuthula N, Meyer TK, Whipple ME, Bowe SN, Bly RA, Abuzeid WM. Implementing a “Distance Traveled” Question to Improve Resident Diversity: Process and Feasibility. OTO Open 2022; 6:2473974X221113847. [PMID: 35923218 PMCID: PMC9340931 DOI: 10.1177/2473974x221113847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Increasing diversity in the physician workforce is important to improving racial and ethnic disparities in health outcomes in the United States. We describe the implementation of a “distance traveled” question (DTQ) in our residency application process. For the 2021-2022 cycle, all applicants to the University of Washington otolaryngology residency program were allowed to complete an optional DTQ. Responses were shared with the application review committee. Following the distribution of interview invites, an anonymous survey was sent to all faculty reviewers. The response rate was 26 of 36 (72%). Among respondents, 20 (77%) felt that the DTQ helped them learn something new about the applicant, and 19 (73%) reported that the DTQ influenced their decision making about the applicant. Thus, a DTQ may provide faculty with new and influential information regarding residency applicants.
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Affiliation(s)
- Sherise Epstein
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Neeraja Konuthula
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Tanya K. Meyer
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Mark E. Whipple
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio–Ft Sam Houston, Texas, USA
| | - Randall A. Bly
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children’s Hospital and Research Institute, Seattle, Washington, USA
| | - Waleed M. Abuzeid
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of Washington, Seattle, Washington, USA
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Abstract
This study compares the racial and ethnic representation of applicants and matched residents from competitive US medical and surgical specialty programs between 2013 and 2018.
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Affiliation(s)
- Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio–Fort Sam Houston, Texas
| | - Randall A. Bly
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle
| | - Xing Wang
- Seattle Children’s Hospital and Research Institute, Seattle, Washington
| | - Mark E. Whipple
- Department of Otolaryngology–Head and Neck Surgery, University of Washington School of Medicine, Seattle
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Bowe SN, Megwalu UC, Bergmark RW, Balakrishnan K. Moving Beyond Detection: Charting a Path to Eliminate Health Care Disparities in Otolaryngology. Otolaryngol Head Neck Surg 2022; 166:1013-1021. [PMID: 35439090 DOI: 10.1177/01945998221094460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The coronavirus pandemic has illuminated long-standing inequities in America's health care system and societal structure. While numerous studies have identified health care disparities within our specialty, few have progressed beyond detection. Otolaryngologists have the opportunity and the responsibility to act. Within this article, leaders from otolaryngology share their experience and perspective on health care disparities, including (1) a discussion of disparities in otolaryngology, (2) a summary of health care system design and incentives, (3) an overview of implicit bias, and (4) practical recommendations for providers to advance their awareness of health care disparities and the actions to mitigate them. While the path forward can be daunting, it should not be a deterrent. Throughout the course of this article, numerous resources are provided to support these efforts. To move ahead, our specialty needs to advance our level of understanding and develop, implement, and disseminate successful interventions toward the goal of eliminating health care disparities.
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft Sam Houston, Texas, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Regan W Bergmark
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.,Lucile Packard Children's Hospital Stanford, Palo Alto, California, USA
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Abstract
PURPOSE OF REVIEW This article will provide an overview of recent disruptions to the otolaryngology residency match process and conclude with questions and resources that can guide future selection system design. RECENT FINDINGS During the implementation of the single accreditation system, the loss of osteopathic programs, reduction of osteopathic leadership positions, and lack of interest in Osteopathic Recognition represent serious threats to the profession; this has implications for the distribution of the otolaryngology workforce, plausibly decreasing healthcare access in less-populated communities. Next, the impacts of COVID-19 reverberated throughout the application process, including the reduction/elimination of away rotations, modification of application requirements, conversion to virtual interviews, and initiation of preference signaling. Soon, the transition to pass/fail scoring for the United States Medical Licensing Exam Step 1 could stimulate a paradigm shift, with a heightened emphasis on holistic review. SUMMARY The last two match cycles have been the most dynamic and unpredictable in decades. Out of the commotion, the otolaryngology community has an opportunity for a fresh start, combining insights from past literature with recent articles compiled for this review. Moving forward, it will be advantageous to approach residency selection as a well-executed quality improvement project, requiring continuous assessment and adjustment.
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Affiliation(s)
- Corinne A Pittman
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Taylor C Standiford
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
| | - Sarah N Bowe
- Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft Sam Houston, Texas, USA
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14
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Bowe SN, Wang X, Whipple ME, Bly RA. Evidence of Specialty-Specific Gender Disparities in Resident Recruitment and Selection. J Grad Med Educ 2021; 13:841-847. [PMID: 35070097 PMCID: PMC8672845 DOI: 10.4300/jgme-d-21-00337.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/28/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Specialty-specific gender disparities are multifactorial, yet one area that is lacking from this discussion is the impact of recruitment and selection. OBJECTIVE Customized data reports were utilized to compare trends in the gender representation of applicants and residents within 11 surgical and medical specialties between 2013 and 2018. METHODS Applicant data was obtained from the Electronic Residency Application Service (ERAS) and resident data from the Accreditation Council for Graduate Medical Education (ACGME). Eleven specialties with the highest number of applications per applicant were included (dermatology, emergency medicine, general surgery, neurological surgery, obstetrics and gynecology [OB/GYN], orthopedic surgery, otolaryngology, plastic surgery, radiation oncology, radiology, urology). A Cochran-Armitage trend test assessed for changes in the proportion of females within the total applicant group and the corresponding matched resident group. A t test was utilized to compare the mean proportion of females for ERAS and ACGME data. RESULTS Otolaryngology, plastic surgery, radiation oncology, and urology had no significant changes over the study period. Dermatology, general surgery, and orthopedic surgery demonstrated increased gender diversity in applicants over time, while OB/GYN demonstrated decreased gender diversity. General surgery and neurological surgery showed increased gender diversity in resident representation over time. Emergency medicine and radiology had increased gender diversity, and OB/GYN had decreased gender diversity in matched residents compared to applicants. CONCLUSIONS Our findings provide baseline data, but also illustrate evident gaps in our understanding and attempts to improve gender diversity. A multifaceted approach to obtaining and assessing data from all stages of residency recruitment and selection is necessary to support these efforts.
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Affiliation(s)
- Sarah N. Bowe
- Sarah N. Bowe, MD, EdM, is Associate Professor, Department of Otolaryngology–Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium
| | - Xing Wang
- Xing Wang, PhD, is Biostatistician III, Department of Otolaryngology–Head and Neck Surgery, University of Washington
| | - Mark E. Whipple
- Mark E. Whipple, MD, ScM, is Professor, Department of Otolaryngology–Head and Neck Surgery, University of Washington, and Professor, Department of Biomedical Informatics and Medical Education, University of Washington
| | - Randall A. Bly
- Randall A. Bly, MD, is Assistant Professor, Department of Otolaryngology–Head and Neck Surgery, University of Washington, and Assistant Professor, Seattle Children's Hospital and Research Institute
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), JBSA-Ft Sam Houston, Texas
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16
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Farsar CJ, Sperling J, Quesada PR, Solis RN, Ojeaga M, Bowe SN, Carlson ML, Brown JR, Levi JR. Development of the National Otolaryngology Interest Group: Conception to Implementation. Otolaryngol Head Neck Surg 2021; 166:413-416. [PMID: 34340617 DOI: 10.1177/01945998211033237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Otolaryngology is a small and highly sought-after surgical subspecialty with sparse residency positions, making it competitive to match into. Allopathic (MD) students without home otolaryngology residency programs, osteopathic (DO) medical students, and underrepresented minorities have historically faced additional challenges in matching into otolaryngology. These specific populations generally experience limited opportunities in establishing mentors, engaging in scholarly activity, and gaining early exposure to clinical settings. Even though the American Osteopathic Association and the Accreditation Council for Graduate Medical Education merger was in part established to create equity among applicants, there remains a substantial disparity among the match rates of medical students of various educational and cultural backgrounds. The National Otolaryngology Interest Group is a student-led interest group created to provide all medical students, especially those facing barriers, with the resources needed to best prepare for matching into an otolaryngology residency program and ultimately a career in otolaryngology.
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Affiliation(s)
| | - Jared Sperling
- The University of Texas Rio Grande Valley School of Medicine, Edinburg, Texas, USA
| | - Pompeyo R Quesada
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The University of Kansas, Kansas City, Kansas, USA
| | - Roberto N Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California-Davis, Sacramento, California, USA
| | - Macaulay Ojeaga
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The University of Kansas, Kansas City, Kansas, USA
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft Sam Houston, Texas, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason R Brown
- Division of Pediatric Otolaryngology, Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Jessica R Levi
- Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Center, Boston, Massachusetts, USA
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17
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Affiliation(s)
- John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Fort Sam Houston, Texas
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lawrence R Lustig
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | | | - Patrick J Antonelli
- Department of Otolaryngology-Head and Neck Surgery, University of Florida, Gainesville, Florida
| | - Robert S Hong
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, Michigan
- Michigan Ear Institute, Farmington Hills, Michigan
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Fort Sam Houston, Texas
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18
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Bowe SN, Bly RA, Whipple ME. Collaborative, Longitudinal Data Are Necessary to Support Diversity Efforts in Residency Recruitment and Selection. Acad Med 2021; 96:480-481. [PMID: 33782231 DOI: 10.1097/acm.0000000000003932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Sarah N Bowe
- Associate professor, Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft. Sam Houston, Texas; ; Twitter: @DrSarahNBowe; ORCID: https://orcid.org/0000-0002-5266-7910
| | - Randall A Bly
- Assistant professor, Department of Otolaryngology-Head and Neck Surgery, University of Washington, and Division of Pediatric Otolaryngology, Seattle Children's Hospital and Research Institute, Seattle, Washington
| | - Mark E Whipple
- Professor, Departments of Otolaryngology-Head and Neck Surgery and Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
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19
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Bowe SN, Villwock JA. Does gender impact personality traits in female versus male otolaryngology residents and faculty? Am J Surg 2020; 220:1213-1218. [PMID: 32650976 PMCID: PMC10165852 DOI: 10.1016/j.amjsurg.2020.06.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/28/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Gender differences in personality have long been a subject of interest. This study assessed personality traits within female and male residents and faculty and evaluated for meaningful differences between the groups. METHODS A series of web-based, commercially available, self-administered five factor-based personality assessments were given to otolaryngology residents and faculty at nine academic training programs. The psychometrically validated assessments evaluate innate personality 1) strengths, 2) challenges, and 3) motivators/values. Differences between groups were evaluated using the Mann-Whitney U test. A standardized measure of effect size, Cohen's d, was calculated to indicate the magnitude of gender differences. Subset analysis was done to examine differences between female and male residents and female and male faculty. RESULTS Seventy-eight faculty (42.6%) and 104 residents (70.3%), responded, which included 63 female (34.6%) participants. Significant differences between females and males overall were found across four traits (mischievous, imaginative, altruistic, and commercial) out of twenty-eight (4/28; 14.3%). Subset analysis of residents revealed two statistically significant differences related to motivators/values (increased altruism in females and increased commercial in males). Faculty exhibited a statistically significant difference in one stress tendency (increased imaginative in males). When examining the seven total traits that exhibited a statistically significant difference between any of the groups (7/84; 8.3%), four were considered a small difference and three a moderate difference. CONCLUSION When personality trait differences were identified in both otolaryngology resident and faculty populations based on gender, they were relatively small. Overall, females and males in otolaryngology exhibit significant overlap in the distribution of their personality traits. Therefore, personality-based initiatives should focus on the individual, rather than perceived gender "norms."
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Affiliation(s)
- Sarah N Bowe
- Associate Professor, Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium
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21
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Mecham JC, Menapace DC, Bowe SN, Carlson ML. Recruitment and Networking With Social Media for the Otolaryngology Match in the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020; 164:545-546. [DOI: 10.1177/0194599820957952] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
COVID-19 has created new challenges and opportunities regarding the way in which programs and applicants will interact in the 2020-2021 otolaryngology residency match cycle. Social media and other virtual platforms offer a flexible and efficient medium for applicants and programs to gain information, communicate, and align interests. In this commentary, we explore ways in which social media may facilitate recruitment and networking in the virtual otolaryngology match.
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Affiliation(s)
- Jeffrey C. Mecham
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Deanna C. Menapace
- Department of Otolaryngology–Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA–Fort Sam Houston, Texas, USA
| | - Matthew L. Carlson
- Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Totten DJ, Marinelli JP, Spear SA, Bowe SN, Carlson ML. With the Incidence of Otosclerosis Declining, Should Stapedectomy Remain a Key-Indicator Case for Otolaryngology Residents? Otolaryngol Head Neck Surg 2020; 163:1070-1072. [PMID: 32689881 DOI: 10.1177/0194599820941836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stapedectomy remains a joint key-indicator case with ossiculoplasty for otolaryngology residents in the United States. Yet, residents consistently report feeling inadequately prepared to perform stapes surgery following graduation. Applying recently described age- and sex-standardized incidence rates of surgically confirmed cases of otosclerosis to the US populace, upper and lower estimates of residents' case exposure to stapedectomy can be approximated. With this, uppermost projections estimate 6484 new cases of stapes surgery are performed annually nationwide. With approximately 1424 otolaryngology residents nationally, the average case exposure is 7.8 stapedectomies throughout their training, with upper and lower estimates of 17.1 and 4.2 cases, respectively. As such, proficiency in stapedectomy is no longer a realistic expectation for US graduating residents. This reality supports the removal of "stapedectomy" from the list of 14 key-indicator case requirements, leaving ossiculoplasty as its own key-indicator case, thereby reinforcing true competence in this fundamental procedure for the graduating otolaryngologist.
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Affiliation(s)
- Douglas J Totten
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John P Marinelli
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Samuel A Spear
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas, USA
| | - Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
There is an extensive amount of data available from the leading organizations involved in the residency selection process. Tracking trends in otolaryngology residency applications and match outcomes is vital to understand the pipeline of individuals joining our profession. As we make changes to the application or match process, proper interpretation of available data is vital to prevent erroneous analyses and inappropriate conclusions. In the commentary, we explore the nuances of data from the Electronic Residency Application Service and National Residency Matching Program to help our specialty direct research endeavors and policy changes that will ultimately affect the makeup of our future workforce.
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Affiliation(s)
- Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), JBSA-Ft Sam Houston, Texas, USA
| | - Soham Roy
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Texas, USA
| | - C. W. David Chang
- Department of Otolaryngology–Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA
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25
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Bowe SN, Schmalbach CE, Laury AM. Regarding "Is the Program-Specific Paragraph Responsible for Declining Application Numbers? A Commentary". Otolaryngol Head Neck Surg 2019; 158:1150-1151. [PMID: 29852829 DOI: 10.1177/0194599818771912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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26
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Bowe SN, Wentland CJ, Hartnick CJ. Pediatric laryngeal electromyography technique for vocal fold immobility using bipolar double hookwire electrodes. Int J Pediatr Otorhinolaryngol 2019; 119:75-78. [PMID: 30684689 DOI: 10.1016/j.ijporl.2019.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
Vocal fold immobility (VFI) is a common cause of dysphonia and dysphagia in children. Laryngeal electromyography (LEMG) is an important adjunctive test in its diagnosis and treatment. In this study, we present an alternative technique in which bipolar double hookwire electrodes allow simultaneous placement and recordings from the bilateral thyroarytenoid and posterior cricoarytenoid muscles. Details of the technique are shown for a 5 y/o F with history of Neurofibromatosis Type 2 with left VFI and aspiration and dysphonia. This modified technique for pediatric LEMG has the potential to be a useful tool in predicting return of laryngeal function.
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, MA, USA
| | - Carissa J Wentland
- Department of Otolaryngology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, MA, USA; Department of Otology & Laryngology, Harvard Medical School, Boston, MA, USA.
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27
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Bowe SN, Colaianni CA, Yamasaki A, Cummings BM, Hartnick CJ. Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement. JAMA Otolaryngol Head Neck Surg 2019; 145:321-327. [PMID: 30763412 DOI: 10.1001/jamaoto.2018.4348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation. Objective Using principles of continuous QI, the objectives of this study were to (1) describe step-by-step methods to sustain QI efforts and (2) revisit a series of process, outcome, and balance measures for sedation weaning management following implementation of a new electronic health record (EHR). Design, Setting, and Participants A standardized sedation weaning protocol was previously developed and instituted in February 2013. To address healthcare system-wide changes, a 7-step, Institute for Healthcare Improvement methodology was used to reevaluate a series of measures comparing a previous postweaning group (2013-2014; 13 patients) and current post-EHR group (2016; 11 patients). We conducted a focus group review of these 24 patients. Main Outcomes and Measures The primary outcome measure was length of sedation weaning. Secondary outcome, process, and balance measures included total length of sedation, absence of standardized wean document, absence of specific recommendations on weaning regimen, length of stay, continued weaning at discharge, discharge location, absence of discharge instructions on weaning regimen or iatrogenic withdrawal syndrome (IWS), discharge within 72 hours of stopping weaning, and readmission. Results The postweaning and post-EHR groups were similar in age (20.5 months [95% CI, 11.92-29.15] vs 26.5 months [95% CI, 17.68-35.40]), as well as male sex (11 of 13 [85%] vs 10 of 11 [91%]), respectively. In the post-EHR group, the standardized sedation wean document was missing from 9 of 11 (82%) medical records. However, the primary outcome measure, length of sedation weaning, remained stable at 9.45 (95% CI, 7.62-11.29) days in the post-EHR group compared with 9.08 (95% CI, 7.00-11.18) days in the postweaning group. In addition, only 5 of 11 (46%) of discharges in the post-EHR group had specific guidance on weaning since the standardized template was no longer in use. As a result, in the post-EHR group, patients were 15.2 (95% CI, 0.46-242.34) times as likely to lack discharge instructions on weaning or IWS. Conclusions and Relevance Quality improvement is meant to be a continuous process in which reevaluation of care practices are regularly performed. System-wide redesign can be achieved using a formal methodological approach. Moving forward, notable QI opportunities for our institution included the development of a flexible sedation weaning template, as well as enhancements to discharge instructions to include IWS diagnosis and treatment.
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts
| | - C Alessandra Colaianni
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts
| | - Alisa Yamasaki
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts
| | - Brian M Cummings
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts.,Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts
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Villwock JA, Bowe SN, Dunleavy D, Overton BR, Sharma S, Abaza MM. Adding Long-term Value to the Residency Selection and Assessment Process. Laryngoscope 2019; 130:65-68. [PMID: 30848482 DOI: 10.1002/lary.27878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/27/2018] [Accepted: 01/30/2019] [Indexed: 11/06/2022]
Abstract
The residency selection process is challenging for both applicants and programs. This is particularly true in competitive specialties such as otolaryngology. The importance of noncognitive competencies in successful residents has been well demonstrated in both medicine and surgery. Unfortunately, there is no streamlined or uniform process for incorporating this information into the selection and training of residents. This review provides a summary of innovative approaches in the selection of residents in otolaryngology and the important role these methods and associated data can play in resident selection and training. The goal of these processes is to create a holistic view of potential residents so programs can enhance the development of current residents and boost long-term success in our specialty. Laryngoscope, 130:65-68, 2020.
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Affiliation(s)
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft. Sam Houston, Texas
| | - Dana Dunleavy
- Selection and Admissions Programs, Association of American Medical Colleges, Washington, DC
| | - B Renee Overton
- Residency and Fellowship Solutions, Association of American Medical Colleges, Washington, DC
| | - Stephanie Sharma
- Partnership Development, LEAD the Difference, Edmonds, Washington
| | - Mona M Abaza
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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30
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Yoshiyasu Y, Chang DR, Bunegin L, Lin RP, Aden JK, Prihoda TJ, Weitzel EK, McMains KC, Malekzadeh S, Bowe SN, Chen PG. Construct validity of a low-cost medium-fidelity endoscopic sinus surgery simulation model. Laryngoscope 2018; 129:1505-1509. [PMID: 30578541 DOI: 10.1002/lary.27748] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Assess construct validity of a low-cost medium-fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training. METHODS Fellowship-trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist. RESULTS Thirty-two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task-specific checklist. CONCLUSIONS This study demonstrated the construct validity of the low-cost medium-fidelity ESS model. LEVEL OF EVIDENCE NA Laryngoscope, 129:1505-1509, 2019.
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Affiliation(s)
- Yuki Yoshiyasu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Daniel R Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Leon Bunegin
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Ryan P Lin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.,Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - James K Aden
- San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, San Antonio, Texas, U.S.A
| | - Thomas J Prihoda
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
| | - Erik K Weitzel
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, U.S.A
| | - Kevin C McMains
- Department of Surgery, Uniformed Services University, Bethesda, Maryland, U.S.A
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery, Georgetown University Medical Center, MedStar Health, Washington, District of Columbia, U.S.A
| | - Sarah N Bowe
- Department of Otolaryngology-Head & Neck Surgery, San Antonio Uniformed Services Health Education Consortium, JBSA-Ft Sam Houston, Texas, U.S.A
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A
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Villwock JA, Bowe SN, Rotich DC, Beltramo A, Friedman A, Kraft SM. What makes us tick: Implications of personality differences among otolaryngology residents and faculty. Laryngoscope 2018; 129:2286-2290. [PMID: 30570136 DOI: 10.1002/lary.27727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The rapid personal and professional growth experienced during medical training and practice is impacted by personality. The surgeon's personality is renowned in both medical lore and literature. However, it is now known that the personality characteristics of today's millennial trainees differ from older faculty. This study investigates the variability of different personality attributes among otolaryngology residents and faculty, as well as the practical implications of these findings. METHODS The opportunity to complete a series of web-based, commercially available, self-administered five factor-based personality assessments was given to otolaryngology residents and faculty at nine academic training programs. The psychometrically validated assessments evaluate innate personality 1) strengths, 2) challenges, and 3) motivators/values. Differences between groups in the assessed metrics were evaluated using two-tailed t tests. RESULTS Seventy-eight otolaryngology faculty and 104 residents completed all three assessments. Of the assessed metrics, there were several significant differences between residents and faculty (all P < 0.05). Residents scored higher than faculty in the domains of interpersonal sensitivity, sociability, and inquisitiveness. With respect to potential challenges, faculty displayed higher levels of skepticism and reservation. In contrast, residents scored higher in the categories of mischievous and dutiful. As for motivators/values, although both groups were highly motivated by altruism, faculty valued tradition more than residents, whereas residents valued hedonism and affiliation more than faculty. CONCLUSION There are notable differences between residents and faculty in multiple domains, with implications for communication, education, and professional development. LEVEL OF EVIDENCE 3 Laryngoscope, 129:2286-2290, 2019.
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Affiliation(s)
| | - Sarah N Bowe
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | | | - Alvin Beltramo
- University of Kansas Medical Center, Kansas City, Kansas
| | - Alan Friedman
- J3Personica, 145 Wyckoff Rd, St 304, Eatontown, New Jersey, U.S.A
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Jamal N, Bowe SN, Brenner MJ, Balakrishnan K, Bent JP. Impact of a Formal Patient Safety and Quality Improvement Curriculum: A Prospective, Controlled Trial. Laryngoscope 2018; 129:1100-1106. [DOI: 10.1002/lary.27527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Nausheen Jamal
- Department of Otolaryngology–Head and Neck SurgeryLewis Katz School of Medicine at Temple University Philadelphia Pennsylvania
| | - Sarah N. Bowe
- Department of Otolaryngology–Head and Neck SurgerySan Antonio Uniformed Services Health Education Consortium (SAUSHEC) Ft. Sam Houston TX
| | - Michael J. Brenner
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Michigan School of Medicine Ann Arbor Michigan
| | - Karthik Balakrishnan
- Mayo Clinic Children's Center and Department of OtorhinolaryngologyMayo Clinic Rochester Minnesota
| | - John P. Bent
- Department of Otorhinolaryngology–Head and Neck Surgery, Albert Einstein College of Medicine at Montefiore Medical Center Bronx New York U.S.A
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McGill M, Raol N, Gipson KS, Bowe SN, Fulk-Logan J, Nourmahnad A, Chung JY, Whalen MJ, Kaplan DL, Hartnick CJ. Preclinical assessment of resorbable silk splints for the treatment of pediatric tracheomalacia. Laryngoscope 2018; 129:2189-2194. [PMID: 30408198 DOI: 10.1002/lary.27540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/03/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Tracheomalacia is characterized by weakness of the tracheal wall resulting in dynamic airway collapse during respiration; severe cases often require surgical intervention. Off-label external splinting with degradable implants has been reported in humans; however, there remains a need to develop splints with tunable mechanical properties and degradation profiles for the pediatric population. The objective of this pilot study is to assess the safety and efficacy of silk fibroin-based splints in a clinically relevant preclinical model of tracheomalacia. METHODS Silk splints were evaluated in a surgically induced model of severe tracheomalacia in N = 3 New Zealand white rabbits for 17, 24, and 31 days. An image-based assay was developed to quantify the dynamic change in airway area during spontaneous respiration, and histopathology was used to study the surrounding tissue response. RESULTS The average change in area in the native trachea was 23% during spontaneous respiration; surgically induced tracheomalacia resulted in a significant increase to 86% (P < 0.001). The average change in airway area after splint placement was reduced at all terminal time points (17, 24, and 31 days postimplantation), indicating a clinical improvement, and was not statistically different than the native trachea. Histopathology showed a localized inflammatory reaction characterized by neutrophils, eosinophils, and mononuclear cells, with early signs suggestive of fibrosis at the splint and tissue interface. CONCLUSION This pilot study indicates that silk fibroin splints are well tolerated and efficacious in a rabbit model of severe tracheomalacia, with marked reduction in airway collapse following implantation and good tolerability over the studied time course. LEVEL OF EVIDENCE NA Laryngoscope, 129:2189-2194, 2019.
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Affiliation(s)
- Meghan McGill
- Department of Biomedical Engineering, Tufts University, Medford
| | - Nikhila Raol
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,the Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Kevin S Gipson
- Department of Pediatrics, Division of Pediatric Pulmonology the Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | | | - Anahita Nourmahnad
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Joon Yong Chung
- Department of Pediatrics, Division of Pediatric Pulmonology the Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael J Whalen
- Department of Pediatrics, Division of Pediatric Pulmonology the Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford
| | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Colaianni CA, Galaiya DJ, Baker JD, Bowe SN, Cohen MS. Computed tomography-fusion image guidance for children with thin calvaria undergoing bone-anchored hearing aid placement. Laryngoscope 2018; 128:2178-2180. [DOI: 10.1002/lary.27143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/04/2018] [Accepted: 01/25/2018] [Indexed: 11/11/2022]
Affiliation(s)
- C. Alessandra Colaianni
- Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Deepa J. Galaiya
- Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Jerry D. Baker
- Medtronic Surgical Technologies, Medtronic Inc.; Minneapolis Minnesota U.S.A
| | - Sarah N. Bowe
- Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Michael S. Cohen
- Department of Otology and Laryngology; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
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35
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Mohan S, Bowe SN, Hirner LM, Zar-Kessler C, Hartnick CJ. Modified approach for pediatric external cricopharyngeal myotomy. Int J Pediatr Otorhinolaryngol 2018; 105:111-114. [PMID: 29447795 DOI: 10.1016/j.ijporl.2017.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
Pediatric cricopharyngeal achalasia is an uncommon but important cause of oropharyngeal dysphagia. Failure of upper esophageal sphincter relaxation is the currently understood pathophysiology. Therapies include balloon dilation, botulinum toxin injection, and endoscopic or open cricopharyngeal myotomy (CPM). Open CPM is usually performed at the posterior midline of the cricopharyngeus and can be a risky procedure given concern for esophageal perforation and damage to the recurrent laryngeal nerve. Here, we present a novel modified technique for open CPM using a superficial anterolateral transection approach in the case of a young male with refractory cricopharyngeal achalasia.
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Affiliation(s)
- Suresh Mohan
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Sarah N Bowe
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Lara M Hirner
- Department of Speech, Language and Swallowing Disorders, Massachusetts General Hospital, Boston, MA, USA
| | - Claire Zar-Kessler
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
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Affiliation(s)
- Robert J. Morrison
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee
| | - Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Michael J. Brenner
- Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
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Abstract
Importance It has been nearly 25 years since medical students were queried regarding their perspectives on otolaryngology-head and neck surgery (OHNS) residency selection. Understanding this viewpoint is critical to improving the current application process. Objective To evaluate the perceptions of 2016 OHNS residency applicants regarding the application process and offer suggestions for reform. Design, Setting, and Participants In this cross-sectional study of anonymous online survey data, a 14-question survey was designed based on resources obtained from a computerized PubMed, Ovid, and GoogleScholar database search of the English language from January 1, 1990, through December 31, 2015, was conducted using the following search terms: (medical student OR applicant) AND (application OR match) AND otolaryngology. The survey was administered to 2016 OHNS residency applicants to examine 4 primary areas: current attitudes toward the match, effect of the new Otolaryngology Program Directors Organization personal statement mandate, sources of advice and information, and suggestions for improvement. In January 2016, an email was sent to 100 program directors asking them to distribute the survey to current OHNS applicants at their institution. One follow-up reminder email was sent in February 2016. A link to the survey was posted on the Otomatch.com homepage on January 28, 2016, with the last response received on March 28, 2016. Main Outcome and Measures Survey responses regarding the residency application process. Results A total of 150 of 370 residency applicants (40.5%) responded to the survey. Of these, 125 respondents (90.6%) noted applying to programs in which they had no specific interest simply to improve their chances of matching. Applicants intended to apply to more programs than they actually did (63.6 vs 60.8; r = 0.19; 95% CI, -0.03 to 0.40). Program directors advised fewer applications than other sources; however, 58 respondents (38.7%) did not receive advice from a program director. A total of 121 respondents (80.7%) found online program information to be insufficient. Finally, 90 of 140 respondents (64.3%) noted that they would agree to a hard cap on applications, among other suggestions for improvement. Conclusions and Relevance Several main themes emerged from the data, providing a foundation for process improvement opportunities: careful consideration to applicant mentorship, including peers; uniform set of criteria for residency program websites; and investigating alternative match platforms, which may allow hard caps, flagging programs of higher interest, or wave application cycles. Overall, the otolaryngology applicant provides a unique perspective regarding the current state of the match and potential opportunities for system-wide improvement.
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Affiliation(s)
- Matthew Ward
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas
| | - Christian Pingree
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas
| | - Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston
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Bowe SN, Diercks GR, Hartnick CJ. Modified surgical approach to hypoglossal nerve stimulator implantation in the pediatric population. Laryngoscope 2017; 128:1490-1492. [PMID: 28771734 DOI: 10.1002/lary.26808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/09/2022]
Abstract
Upper airway stimulation with the hypoglossal nerve stimulator is a promising treatment modality for severe obstructive sleep apnea in carefully selected patients with Down syndrome. The pediatric population presents a greater variety in body habitus, including thorax size. A modified surgical approach, utilizing a medially placed, single chest incision, instead of two separate chest incisions, provides an alternative that is particularly useful for pediatric patients with small stature. As this technology is evaluated for Food and Drug Administration clearance in the pediatric population, it is important to consider modifications in surgical technique, partnering prior surgical experience with the technical support of company representatives. Laryngoscope, 128:1490-1492, 2018.
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Gillian R Diercks
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Bowe SN, Jones WS. Continuous Leadership Education and Development at the San Antonio Uniformed Services Health Education Consortium. Mil Med 2017; 182:1624-1627. [DOI: 10.7205/milmed-d-16-00260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sarah N. Bowe
- San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Woodson Scott Jones
- San Antonio Uniformed Services Health Education Consortium (SAUSHEC), San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
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Affiliation(s)
- Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - C Alessandra Colaianni
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Christopher J Hartnick
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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Abstract
There has been a heightened focus on improving the resident selection process, particularly within highly competitive specialties. Previous research, however, has generally lacked a theoretical background, leading to inconsistent and biased results. Our recently published systematic review examining applicant characteristics and performance in residency can provide historical insight into the predictors (ie, constructs) and outcomes (ie, criteria) previously deemed pertinent by the otolaryngology community. Personnel psychology uses evidence-based practices to identify the most qualified candidates for employment using a variety of selection methods. Extensive research in this discipline has shown that integrity tests, structured interviews, work samples, and conscientiousness offer the greatest increase in validity when combined with general cognitive ability. Blending past research knowledge with the principles of personnel selection can provide the necessary foundation with which to engage in theory-driven, longitudinal studies on otolaryngology resident selection moving forward.
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Affiliation(s)
- Sarah N. Bowe
- Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Adrienne M. Laury
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Ft. Sam Houston, Texas, USA
| | - Stacey T. Gray
- Department of Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Bowe SN, Laury AM, Gray ST. Associations between Otolaryngology Applicant Characteristics and Future Performance in Residency or Practice: A Systematic Review. Otolaryngol Head Neck Surg 2017; 156:1011-1017. [DOI: 10.1177/0194599817698430] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective This systematic review aims to evaluate which applicant characteristics available to an otolaryngology selection committee are associated with future performance in residency or practice. Data Sources PubMed, Scopus, ERIC, Health Business, Psychology and Behavioral Sciences Collection, and SocINDEX. Review Methods Study eligibility was performed by 2 independent investigators in accordance with the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Data obtained from each article included research questions, study design, predictors, outcomes, statistical analysis, and results/findings. Study bias was assessed with the Quality in Prognosis Studies tool. Results The initial search identified 439 abstracts. Six articles fulfilled all inclusion and exclusion criteria. All studies were retrospective cohort studies (level 4). Overall, the studies yielded relatively few criteria that correlated with residency success, with generally conflicting results. Most studies were found to have a high risk of bias. Conclusion Previous resident selection research has lacked a theoretical background, thus predisposing this work to inconsistent results and high risk of bias. The included studies provide historical insight into the predictors and criteria (eg, outcomes) previously deemed pertinent by the otolaryngology field. Additional research is needed, possibly integrating aspects of personnel selection, to engage in an evidence-based approach to identify highly qualified candidates who will succeed as future otolaryngologists.
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Affiliation(s)
- Sarah N. Bowe
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Adrienne M. Laury
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Stacey T. Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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Bowe SN, Schmalbach CE, Laury AM. The State of the Otolaryngology Match: A Review of Applicant Trends, "Impossible" Qualifications, and Implications. Otolaryngol Head Neck Surg 2017; 156:985-990. [PMID: 28319452 DOI: 10.1177/0194599817695804] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective This State of the Art Review aims (1) to define recent qualifications of otolaryngology resident applicants by focusing on United States Medical Licensing Examination (USMLE) scores, Alpha Omega Alpha (AOA) status, and research/publications and (2) to summarize the current literature regarding the relationship between these measures and performance in residency. Data Sources Electronic Residency Application Service, National Residency Matching Program, PubMed, Ovid, and GoogleScholar. Review Methods Electronic Residency Application Service and National Residency Matching Program data were analyzed to evaluate trends in applicant numbers and qualifications. Additionally, a literature search was performed with the aforementioned databases to identify relevant articles published in the past 5 years that examined USMLE Step 1 scores, AOA status, and research/publications. Conclusions Compared with other highly competitive fields over the past 3 years, the only specialty with decreasing applicant numbers is otolaryngology, with the rest remaining relatively stable or slightly increased. Additionally, USMLE Step 1 scores, AOA status, and research/publications do not reliably correlate with performance in residency. Implications for Practice The consistent decline in applications for otolaryngology residency is concerning and reflects a need for change in the current stereotype of the "ideal" otolaryngology applicant. This includes consideration of additional selection measures focusing on noncognitive and holistic qualities. Furthermore, otolaryngology faculty should counsel medical students that applying in otolaryngology is not "impossible" but rather a feasible and worthwhile endeavor.
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Affiliation(s)
- Sarah N Bowe
- 1 Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Cecelia E Schmalbach
- 2 Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Adrienne M Laury
- 3 Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
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Laury AM, Bowe SN, Lospinoso J. Integrating Morbidity and Mortality Core Competencies and Quality Improvement in Otolaryngology. JAMA Otolaryngol Head Neck Surg 2017; 143:135-140. [DOI: 10.1001/jamaoto.2016.2910] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adrienne M. Laury
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), Fort Sam Houston, Texas
| | - Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Joshua Lospinoso
- 782nd Military Intelligence Battalion, Detachment Texas, Fort Sam Houston, Texas
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Lanigan A, Lospinoso J, Bowe SN, Laury AM. The Nasal Fracture Algorithm: A Case for Protocol-Driven Management to Optimize Care and Resident Work Hours. Otolaryngol Head Neck Surg 2017; 156:1041-1043. [PMID: 28118548 DOI: 10.1177/0194599816688179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care.
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Affiliation(s)
- Alexander Lanigan
- 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Sarah N Bowe
- 3 Department of Otology and Laryngology, Division of Pediatric Otolaryngology, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Adrienne M Laury
- 1 Department of Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
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Bowe SN, Weitzel EK, Hannah WN, Fitzgerald BM, Kraus GP, Nagy CJ, Harrison SA. Introducing a Novel Applicant Ranking Tool to Predict Future Resident Performance: A Pilot Study. Mil Med 2017; 182:e1514-e1520. [DOI: 10.7205/milmed-d-15-00436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sarah N. Bowe
- San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Erik K. Weitzel
- San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - William N. Hannah
- San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Brian M. Fitzgerald
- San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Gregory P. Kraus
- San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Christopher J. Nagy
- San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Stephen A. Harrison
- San Antonio Uniformed Services Health Education Consortium, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
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Laury AM, Bowe SN, Stramiello J, McMains KC. Balloon dilation of sinus ostia in the Department of Defense: Diagnoses, actual indications, and outcomes. Laryngoscope 2016; 127:544-549. [PMID: 27659163 DOI: 10.1002/lary.26315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/21/2016] [Accepted: 08/15/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the primary diagnoses for which balloon catheter dilation (BCD) of sinus ostia is being employed in a profit-blind health care system, the Department of Defense. STUDY DESIGN Retrospective chart review. METHODS From January 1, 2011 to December 31, 2013, 319 consecutive patient charts were reviewed for International Classification of Diseases, Ninth Edition (ICD-9) diagnoses, presence of chronic rhinosinusitis (CRS) defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), preoperative Lund-Mackay scores, nasal endoscopy findings, sinuses dilated, postoperative outcomes, and complications. RESULTS Of the 319 patients identified, 217 had sufficient documentation to be included. A CRS ICD-9 code was applied in 182 of 217 (83.9%) and recurrent acute rhinosinusitis in 12 of 217 (5.6%). Only 50.5% of CRS patient charts met criteria using EPOS guidelines. In contrast, 39.6% met the ICD-9 criteria for atypical facial pain. Patients with Lund-Mackay scores ≤ 4 were reviewed for number of sinuses dilated. Eighty-eight of 123 patients (71.5%) had sinuses dilated that were free from opacification/mucosal edema on preoperative imaging. CONCLUSIONS Balloon dilation of sinus ostia has an expanding role in treating sinus disease. In the studied population, BCD is often utilized for alternate indications for which there is currently no evidence of efficacy. Future studies are needed to evaluate the efficacy of this technology in treating these alternate indications. LEVEL OF EVIDENCE 4. Laryngoscope, 127:544-549, 2017.
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Affiliation(s)
- Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft. Sam Houston, Texas, U.S.A
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft. Sam Houston, Texas, U.S.A
| | - Joshua Stramiello
- University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
| | - Kevin C McMains
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft. Sam Houston, Texas, U.S.A
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Bowe SN, Laury AM, Kepchar JJ, Lospinoso J. Programmatic Assessment of a Comprehensive Quality Improvement Curriculum in an Otolaryngology Residency. Otolaryngol Head Neck Surg 2016; 155:729-732. [DOI: 10.1177/0194599816654685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/24/2016] [Indexed: 11/16/2022]
Abstract
To date, there is minimal literature discussing quality improvement curricula in otolaryngology. Herein, we present our program, including didactic, web-based, and experiential learning, developed in the setting of a preexisting institutional quality and safety policy. Nine otolaryngology residents were evaluated with assessments focused on learner satisfaction, learner attitudes, and knowledge acquisition according to the Kirkpatrick framework. Wilcoxon signed-rank test was used to compare results. While the total score increased across all assessments, it was significant for only the Quality Improvement Knowledge Application Tool Revised ( P < .05). We find our initial learning outcomes encouraging and hope that our comprehensive curriculum can serve as a resource to other programs, which can be adapted to fit within the context of variable training environments. Furthermore, it is imperative to consider continuous assessment and refinement of any educational program, using the same quality improvement principles that we endeavor to teach.
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Affiliation(s)
- Sarah N. Bowe
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Adrienne M. Laury
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Jessica J. Kepchar
- Department of Otolaryngology–Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Joshua Lospinoso
- 782nd Military Intelligence Battalion, Detachment Texas, Ft Sam Houston, Texas, USA
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Harvey M, Bowe SN, Laury AM. Clinical Practice Guidelines: Whose Practice Are We Guiding? Otolaryngol Head Neck Surg 2016; 155:373-5. [PMID: 27329423 DOI: 10.1177/0194599816655145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/26/2016] [Indexed: 11/17/2022]
Abstract
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has just released an update to the clinical practice guideline (CPG) on otitis media with effusion. This common condition is frequently managed by primary care providers; however, their awareness and utilization of the AAO-HNSF CPGs are unknown. We performed a cross-sectional survey to assess familiarity with otologic diagnoses, evaluation skills, and guidelines. Only 38.5% of respondents use pneumatic otoscopy, and roughly 50% utilize a CPG for management of otitis media or for referral for tympanostomy tube insertion. Providers predominantly use the acute otitis media guideline from the American Academy of Pediatrics. In this single-institution study, providers are largely unaware of the AAO-HNSF CPGs and could benefit from additional training, including workshops taught by otolaryngologists within individual health care systems or development of a national otolaryngology medical student curriculum. A more immediate option includes referencing our CPGs on specialty societies' websites or newsletters.
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Affiliation(s)
- Morgan Harvey
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Sarah N Bowe
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
| | - Adrienne M Laury
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Ft Sam Houston, Texas, USA
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