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Coleman JR. The Trauma Fellow's Perspective on Grit and Resilience and Its Role in Wellness. CURRENT TRAUMA REPORTS 2023; 9:1-6. [PMID: 37362904 PMCID: PMC10061407 DOI: 10.1007/s40719-023-00255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/03/2023]
Abstract
Purpose of Review To describe the unique stressors of surgical training and fellowship and how grit and resilience influence trainee wellness. Recent Findings Surgical training is an intense, high-stress experience. For fellows-in-training, unique stressors are associated with this chapter of training, from financial pressors to the stress of job acquisition. Wellness is essential for surgical fellows, not just for the critical need for quality mental health of providers, but also for the patients who are also affected by provider burnout. There are various wellness programs that can be instituted nationally and institutionally to optimize fellow wellness, but one of the most high-yield foci for fellow wellness is focused mentorship, the key to assuring wellness and harnessing grit. Summary Surgical residency and fellowship are prodigiously demanding experiences, which mandate grit and resilience. It is imperative that widespread cultural and institutional changes take place to best support surgical trainees.
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Affiliation(s)
- Julia R. Coleman
- Department of Surgery, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210 USA
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2
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Tamaki A, Cabrera CI, Cooley CR, Fowler NM, Scarola DE, Li S, Thuener JE, Quereshy H, Garneau JC, Lavertu P, Teknos TN, Rezaee RP. Job market in head and neck surgery: A survey and analysis of recent fellowship graduates. Am J Otolaryngol 2022; 43:103591. [PMID: 35988362 DOI: 10.1016/j.amjoto.2022.103591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/07/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Recent years have seen increase in individuals pursuing postgraduate fellowships in head and neck (HN) surgery. This has presented concerns about insufficient jobs where graduates can apply their scope of specialized training. METHODS Data was collected in two manners- a survey and a manual online search of American Head and Neck Society (AHNS) fellowship graduates. A 25-question survey was sent in 2021 to approximately 400 HN fellows who graduated between 2010 and 2020. The AHNS list of graduates from the same years were searched online to collect information including gender, graduation year, fellowship training, and current job practice. RESULTS Of the 78 survey responses, 64.1 % were male and 34.6 % female. 96.2 % reported ablative, 84.6 % microvascular, and 82.1 % TORS training. Mean number of interviews was 4 with most interviewing during the 3rd quarter (January to March). Majority reported being in academic and university-based practices (79.6 %). Online search was done on 393 graduates. Since 2010 the number of graduates almost doubled. There was a statistically significant increase in females by year (p = 0.022). There was a significant decrease (p = 0.022) in graduates with additional fellowship training from that of their AHNS fellowship. There was also a statistically significant increase in graduates being in academic practices (p = 0.022). CONCLUSION Despite growing numbers, there appears to be more graduates entering an academic practice, although the definition of an academic HN practice may be evolving. These results provide guidance on how to approach the job search in a select market. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Nicole M Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Danielle E Scarola
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Shawn Li
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jason E Thuener
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Humzah Quereshy
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Pierre Lavertu
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rod P Rezaee
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
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3
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Hesham HT, Grundfast K, Sarber K. Making a Major Change: Changing Your Practice Setting, Retirement, and Locums. Otolaryngol Clin North Am 2021; 55:33-41. [PMID: 34823719 DOI: 10.1016/j.otc.2021.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The goal of this article is to discuss factors associated with career change and give data and recommendations of how to prepare for a career change in regards to early, mid, and late career.
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Affiliation(s)
- Hosai Todd Hesham
- Adjunct Faculty, Department of Surgery, Division of Otolaryngology, George Washington University, Washington, DC, USA; Maryland ENT Associates, Privia, Private Practice, Silver Spring, MD, USA.
| | | | - Kathleen Sarber
- Department of Surgery, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA
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Grose E, Chen T, Siu J, Campisi P, Witterick IJ, Chan Y. National Trends in Gender Diversity Among Trainees and Practicing Physicians in Otolaryngology-Head and Neck Surgery in Canada. JAMA Otolaryngol Head Neck Surg 2021; 148:13-19. [PMID: 34792563 DOI: 10.1001/jamaoto.2021.1431] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Importance Monitoring the evolution of gender diversity within medicine is essential to understanding the medical workforce and anticipating its future. Objective To evaluate gender distribution and trends among trainees and practicing physicians in the field of otolaryngology-head and neck surgery (OHNS) across Canada. Design, Setting, and Participants This cross-sectional study collected demographic data on the Canadian population, medical students, resident physicians, fellows, practicing physicians, and full-time professors from the following publicly available databases: the Canadian Post-MD Education Registry, the Canadian Medical Education Statistics from the Association of Faculties of Medicine of Canada, the Canadian Medical Association Masterfile, the Canadian Resident Matching Service archives, and the Canadian Institute for Health Information from 2000 to 2019. Information about the gender distribution in leadership positions and fellowships was obtained through publicly available websites where gender was either listed or assigned by authors. Main Outcomes and Measures The primary outcomes were the proportion of women in OHNS and the evolution of gender diversity over time. Results In 2019, 65 of 155 of OHNS trainees were female (41.9%), whereas female representation among all surgical trainees combined was 1225 of 2496 (49.1%). Female OHNS trainees and practicing physicians are underrepresented despite a 13.3% increase in female trainees and a 14.3% increase in female staff physicians from 2000 to 2019. Proportionally fewer female graduates pursued a fellowship during a 10-year period compared with their male counterparts, with otology and neurotology having the lowest female representation (6 of 27 [22.2%]). A minimal increase occurred in the number of women holding academic leadership positions (eg, 4 of 13 residency training programs had a previous or current female director). Conclusions and Relevance Despite the overall increase in the representation of women in the field of OHNS in Canada, these findings suggest that persistent gender gaps remain with respect to academic leadership positions and fellowship training. Continuous monitoring of the surgical workforce is important to highlight and address gender disparities within OHNS.
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Affiliation(s)
- Elysia Grose
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tanya Chen
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Siu
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Paolo Campisi
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Yvonne Chan
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, St Michael's Hospital, Toronto, Ontario, Canada
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Damazo B, Bailey T, Fisher DR, Dehom S, Cress V, Murry T, Johns MM, Krishna P, Crawley BK. Recent Laryngology Fellowship Graduates: Where Are They Now? Ann Otol Rhinol Laryngol 2021; 131:979-986. [PMID: 34622694 DOI: 10.1177/00034894211049574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Over the past 30 years laryngology fellowships have grown in number and diversity. This study investigated the career trajectories of recent laryngology fellowship graduates with the purpose of informing residents considering fellowship. STUDY DESIGN Cross-sectional survey. SETTING Academic medical center. METHODS The directors of all 27 US laryngology fellowships that graduated/recruited fellows from 2010 to 2019 were contacted, and a list of former fellows was compiled. A short survey was administered in person or via email or phone. Additional data was gathered through internet searches. RESULTS One hundred eighty-three fellows were identified having completed American laryngology fellowships between 2010 and 2019 (100M:83F). Fifteen percent now practice internationally and 68% are in academic practice. A higher proportion of women than men enter laryngology fellowship after otolaryngology residency. One hundred twenty-nine fellows responded to our survey. Two-thirds of former fellows report current participation in laryngology research. Seventy-two percent of former fellows are still in their first job after fellowship and 53% believe they have their ideal practice. Women were more likely to enter academics than men after laryngology fellowship. Responders were overwhelmingly satisfied with their fellowship experience, with 95% saying they would choose to pursue fellowship training again. CONCLUSIONS Most former laryngology fellows enter academia, contribute to laryngology research, practice away from their training institution, and believe they have found their ideal practice. The results of this study may be useful to residents considering fellowship training, centers considering establishing laryngology fellowships, and practices recruiting fellowship graduates.
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Affiliation(s)
- Benjamin Damazo
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Traci Bailey
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Daniel R Fisher
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Salem Dehom
- School of Nursing, Loma Linda University, Loma Linda, CA, USA
| | - Victoria Cress
- School of Medicine, Loma Linda University, Loma Linda CA, USA
| | - Thomas Murry
- Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Center, Loma Linda University, Loma Linda, CA, USA
| | - Michael M Johns
- Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Priya Krishna
- Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Center, Loma Linda University, Loma Linda, CA, USA
| | - Brianna K Crawley
- Department of Otolaryngology-Head and Neck Surgery, Voice and Swallowing Center, Loma Linda University, Loma Linda, CA, USA
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Vohra V, Watley DC, Yan CH, Locke TB, Bernstein IA, Levy JM, Rowan NR. Predictors of academic career placement and scholarly impact in fellowship-trained rhinologists. Int Forum Allergy Rhinol 2021; 12:62-70. [PMID: 34309228 DOI: 10.1002/alr.22873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND As rhinology fellowship positions outpace the availability of academic rhinology jobs, it is increasingly important to identify characteristics that are associated with academic placement after fellowship completion. In this study, we evaluated the association of academic characteristics during training with current job placement and posttraining scholarly impact. METHODS Previous rhinology fellows were identified using publicly available data. Bibliometric indices, training institutions, graduate degrees, and job placement data were used in bivariate and multivariable regression analyses to assess for association with predictors and academic trajectory. RESULTS Data from 265 rhinologists, all graduating between 1991 and 2020, were included. Most surgeons (n = 185, 70%) held an academic position and 80 (30%) surgeons worked in a nonacademic setting; 93.2% had a Doctor of Medicine (MD) degree and 80.3% were male. Multivariable logistic regression indicated that a designation of MD, compared with Doctor of Osteopathic Medicine (DO; odds ratio [OR], 5.93; 95% confidence interval [CI], 1.97-21.9), number of publications during fellowship (OR, 1.19; 95% CI, 1.02-1.41), and h-index during training (OR, 1.25; 95% CI, 1.07-1.49]) were independently predictive of academic job placement. Meanwhile, number of primary authorships during fellowship (β = 1.47; 95% CI, 1.07-1.88]), h-index during training (β = 0.48; 95% CI, 0.25-0.71), and PhD (β = 4.16; 95% CI, 1.57-6.76) were associated with posttraining h-index. Medical school ranking; graduate degrees, including Master of Science (MS), Master of Business Administration (MBA), and Master of Public Health (MPH); and research metrics before residency were not associated with either academic placement or posttraining h-index. CONCLUSION The predictors of academic job placement in rhinology are unclear, but h-index during training, and research productivity during fellowship may serve as indicators of an academic career.
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Affiliation(s)
- Varun Vohra
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Duncan C Watley
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carol H Yan
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA
| | - Tran B Locke
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX
| | - Isaac A Bernstein
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joshua M Levy
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
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Miller RH, McCrary HC, Gurgel RK. Assessing Trends in Fellowship Training Among Otolaryngology Residents: A National Survey Study. Otolaryngol Head Neck Surg 2021; 165:655-661. [PMID: 33618575 DOI: 10.1177/0194599821994477] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To summarize trends in otolaryngology fellowship applications, fellowships selected, and reasons for pursuing a fellowship. STUDY DESIGN One-page anonymous questionnaire. SETTING A survey was completed by examinees at the conclusion of their American Board of Otolaryngology-Head and Neck Surgery oral examination from 2011 to 2019. METHODS Data included age, gender, fellowship type, reasons for doing a fellowship, and type of practice that examinees will enter. Spearman correlation and Pearson chi-square tests were completed. RESULTS Over the 8-year study, 58% of the 2243 responding examinees did fellowships. The most frequently chosen fellowship was facial plastic surgery (25%), followed by pediatric otolaryngology (21%), head and neck surgery (19%), rhinology (13%), laryngology (9%), and neurotology (8%). The 2 most common reasons for doing a fellowship were desire for additional expertise beyond residency training (35%) and intellectual appeal (30%). Over the study period, the number of residents choosing to do a fellowship increased from 45.6% in 2011 to 61.5% in 2019, with a positive correlation between year and number of residents (r = 0.73, P = .036). When the data were stratified by gender, there were statistically significant differences in fellowship selection (P < .001), notably with women selecting pediatric otolaryngology at a higher frequency than men (30.9% vs 15.8%). CONCLUSION There is a statistically significant increasing trend of otolaryngology residents who choose to undergo further training in fellowship. These data from a large, long-term study will be valuable in planning for training and workforce needs in the future.
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Affiliation(s)
- Robert H Miller
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Hilary Caitlyn McCrary
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Utah, USA
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Utah, USA
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Lawlor C, Kawai K, Tracy L, Sobin L, Kenna M. Women in Otolaryngology: Experiences of Being Female in the Specialty. Laryngoscope 2020; 131:E380-E387. [PMID: 32702136 DOI: 10.1002/lary.28917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES A broad survey of women otolaryngologists on the current state of the field, including opportunities for advancement, support of family leave, and prevalence of harassment, has not been performed since 1998. An update on the experiences of female otolaryngologists is vital to continue to advance the specialty. STUDY DESIGN Anonymous web-based survey. METHODS Survey of members of the Women in Otolaryngology (WIO) section of the American Academy of Otolaryngology-Head and Neck Surgery (all members of the AAO-HNS that identify as female are automatically members of this section). Distributed via AAO-HNS. RESULTS Five hundred thirty-five responses out of 2303 total WIO members (response rate of 23.2%). Respondents ranged in age from 25 to >65 years. Respondents reported that in the residency programs they attended, 29% of residents, 13% of faculty, and 7% of department leaders were women. Forty-four percent disagreed that their department leaders and 39% disagreed that their male co-residents were supportive of women starting families in training. Younger respondents were more likely to feel that their department leaders were supportive of female residents, maternity leave, etc. Harassment in the current work environment did not differ by age; 53% reported harassment-free, 31% subtle undertones, 8% noticeable tones, 2% significant harassment. Harassment in the workplace varied by region; the greatest level of harassment was in the Midwest. CONCLUSIONS Women otolaryngologists continue to experience harassment in the workplace. It is encouraging that younger otolaryngologists feel more supported by their departments in both their careers and their personal lives. This survey highlights critical areas for continued growth within our specialty. LEVEL OF EVIDENCE IV Laryngoscope, 131:E380-E387, 2021.
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Affiliation(s)
- Claire Lawlor
- Department of Otolaryngology, Children's National Medical Center, Washington, District of Columbia, U.S.A.,George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Lauren Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Lindsay Sobin
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts, Worcester, Massachusetts, U.S.A
| | - Margaret Kenna
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
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Factors influencing the choice of practice location among Canadian otolaryngologists. The Journal of Laryngology & Otology 2019; 133:339-343. [PMID: 30924439 DOI: 10.1017/s0022215119000409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Little is known about what shapes the choice of employment location in a competitive surgical specialty like otolaryngology - head and neck surgery. This study aimed to identify factors important in determining practice location among Canadian otolaryngologists METHODS: An online survey was distributed nationally to active members of the Canadian Society of Otolaryngology - Head and Neck Surgery. The survey collected data on general demographics, current practice description, training location, factors deemed important in practice location decisions, and job satisfaction. RESULTS A total of 122 survey responses were collected, with a similar proportion of participants in academic versus community practice. The majority of respondents (73 per cent) practised in the same province as their residency training. Participants identified job vacancy, colleague interaction, spouse opinion and hospital services as important in the decision of practice location. CONCLUSION Key determinants of practice location among Canadian otolaryngologists include job vacancies, spouse opinion, and colleague interactions. Overall, Canadian otolaryngologists report high satisfaction with current employment.
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Riley CA, Soneru CP, Husain Q, Gray ST, Senior BA, Tabaee A. Faculty Attitudes Toward Rhinology Fellowship Training: A Survey of Rhinology Fellowship Programs. Am J Rhinol Allergy 2018; 33:8-16. [DOI: 10.1177/1945892418801403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The number of rhinology fellowship programs has grown rapidly over the past decade. To date, no standardization or accreditation process exists, raising the potential for disparate programs. The attitudes of faculty regarding training are important to elucidate the educational experience of rhinology fellowship. Methods An anonymous, web-based survey of rhinology faculty assessed the subjective attitudes toward various domains of fellowship training including surgery, office-based procedures, research, and career development. A 5-point Likert-type scale assessing importance was used (1—not at all important, 5—extremely important). Results A total of 34 faculty (response rate 35.8%) completed the survey. The surgical procedures that received the highest mean importance scores were endoscopic surgery for advanced inflammatory disease (median = 5), cerebrospinal fluid leak closure (5), and extended endoscopic sinus surgery (5). The procedures with the lowest scores were nasal valve repair (2), inferior turbinate surgery (3), and open approaches to the sinuses (4). A wide range of responses was noted for the minimum target number of fellow cases for the surveyed procedures. Higher importance scores were noted for direct attending supervision (5) when compared to fellow autonomy (4, P < .001) or shadowing (3.5, P < .001) in the operating room. Higher scores were noted for career preparation in academic (4) versus private practice (3, P < .001) and providing opportunities for clinical (4) versus basic science research (2, P < .001). The majority of faculty felt that there were too many fellowship positions with respect to the market place for private practice (58.8%), academic jobs (85.3%), and overall societal need (61.8%). Conclusion A range of faculty attitudes with respect to fellowship training was noted in this study. Continued assessment and refinement of the educational experience in rhinology fellowships is necessary.
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Affiliation(s)
- Charles A. Riley
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
| | - Christian P. Soneru
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
| | - Qasim Husain
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
| | - Stacey T. Gray
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Brent A. Senior
- Department of Otolaryngology – Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Abtin Tabaee
- Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medicine – New York Presbyterian Hospital, New York, New York
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12
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Dedmon MM, O'Connell BP, Adams AS, Wanna GB, Haynes DS. Improving resident familiarity with the translabyrinthine approach to the internal auditory canal. Am J Otolaryngol 2017; 38:526-528. [PMID: 28532970 DOI: 10.1016/j.amjoto.2017.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/05/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To increase otolaryngology resident experience with drilling and dissection of the internal auditory canal (IAC) via a translabyrinthine approach. STUDY DESIGN Pilot study involving temporal bone education and drilling with completion of pre- and post-drilling surveys. METHODS Participants observed an educational presentation on IAC anatomy and drilling, followed by manipulation of IAC nerves using a prosected cadaveric temporal bone. Participants then drilled the IAC and identified nerves using temporal bones with previously drilled mastoidectomies and labyrinthectomies. Pre- and post-drilling 5-point Likert-based surveys were completed. RESULTS 7 participants were included in this study ranging in experience from PGY1 through PGY 5. The median number of times the IAC had been drilled previously was 0. Participants reported statistically significantly improved familiarity with the translabyrinthine approach after the session with median scores increasing from 2 to 3 (p=0.02), and a near-significant increase in familiarity with IAC anatomy with median scores increasing from 3 to 4 (p=0.06). Prior to the session, 71% of participants either disagreed or strongly disagreed that they had an idea of what the procedure would be like in a real operating room, whereas after the session 0% reported disagreement. 100% of participants were very satisfied with the overall experience. CONCLUSIONS An educational session and temporal bone drilling experience using prosected bones significantly increased the reported familiarity with the translabyrinthine approach. Experiences such as this may enhance resident exposure to advanced lateral skull base approaches in a safe environment, and increase comprehension of the complex anatomic relationships of the IAC.
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Zender CA, Clancy K, Melki S, Li S, Fowler N. The impact of a head and neck microvascular fellowship program on otolaryngology resident training. Laryngoscope 2017; 128:52-56. [PMID: 28602040 DOI: 10.1002/lary.26680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the impact of a microvascular head and neck (H&N) fellowship on senior residents' surgical experience. STUDY DESIGN Retrospective review of Accreditation Council for Graduate Medical Education-generated operative case log reports, retrospective chart review, and electronic survey. METHODS A retrospective review of one institution's residents' H&N operative case logs and free flap operative reports was performed to determine changes in key indicator cases (KICs) after the addition of a H&N fellowship. An electronic survey was distributed to senior residents at all U.S. otolaryngology residency programs to determine residents' perceptions of a H&N fellow's impact on their surgical experience. An electronic survey was distributed to senior medical students applying to surgical residencies to explore the perceived impact that a fellowship has on the desirability of a residency program. RESULTS The average number of each postgraduate year (PGY)5's H&N KIC before and after the addition of the fellowship were: parotidectomy, 19 versus 17.8; neck dissection, 33.2 versus 40.6; oral cavity resection, 15.3 versus 12.6; thyroid/parathyroid, 45.5 versus 45.6; and flaps/grafts, 56.7 versus 42. PGY5 participation as first assistant in free flaps dropped from 78% to 17%; however, residents still participated in some aspect of 45% of the cases. Seventy percent of senior residents reported a positive perception of the H&N fellow on their H&N operative experience. Eighty-nine percent of senior medical student respondents reported a nonnegative perception of a fellowship in their applied field. CONCLUSION The addition of a H&N fellowship did not decrease senior residents' H&N KIC, and most senior residents at programs with fellowships report that the fellow has a positive impact on their H&N operative experience. LEVEL OF EVIDENCE 4. Laryngoscope, 128:52-56, 2018.
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Affiliation(s)
- Chad A Zender
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Kate Clancy
- Case Western Reserve School of Medicine, Cleveland, Ohio, U.S.A
| | - Sami Melki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Shawn Li
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
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Brietzke SE, Ishman SL, Cohen S, Cyr DD, Shin JJ, Kezirian EJ. National Database Analysis of Single-Level versus Multilevel Sleep Surgery. Otolaryngol Head Neck Surg 2017; 156:955-961. [DOI: 10.1177/0194599817696503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Recent evidence suggests that multilevel sleep surgery improves outcomes when compared with palate surgery alone for most patients. The study objective was to compare demographic and outcomes data for palate surgery (uvulopalatopharyngoplasty [UPPP]) alone versus multilevel surgery through a national insurance claims database. Study Design Retrospective cohort study. Setting National insurance claims database. Subjects and Methods An adult cohort undergoing single-level UPPP versus UPPP with nasal and/or tongue/hypopharyngeal surgery was identified in the Truven Health Analytics MarketScan Research Databases for the years 2010 through 2012. Demographic and outcomes data were assessed at short-term (≤14 days), intermediate (15-60 days), and long-term (61-183 days) intervals via a multivariate regression model adjusted for age, sex, geographic region, insurance type, and the Charlson-Deyo comorbidity score. The primary long-term complication considered was positive airway pressure (PAP) equipment supply, implying possible treatment failure. Results The cohort included 14,633 patients: 7559 (51.6%), UPPP alone; 5219 (35.7%), UPPP + nasal surgery; 1164 (7.95%), UPPP + tongue/hypopharyngeal surgery; and 691 (4.7%), UPPP + nasal + tongue/hypopharyngeal surgery. Demographic data were similar among the groups. UPPP alone had lower rates of postoperative bleeding than UPPP + tongue/hypopharyngeal surgery (4.31% vs 6.19%, P = .004). Multivariate modeling indicated that the addition of either nasal surgery (odds ratio = 1.21, 95% CI = 1.10-1.34, P < .001) or tongue/hypopharyngeal surgery (odds ratio = 1.15, 95% CI = 1.00-1.32, P = .048) to UPPP was associated with increased odds of postoperative continuous positive airway pressure. Conclusions UPPP alone is currently the predominant form of sleep surgery in the United States. Multilevel surgery had greater odds of postoperative bleeding and positive airway pressure equipment supply than UPPP alone. Dedicated studies formally evaluating single- versus multilevel sleep surgery and the impact of possible surgeon/patient selection bias should be a priority.
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Affiliation(s)
- Scott E. Brietzke
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Stacey L. Ishman
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio, USA
| | - Seth Cohen
- Duke University, Durham, North Carolina, USA
| | - Derek D. Cyr
- Duke Clinical Research Institute, Durham, North Carolina, USA
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