Influence of Gender and Racial Diversity on the Otolaryngology Residency Match

Factors Influencing Underrepresented Medical Students' Career Choice in Surgical Subspecialties

OBJECTIVES

Surgical subspecialties rank among the least racially and gender diverse of the medical specialties. The purpose of this systematic review is to evaluate the current factors that influence female, gender and sexual minority (GSM), and underrepresented in medicine (URiM)-identifying medical students' decision to pursue a career in a surgical subspecialty.

DATA SOURCES

A structured literature search of PubMed, Scopus, Web of Science, and Medline was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Criteria for eligibility included surveys and interviews assessing factors and barriers influencing underrepresented medical students' career choices.

REVIEW METHODS

Two independent researchers screened the articles' titles and abstracts for relevance; three performed full-text reviews.

RESULTS

Of 343 studies identified, 17 met the inclusion criteria. Fourteen (82%) were survey-based studies; three (18%) were qualitative interviews. Represented minorities included females (14), URiM (13), and GSM (4). Female medical students were most influenced by (1) exposure to surgery, (2) mentorship, and (3) surgical lifestyle. URiM medical students were most influenced by (1) mentorship, (2) culture and diversity, (3) research opportunities, and (4) personality fit. GSM medical students were most influenced by identity acceptance and instances of discrimination and bias.

CONCLUSIONS

Our review provides granular data on positive and negative factors influencing career choice among underrepresented medical students to facilitate the development of a more diverse surgical workforce. Female medical students were more positively influenced by increased exposure to surgical subspecialties, whereas URiM medical students were more positively influenced by race-concordant mentorship. Laryngoscope, 134:1498-1506, 2024.

The Importance of Female Mentors and Safety in the Workplace to Female Otolaryngology Applicants When Creating Rank Lists

OBJECTIVES

The aim of this research is to understand the importance of female career mentors, research mentors, co-residents, and program directors/chairs to current female otolaryngology residents when applying to residency. The importance of safety in the workplace was also investigated.

METHODS

Surveys were sent via electronic mail to 119 programs, and program directors were asked to distribute them to female residents. Using the Likert scale, participants ranked the importance of various factors when creating a rank list, in particular, importance of safety in the workplace and importance of female mentors in various leadership positions. Demographic information, geographic location, LGBTQ identification, and fellowship plans were also collected.

RESULTS

There were 62 participants nationally. Eighty-seven percent (n = 54) of participants stated that having at least 1 female attending and having female co-residents was "very important" or "important" when ranking programs. A number of respondents replied that having a female career development mentor (38.7% [n = 24] and 43.5% [n = 27]), female program director or chair (4.8% [n = 3] and 16.1% [n = 10]), and female research mentor (12.9% [n = 8] and 29% [n = 18]) was "very important" or "important," respectively. Ninety-three percent (n = 58) replied that feeling safe in their training environment was "very important" or "important."

CONCLUSION

Having female mentors as well as safety in the workplace in residency is important to a vast majority of residents and applicants when creating a rank list. Programs with women in these roles may gain a disproportionate number of female residents because they may be more desirable places than those without women in these roles.

Residency Selection in Otolaryngology: Past, Present, & Future

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.

Exposure to Otolaryngology: Impact on Female Students Considering Surgery

INTRODUCTION

Otolaryngology continues to be dominated by men. As of 2019, only 18.4% of practicing otolaryngologists were women. The goal of this project was to introduce female students to otolaryngology as a career.

METHODS

A Women in Otolaryngology event was held in September 2021. Participants included undergraduate and first- or second-year medical students from the University at Buffalo. During the event, students rotated through three skills stations working with female otolaryngology residents and attending physicians. Participants completed pre-and post-course surveys regarding their attitudes toward women in surgery and their perceptions of surgery and otolaryngology.

RESULTS

A total of 17 students that completed both the pre- and post-course surveys were included. The mean age was 22.6 years (range 18-25 yr). Specifically, 13 (76.5%) of the participants were Caucasian, three (17.6%) were Asian, and one (5.9%) was Hispanic, and 15 (88.2%) were medical students. On the pretest, 10 (55.6%) participants strongly agreed or agreed that otolaryngology as a career is open to females, while on the posttest, 16 (88.9%) participants strongly agreed or agreed (p=0.002). Nine (50.0%) participants strongly agreed or agreed that they have access to resources to help make a decision if they want to pursue a career in otolaryngology before the event, while, after the event, 16 (88.9%) participants strongly agreed or agreed (p=0.007). Five (27.8%) participants strongly agreed or agreed prior to the event that they felt confident in their knowledge of what otolaryngology includes, while afterward 15 (83.3%) strongly agreed or agreed (p=0.002).

CONCLUSION

The Women in Otolaryngology event increased participants' confidence in understanding otolaryngology, promoted understanding of resources available, and demonstrated the openness of the specialty to women.

An Evaluation of Otolaryngology Residency Program Websites

INTRODUCTION

 Otolaryngology remains one of the most competitive specialties to match into during the residency application process. Medical students often apply to many programs to increase their chances of matching into a residency program and rely on residency websites to gather information about the programs they apply to. The purpose of this study was to determine the comprehensiveness of the information on otolaryngology residency program websites.

METHODS

One hundred twenty-two publicly available otolaryngology residency program websites were evaluated for the presence of 47 criteria. Size, geographic location, and affiliation with a Top 50 ranked hospital for ear, nose, and throat care, according to the US News and World Report, were determined for each program. Frequencies were calculated for each of the different residency website criteria and non-parametric comparisons were used to analyze the relationship between the location, size, and ranking of each program, and the comprehensiveness of the program website.

RESULTS

 An average of 19.1 items (SD: 6.6 items) out of the 47 searches were present on the otolaryngology residency program websites. More than 75% of the websites contained the following program features: facility descriptions, descriptions of didactics, and research requirements. A total of 89.3% of the websites had a current resident list, 87.7% of these websites had photos of their residents, and 86.9% had a program contact email. Otolaryngology residency programs affiliated with a Top ENT hospital had a higher average number of criteria satisfied (21.6 criteria) compared to those that were not affiliated (17.9 criteria).

CONCLUSION

 The inclusion of research selection criteria, call schedule/requirements, average Step 2 scores of matched residents, and social aspects of residency could improve otolaryngology residency applicant satisfaction with residency program websites. Updating otolaryngology residency websites will assist prospective applicants as they apply to a wide variety of residency programs.

Analyzing Diversity Elements on Otolaryngology Residency Program Websites

OBJECTIVE

To investigate how the internet presence of Otolaryngology residency programs influences recruitment of diverse applicants.

STUDY DESIGN

Retrospective cohort study.

SETTING

Website, Instagram, and AAMC Residency Explorer data from all US, non-military, allopathic otolaryngology residency programs.

METHODS

We identified 10 common ways in which residency programs communicate their commitment to diversity through web-based platforms. We then analyzed program websites and Instagram pages for the presence of these 10 diversity elements. Univariate and multivariate linear regression were used to evaluate the association between presence of a diversity elements and the proportion of underrepresented minority residents in the program.

RESULTS

Review of 106 Otolaryngology residency program websites and Instagram pages was completed from February to May 2021. Most programs (69.8%) satisfied at least one diversity element. Of the programs reviewed, 83 had demographic information available for comparison. After adjusting for Doximity ranking, multivariate linear regression demonstrated that several elements were positive predictors of program diversity. Diversity and inclusion message (p < 0.0001), statement encouraging URM applicants (p < 0.0001), dedicated diversity chair/committee (p = 0.005), and diversity related articles/blog posts (p = 0.006) were independently associated with a greater proportion of URM residents in a given program.

CONCLUSION

These data demonstrate that providing diversity related information on residency program websites may play a role in improving program diversity. The large percentage of programs that lack the presence of any diversity element (30.2%) demonstrates that there is significant room for improvement. This study presents a promising strategy through which programs can improve recruitment of diverse residents.

What Prospective Applicants Look for on Otolaryngology Residency Websites

OBJECTIVE

To determine what prospective residency applicants look for on otolaryngology residency program websites.

STUDY DESIGN

Survey.

SETTING

The survey was distributed in a virtual format through Google Forms. A link to the survey was given at the University at Buffalo Otolaryngology Chautauqua, sent to Otolaryngology program directors with requests to forward to PGY1 residents and Otolaryngology interest groups, sent to medical school Otolaryngology interest group leaders, posted on Twitter through several accounts, and on otomatch.com.

METHODS

A 45 item survey was given to fourth year medical students applying to otolaryngology, re-applicants applying to otolaryngology, and first year otolaryngology residents who had recently matched. Data collected included participant's age, sex, race and ethnicity, current status in school/residency program, and their type of medical degree (MD or DO). Participants were then asked to mark the components listed that they wished to see. Components were separated into 5 categories: Application/Selection Criteria, Employment Aspects, Program Features, Social/Community, and Faculty/Contact Information. Data was analyzed using Mann-Whitney and Kruskal Wallis tests when appropriate. P value <.05 was considered statistically significant.

RESULTS

One hundred one surveys were collected. Sixty-four (63.4%) participants were fourth-year medical students, 32 (31.7%) were first-year residents, and 5 (5.0%) were re-applicants. Thirteen of the items on the survey were sought by 80% or more of respondents. Ninety-nine (98.0%) of the participants wanted to see a current resident list with photos and 97 (96.0%) wanted to see the intern year schedule online. Eighty-five percent agreed that salary and benefits information would be valuable on residency websites. Women expressed significantly more interest in salary (P = .034), benefits (P = .026), and parking information (P = .048).

CONCLUSION

Our study provides insight on key items to include on residency program websites. Websites that contain information that applicants want to use can be helpful for application decisions in the future.

The Significance of Female Faculty and Department Leadership to the Gender Balance of Ophthalmology Residents

PURPOSE

To examine the gender balance of academic ophthalmology departments by determining the association between the rates of female residents in ophthalmology programs and department chair/residency program director (PD) gender and rate of female faculty within the department.

DESIGN

Retrospective cross-sectional study.

METHODS

Demographic information on ophthalmology programs, including size, location, and gender distribution of leadership, faculty, and residents was collected from public online resources. Departments with residency programs were included for analyses if they were both Accreditation Council Graduate Medical Education accredited and available for application through the San Francisco Match for the 2020-2021 application cycle. For analyses, a binomial regression was fitted to identify factors associated with the female faculty and resident proportions.

RESULTS

In 117 total programs, 16.7% of chairs and 37.7% of PDs were female. There were more female residents at programs with female PDs (P = .02), with more female faculty (P < .001), and at larger departments (P = .001) and residency programs (P = .04). In multivariate analysis, more female faculty members increased the odds of having more female residents (P < .001). Chair gender did not correlate with the proportion of female faculty or residents. There were the most female residents in the Northeast and the fewest in the Southwest (P = .003).

CONCLUSIONS

Although gender of department chair did not correlate with proportion of female faculty or residents, programs with more female faculty members had more female residents. Deans and programs should strive for departmental diversity and the recruitment and success of female residents to ensure the use of their full academic capital.

Sex Differences in Faculty Positions Among Top-Ranked US Otolaryngology Departments

Objective

This study aims to characterize the top-ranked departments in otolaryngology to provide an indicator of the state of diversity within otolaryngology and to draw a comparison with other medical and surgical fields.

Study Design

This cross-sectional study examined the 20 highest-ranked otolaryngology programs according to the US News & World Report ranking of best hospitals for ear, nose and throat.

Setting

Academic otolaryngology departments in the United States.

Methods

Faculty demographic and biographical data were collected from departmental websites. The Web of Science h-index was used as a surrogate for academic productivity. Descriptive statistics and chi-square analysis were used to characterize the cohort and compare otolaryngology with other fields.

Results

Of 562 otolaryngologists on faculty at the 20 highest-ranked programs, 413 (73.5%) were men and 149 (26.5%) were women. Among the faculty in the cohort, 174 (31.0%) were professors, 145 (25.8%) were associate professors, and 183 (32.6%) were assistant professors. Across faculty appointments, the proportion of women grew smaller as academic rank increased. When compared with all faculty across US medical schools, the departments in this study had significantly lower proportions of female professors (P = .0047), associate professors (P = .0009), and assistant professors (P = .0005). Male faculty members had higher h-indices than their female counterparts among professors (P = .004), associate professors (P = .008), assistant professors (P = .0002), and clinical assistant professors (P = .0009).

Conclusion

Women are underrepresented across all academic ranks in top-ranked otolaryngology programs. The current state of diversity in otolaryngology yields many opportunities to advance representation for women in the field.

Hurdles in Diversifying Otolaryngology: A Survey of Medical Students

The field of otolaryngology has one of the lowest rates of racial and ethnic diversity. An anonymous survey was distributed to members of the Student National Medical Association at different medical schools to identify factors that may contribute to this disparity. Responses were received from 104 students at 36 allopathic medical schools. Most respondents identified as black (86.5%). One-third of students (34.6%) noted that they were discouraged from pursuing otolaryngology due to lack of mentorship, and among these students, most noted that they lack mentors of the same race (75%). One-fourth of respondents (25%) indicated that they lack a home otolaryngology program. The most common reasons for participants' disinterest in otolaryngology included competitiveness, inadequate exposure, research, and the high board scores needed to match. This hypothesis-generating, proof-of-concept study highlights potential barriers that may discourage underrepresented medical students from pursuing a career in otolaryngology.

Otolaryngology residency program websites in a socially distanced application cycle

OBJECTIVE

To provide an updated evaluation of otolaryngology residency program websites during a socially distanced application cycle. Criteria were selected to evaluate for level of comprehensiveness, new content accommodating a virtual interview cycle, and stated commitment to diversity and inclusion.

STUDY DESIGN

Review of otolaryngology residency program websites.

SETTING

Online websites between December 2020 and January 2021.

METHODS

Otolaryngology residency program websites were evaluated for selected criteria. Programs were categorized by geographic location, size, and Doximity rankings. Differences between groups were analyzed using Student's t-test and analysis of variance with a significance level of P < .05.

RESULTS

118 otolaryngology residency program websites contained a mean (SD) of 16.3 (4.7) of 31 criteria (52.6%). Fewer than one third included virtual/video tours of facilities or the surrounding area. Only 33% had a stated commitment to diversity and inclusion. There was no difference in number of criteria included when categorized by geographic location (P = .22). Larger programs (17.9 vs 14.5, P < .001) and programs ranked in the top 50 by Doximity (17.7 vs 15.2, P = .003) included a significantly greater number of criteria.

CONCLUSION

While the comprehensiveness of otolaryngology residency program websites has improved, considerable room for improvement remains. Programs should strive to maintain updated websites that highlight training opportunities, program culture, and commitment to diversity and inclusion. Programs also should consider prioritizing the development of new online resources that may be especially useful to applicants during a virtual interview cycle.

Mentoring as a Buffer for the Syndemic Impact of Racism and COVID-19 among Diverse Faculty within Academic Medicine

Within this article, we explore the dual impact of two pandemics, racism and COVID-19, on the career and psychological well-being of diverse faculty within academic medicine. First, we present a discussion of the history of racism in academic medicine and the intensification of racial disparities due to the COVID-19 pandemic. As a result of the syndemic of racism and COVID-19, the outlook for the recruitment, retention, and advancement of diverse faculty and leaders within academic medicine is at risk. While mentoring is known to have benefits for career and personal development, we focus on the unique and often unacknowledged role that mentoring can play as a buffer for women and people of color, especially when working in institutions that lack diversity and are now struggling with the syndemic of racism and COVID-19. We also discuss the implications of acknowledging mentoring as a buffer for future leadership development, research, and programs within academic medicine and health professions.

Increasing the Number of Black Otolaryngologists

Otolaryngology continues to have one of the lowest percentages of black physicians of any surgical specialty, a number than has not improved in recent years. The history of exclusion of black students in medical education as well as ongoing bias affecting examination scores, clerkship grades and evaluations, and honors society acceptance of black students may factor into the disproportionately low number of black otolaryngology residents. In order to increase the number of black physicians in otolaryngology, intentional steps must be taken to actively recruit, mentor, and train black physicians specializing in otolaryngology.

Diversity and Inclusion-Why Does It Matter

Otolaryngology has historically lagged behind other specialties with respect to diversity, equity and inclusion (DEI) and remains one of the least diverse specialties as it relates to gender, race and ethnicity. Strategies aimed at increasing DEI include programs designed to provide mentorship, coaching, and sponsorship. Pipeline efforts, inclusivity on committees, bi-directional communication, and equal pay are additional DEI efforts that have been successful in recruiting and retaining those under-represented in medicine (URiM). Closing the equity gap requires commitment; daily action and measuring progress is required. Finally, use feedback to make refinements as opportunities exist to continually improve DEI efforts.