Limitations in Faculty Advancement for Underrepresented Groups in Academic Otolaryngology.

OBJECTIVE: Despite the increasing racial diversity of the United States, representation in academic medicine faculty does not reach concordance with the general population and worsens with higher rank. Few studies have examined this within academic Otolaryngology and surgical subspecialties. This project aims to compare rank equity in academic Otolaryngology on self-reported gender and race/ethnicity between the years 2000 and 2020. METHODS: Publicly available data were obtained from the Association of American Medical Colleges under the "Data & Reports" section for the years 2000 and 2020. The report comprised of full-time faculty from all U.S. medical schools. To determine parity between faculty ranks across gender and race/ethnicity, rank equity index (REI) was calculated for associate/assistant, professor/associate, and professor/assistant professor comparisons. RESULTS: The percentage of women faculty in Otolaryngology has increased from 21% in 2000 to 37% in 2020; however, they did not achieve parity at all rank comparisons for both years. On the contrary, men were above parity at all rank comparisons. Improvements in rank equity occurred for Black/African American (Black) and Hispanic Latino/Spanish Origin (Latine) faculty between the years 2000 and 2020; however, when accounting for gender, benefits were concentrated among men. CONCLUSION: Advancement along the academic ladder is limited for women of all racial groups in academic Otolaryngology. While improved rank equity was seen for Black and Latine faculty, these improvements were largely among men. Future directions should aim to identify barriers to recruitment, retention, and promotion for women and underrepresented in medicine (URiM) academic otolaryngologists and create interventions that diversify Otolaryngology faculty at all ranks. LEVEL OF EVIDENCE: NA Laryngoscope, 134:1625-1632, 2024.

Racial and Ethnic Bias in Letters of Recommendation and Personal Statements for Application to Otolaryngology Residency.

INTRODUCTION: The persistent lack of racial and ethnic diversity within the field of otolaryngology calls for an analysis of potential bias within the residency application system. Letters of recommendation (LORs) and personal statements (PSs) are the most important subjective application constituents. This subjectivity predisposes these components to implicit bias. In applications to various surgical subspecialties, prior linguistic studies assessing bias in reviews of LOR show race-based differences. Thus far, racial and ethnic linguistic differences in LORs for otolaryngology applicants have not been analyzed in the literature. METHODS: LORs and PSs were abstracted from otolaryngology - head and neck surgery applications in the Electronic Residency Application Service for the 2019-20 and 2020-21 application cycles. Linguistic Inquiry and Word Count 2015 was used for quantitative analysis of emotional, cognitive, and structural components of written text. RESULTS: Race-pair analysis of the 2019-2021 application cycles revealed higher mean "teaching" scores for LORs for Asian, black, Hispanic, and white applicants when compared to applicants who self-identified as Other. White applicants had lower scores for the terms "research" and "analytic" when compared to Asian and black applicants, respectively. Analysis of PSs revealed greater scores for an "authentic" writing style for white versus Asian applicants. White applicants were found to have higher scores for "tone" compared to black applicants. CONCLUSION: Minor racial and ethnic language differences exist in both LORs and PSs. A statistically significant difference was observed among LORs, with the "teaching" term used more frequently for Asian, black, Hispanic, and white applicants compared to self-identified Other individuals. For PSs, statistically significant differences were observed among white applicants, who wrote about themselves using more "authentic" language when compared with Asian applicants and who also had higher scores for "tone" compared to black applicants. Although these differences were statistically significant, the practical impact of the variances is likely small.

The next step: Replacing step 1 as a metric for residency application.

Objective: As of January 2022, USMLE Step 1 scores are reported as pass/fail. Historically, Step 1 scores have been a critical component of residency applications, representing one of the few metrics standardized across all applicants independent of the school they attended. In competitive specialties, such as otolaryngology, programs routinely get 100+ applicants for each residency spot and use Step 1 as a screening tool. This study seeks to assess quantifiable metrics in the application that highly competitive residency programs could use for screening in place of Step 1 scores. Methods: Otolaryngology applications to an academic medical center for the 2019-20 and 2020-21 ERAS cycles were reviewed. Board scores and quantitative research data were extracted. The relationships between Step 1 score and the other metrics were examined by computing Pearson's correlation coefficients and building regression models. Similar analyses were done separately for three different score tiers defined by Step 1 cutoffs at 220 points and 250 points. Results: Step 2 score was the only variable that had meaningful correlation with Step 1 score (R = .67, p < 2.2e-16). No other objective metric such as journal articles, posters, or oral presentations correlated with Step 1 scores. Conclusion: Step 1 scores were moderately correlated with Step 2 scores; however, using a Step 2 cutoff instead of a Step 1 cutoff would identify a different cohort of applicants for interview. No other quantifiable application metric had a positive correlation. In future match cycles, highly competitive residency programs will need to adopt new methods to screen candidates.Level of Evidence: Level 3.

Sex bias in letters of recommendation and personal statements for otolaryngology residency.

Objective: Application for otolaryngology residency is highly competitive, with letters of recommendation (LORs) and applicant personal statements (PSs) representing important components of the application process. However, their inherently subjective nature predisposes them to potential implicit bias. Otolaryngology has historically been predominated by male physicians and while implicit sex bias has been demonstrated in LORs for application to residency of multiple specialties, data is limited for otolaryngology. Methods: LORs and PSs for all otolaryngology applicants to an academic medical center during the 2019-20 and 2020-21 cycles were abstracted. Quantitative analysis was performed using Linguistic Inquiry and Word Count 2015 (LIWC2015), a validated software application designed to analyze various emotional, cognitive, and structural components of written text. Results: LORs written for females were found to be written from a perspective of higher expertise and confidence while LORs written for males were associated with a more honest, personal, and disclosing tone. Moreover, LORs written for female applicants were found to reference achievement and "grindstone" terminology more than those written for men. No differences were observed in any word category between PSs written by male and female applicants. Conclusion: Minor linguistic differences exist in multiple domains between LORs written for male and female applicants for otolaryngology residency. These tended to favor female applicants, with their letters demonstrating higher clout, achievement, and grindstone scores. This trend was unexpected in this historically predominantly male specialty. While differences were statistically significant, the overall difference in an entire letter of recommendation is likely subtle. Level of Evidence: 3.

Predictors of otolaryngology applicant success using the Texas STAR database.

OBJECTIVES: To examine applicant characteristics and behaviors associated with a successful match into otolaryngology residency. METHODS: Self-reported survey data from applicants to otolaryngology residency between 2018 and 2020 were obtained from the Texas STAR database. Characteristics and predictors associated with a successful match were examined using Chi-square tests, two-sided t-tests, and logistic regression models. RESULTS: A total of 315 otolaryngology residency applicants responded to the survey of whom 274 matched (87%) and 41 did not match (13%). Matched applicants had a significantly higher mean USMLE Step 1 score (P = .016) and Step 2 CK score (P = .007). There were no significant differences in AOA status (45% vs 36%; P = .207), mean number of applications submitted (70 vs 69; P = .544), and mean number of away rotations (2.1 vs 2.0; P = .687) between matched and unmatched applicants. Significant predictors of a successful match included receiving honors in 5 or more clerkships (OR 2.0, 95% CI 1.0-4.0; P = .040), receiving honors in an ENT clerkship (OR 3.7, 95% CI 1.0-12.9; P = .044), and having 3 or more peer-reviewed publications (OR 2.3, 95% CI 1.1-4.5; P = .020). The majority of applicants (79.9%) matched at a program where they either did an away rotation, had a personal geographic connection, or attended medical school in the same geographic region. CONCLUSIONS: Board scores, excelling on clinical rotations, and having productive research experience appear to be strong predictors of a successful match in otolaryngology. The majority of applicants report a personal or geographic connection to the program at which they match. LEVEL OF EVIDENCE: 4.

Otolaryngology boot camps: Current landscape and future directions.

OBJECTIVES: Simulation-based boot camps have gained popularity over the past few years, with some surgical specialties implementing mandatory national boot camps. However, there is no consensus in otolaryngology on boot camp timing, learner level, or curriculum. The purpose of this study is to examine the current landscape and gather opinions regarding future curriculum and standardization of boot camps in otolaryngology. METHODS: A survey was developed to examine current resident participation and boot camp content while also seeking opinions regarding improving boot camp enrollment and standardizing curriculum. A cross-sectional survey of all otolaryngology residency program directors in the United States and Puerto Rico was performed via SurveyMonkey. Responses were collected anonymously, and results were analyzed by descriptive statistical analysis. RESULTS: Of the 45% (48 of 106) who responded, 76.6% reported their residents participate in boot camps. The most common skills taught were basic suturing and airway management skills. The majority (95%) was likely to send residents to a local boot camp, with 56% favoring early postgraduate year (PGY)-1 participation and 42% favoring a 1-day boot camp. Subsidized expenses, improved regional access, and supplementary boot camp information would help the program director in their decision to send residents to boot camp. Only 32% felt boot camps should be standardized, and 27% felt they should be mandatory. CONCLUSION: Many otolaryngology residency programs participate in boot camps. Additional data on the benefits of boot camps, improved access, and reduced financial burden may improve participation. Further discussion of ideal timing, PGY level, and standardized curriculum should occur in conjunction with the otolaryngology academic societies and oversight from accreditation and certifying bodies. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2707-2712, 2019.

Cochlear implantation in children with postlingual hearing loss.

OBJECTIVES/HYPOTHESIS: Although it is clear that early auditory stimulation through cochlear implantation (CI) has been shown to improve speech and language development trajectories for children with prelingual hearing loss, data supporting implantation in postlingual children are mostly lacking. The purpose of this study was to characterize speech perception abilities following CI in a group of children with previously well-developed language abilities. STUDY DESIGN: Retrospective analysis. METHODS: Twenty-eight hearing-impaired children who received CIs were selected for study based on the presence of well-developed spoken language skills before implantation. Fifteen children with prelingual hearing loss served as a control group. Speech perception skills were assessed using developmentally appropriate measures. RESULTS: Children with postlingual hearing loss showed a statistically significant improvement in open-set speech perception scores as early as 6 months following CI, whereas prelingual children demonstrated significant improvements only after 24 months of use. Despite these early disparities in performance, the two groups were similar 36 months after implantation and beyond (60 months of implant use). CONCLUSIONS: Children with well-developed language abilities before CI showed substantial (and statistically significant) early improvements in open-set speech perception abilities following implantation that continued beyond 2 years of follow-up. These results suggest that postlingual children are excellent candidates for CI.

Detection of intracochlear damage with cochlear implantation in a gerbil model of hearing loss.

HYPOTHESIS: Cochlear trauma due to electrode insertion can be detected in acoustic responses to low frequencies in an animal model with a hearing condition similar to patients using electroacoustic stimulation. BACKGROUND: Clinical evidence suggests that intracochlear damage during cochlear implantation negatively affects residual hearing. Recently, we demonstrated the usefulness of acoustically evoked potentials to detect cochlear trauma in normal-hearing gerbils. Here, gerbils with noise-induced hearing loss were used to investigate the effects of remote trauma on residual hearing. METHODS: Gerbils underwent high-pass (4-kHz cutoff) noise exposure to produce sloping hearing loss. After 1 month of recovery, each animal's hearing loss was determined from auditory brainstem responses and baseline intracochlear recording of the cochlear microphonic and compound action potential (CAP) obtained at the round window. Subsequently, electrode insertions were performed to produce basal trauma, whereas the acoustically generated potentials to a 1-kHz tone-burst were recorded after each step of electrode advancement. Hair cell counts were made to characterize the noise damage, and cochlear whole mounts were used to identify cochlear trauma due to the electrode. RESULTS: The noise exposure paradigm produced a pattern of hair cell, auditory brainstem response, and intracochlear potential losses that closely mimicked that of electrical and acoustic stimulation patients. Trauma in the basal turn, in the 15- to 30-kHz portion of the deafened region, remote from preserved hair cells, induced a decline in intracochlear acoustic responses to the hearing preserved frequency of 1 kHz. CONCLUSION: The results indicate that a recording algorithm based on physiological markers to low-frequency acoustic stimuli can identify cochlear trauma during implantation. Future work will focus on translating these results for use with current cochlear implant technology in humans.