Publications by authors named "Sonya Malekzadeh"

50 Publications

Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation.

Otolaryngol Head Neck Surg 2021 May 18:1945998211013314. Epub 2021 May 18.

Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.

Simulation training has taken a prominent role in otolaryngology-head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.
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http://dx.doi.org/10.1177/01945998211013314DOI Listing
May 2021

Optimizing the Virtual Otolaryngology Residency Information Sessions: A Survey of Applicants.

OTO Open 2021 Jan-Mar;5(1):2473974X211001407. Epub 2021 Mar 26.

Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.

The 2020-2021 otolaryngology residency application cycle has been immensely distorted by travel restrictions mandated in response to coronavirus disease 2019, limiting opportunities for applicants to meet and rotate with programs of interest. The purpose of this study was to evaluate otolaryngology applicants' preferences toward the content and format of virtual residency information sessions. An anonymous online survey was developed to gauge applicants' virtual exposure to otolaryngology programs and investigate their preferences during virtual sessions. Almost all respondents attended at least 1 virtual information session (89%). Respondents felt that the most important aspects of these sessions were meeting residents, learning about operative volume, and meeting faculty. The majority (85%) preferred these sessions last no longer than 2 hours. Participants preferred virtual sessions to include breakout sessions with participant video/microphone on. These findings have implications for future virtual resident recruitment strategies.
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http://dx.doi.org/10.1177/2473974X211001407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013640PMC
March 2021

New Age Mentoring and Disruptive Innovation-Navigating the Uncharted With Vision, Purpose, and Equity.

JAMA Otolaryngol Head Neck Surg 2021 04;147(4):389-394

Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina.

For individuals aspiring to a career in otolaryngology-head and neck surgery, mentorship can shape destiny. Mentorship helps assure safe passage into the specialty, and it influences the arc of professional development across the career continuum. Even before the novel coronavirus disease 2019 (COVID-19) pandemic, technology and social networking were transforming mentorship in otolaryngology. Now, in an increasingly virtual world, where in-person interactions are the exception, mentorship plays an even more pivotal role. Mentors serve as trusted guides, helping learners navigate accelerating trends toward early specialization, competency-based assessments, and key milestones. However, several structural barriers render the playing field unlevel. For medical students, cancellation of visiting clerkships, in-person rotations, and other face-to-face interactions may limit access to mentors. The pandemic and virtual landscape particularly threaten the already-leaky pipeline for underrepresented medical students. These challenges may persist into residency and later career stages, where structural inequities continue to subtly influence opportunities and pairings of mentors and mentees. Hence, overreliance on serendipitous encounters can exacerbate disparities, even amid societal mandates for equity. The decision to take deliberate steps toward mentoring outreach and engagement has profound implications for what otolaryngology will look like in years to come. This article introduces the concept of new age mentoring, shining a light on how to modernize practices. The key shifts are from passive to active engagement; from amorphous to structured relationships; and from hierarchical dynamics to bidirectional mentoring. Success is predicated on intentional outreach and purposefulness in championing diversity, equity, and inclusion in the progressively technology-driven landscape.
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http://dx.doi.org/10.1001/jamaoto.2020.5448DOI Listing
April 2021

Critical Evaluation of Trends in Otolaryngology Resident Caseload by Subspecialty from 2005 to 2019.

Ann Otol Rhinol Laryngol 2021 Aug 8;130(8):915-922. Epub 2021 Jan 8.

Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC, USA.

Background: Subspecialty caseloads logged by otolaryngology residents over the last 15 years is currently unknown. This study examines the trends at the national level.

Methods: Otolaryngology case log data was collected from the Accreditation Council for Graduate Medical Education (ACGME) from 2005 to 2019. Data were categorized according to the following surgical subspecialties: pediatrics, rhinology/skull base, head and neck, facial plastics, otology, and laryngology. Linear regression analyses were performed for each procedure within each subspecialty, total subspecialty means, and total caseload means across all years.

Results: Overall surgical volume significantly increased between 2005 and 2019 ( < .0001); however, there was a significant decline in pediatrics procedures ( = 0.80,  < .0001). Rhinology/skull base procedures increased the most drastically ( = 0.96,  < .0001).

Conclusion: While total mean resident case logs have steadily increased between 2005 and 2019, pediatric cases have declined substantially due to fewer tympanostomy tube insertions and adenotonsillectomies. Rhinology/skull base procedures have increased most significantly secondary to an increase in endoscopic sinus surgeries. Despite changes in case volume amongst specialties, the annual increase in resident case load suggests that otolaryngology residents are meeting the demands of their graduate medical training.
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http://dx.doi.org/10.1177/0003489420987217DOI Listing
August 2021

A Multispecialty Critical Airway Simulation Course for Medical Students.

Laryngoscope 2021 07 11;131(7):1482-1486. Epub 2020 Nov 11.

Georgetown University School of Medicine, Washington, District of Columbia, U.S.A.

Objectives: To develop a novel multispecialty simulation-based course that teaches both technical and nontechnical skills in the management of adult and pediatric critical airways to graduating medical students and 2) to encourage a collaborative, multispecialty approach to the management of a difficult airway amongst fourth-year medical students who have enrolled in otolaryngology, anesthesia, and emergency medicine residency programs.

Methods: Fourth-year medical student who had matched into otolaryngology, anesthesia, and emergency medicine participated in an intensive half-day course consisting of a series of hands-on skills stations with increasing complexity, followed by simulated complex patient scenarios designed for shared management of airway emergencies. Participants completed questionnaires prior to and immediately after the course. Fischer's exact test was utilized to compare data between the precourse and postcourse surveys. Free-text responses were qualitatively assessed to inform course development.

Results: Thirty-four medical students were enrolled (6 otolaryngology, 15 anesthesia, 13 emergency medicine), and 30 students completed both surveys. Fisher's exact test demonstrated improved confidence (P < .05) for every skill. More than 85% of participants strongly agreed or agreed that the intervention was useful in developing their knowledge, technical skills, and self-confidence and in improving clinical performance prior to residency.

Conclusions: This critical airway course introduces a multispecialty simulation-based course designed to impart graduating medical students with the necessary knowledge, skills, and behaviors for critical airway management while fostering interprofessional collaboration. Our course was successful in improving confidence and was perceived as useful in developing knowledge, technical skills, self-confidence, and clinical performance prior to residency.

Level Of Evidence: NA Laryngoscope, 131:1482-1486, 2021.
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http://dx.doi.org/10.1002/lary.29264DOI Listing
July 2021

Preference Signaling for the Otolaryngology Interview Market.

Laryngoscope 2021 03 6;131(3):E744-E745. Epub 2020 Oct 6.

Georgetown University Medical Center, Washington, District of Columbia, U.S.A.

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http://dx.doi.org/10.1002/lary.29151DOI Listing
March 2021

The Effects of Pass/Fail USMLE Step 1 Scoring on the Otolaryngology Residency Application Process.

Laryngoscope 2021 03 3;131(3):E738-E743. Epub 2020 Sep 3.

Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, U.S.A.

Objectives: To investigate how the decision to report United States Medical Licensing Examination (USMLE) Step 1 score as pass/fail will influence future otolaryngology residency application and match processes.

Study Design: Survey study.

Methods: An anonymous and voluntary survey approved by the Otolaryngology Program Directors Organization was administered to academic faculty members from April 24, 2020 through May 19, 2020.

Results: Two hundred fifty-seven surveys were received from department chairs (17.5%), program directors (24.1%), associate program directors (12.5%), and department faculty (45.9%). USMLE Step 1 has been the most heavily weighted metric for offering interviews (44.0%), and it has correlated with residents' medical knowledge (77.0%) and in-service performance (79.8%) but not with surgical skills (57.6%) or patient care (47.1%). In total, 68.1% disagreed with the decision to make USMLE Step 1 pass/fail. This change is anticipated to lead to an increase in significance of USMLE Step 2 CK (89.1%), core clerkship grades (80.9%), elective rotation at the respective institutions (65.7%), Alpha Omega Alpha and other awards (64.6%), and letters of recommendation (63.8%). The new scoring is also anticipated to especially benefit students from top-ranked schools (70.8%), increase medical students' anxiety/uncertainty regarding obtaining interview invites (59.1%), and negatively affect international (51.4%), doctor of osteopathic medicine (45.9%), and underrepresented students (36.9%). Indication that USMLE Step 2 CK will significantly increase in weight varied according to department position (P = .049), geographic region (P = .047), years of practice (P < .001), and residency program size (P = .002).

Conclusion: Most academic otolaryngologists disagreed with changing USMLE Step 1 scoring to pass/fail and believe that it will increase other objective/subjective metrics' weight and put certain student populations at a disadvantage.

Level Of Evidence: N/A. Laryngoscope, 131:E738-E743, 2021.
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http://dx.doi.org/10.1002/lary.29072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051359PMC
March 2021

Regionalization of ORL Boot Camps: Report of the Society of University Otolaryngologists Task Force.

Laryngoscope 2021 04 28;131(4):737-743. Epub 2020 Aug 28.

Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A.

Objectives: Simulation-based boot camps have emerged as timely vehicles to help novice residents develop the skills needed to manage medical emergencies. Geographically regional boot camps provide opportunities for interaction between residents and faculty from multiple otolaryngology programs. The Society of University Otolaryngologists (SUO) Boot Camp Task Force investigated the concept of regional access to otolaryngology boot camps with the goal of making more regional boot camps available for otolaryngology residents across the United States.

Study Design: Interviews.

Methods: The SUO Boot Camp Task Force assessed regional access to otolaryngology boot camps with a focus on geographic distribution, curricular content, and finances. Boot camp directors were contacted by email and telephone and interviewed to elicit information on all these areas.

Results: Data were available from 10 known regional simulation-based boot camps designed for novice residents. Individual boot camps included from 12 to 30 residents and 10 to 50 faculty members. Curricula included both technical (ie, procedural) and non-technical (eg, communication, leadership) skills for individuals and teams. Content was heavily weighted toward a variety of airway problems and management techniques, although various conditions involving hemorrhage, and airway fires were also addressed. Funding and expense structures had the greatest variability.

Conclusions: Considerable variability was identified among the known regional boot camps in terms of numbers of participants and finances, but fewer differences in curriculum. Geographic opportunity for 9 to 10 new boot camps was identified. The SUO Task Force recommends that a consensus be developed for several individual skill and teamwork scenario objectives to be included in each boot camp. Laryngoscope, 131:737-743, 2021.
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http://dx.doi.org/10.1002/lary.29052DOI Listing
April 2021

SimTube: A National Simulation Training and Research Project.

Otolaryngol Head Neck Surg 2020 09 26;163(3):522-530. Epub 2020 May 26.

Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and the Albert Einstein College of Medicine Bronx, New York, USA.

Objective: To test the feasibility and impact of a simulation training program for myringotomy and tube (M&T) placement.

Study Design: Prospective randomized controlled.

Setting: Multi-institutional.

Subjects And Methods: An M&T simulator was used to assess the impact of simulation training vs no simulation training on the rate of achieving competency. Novice trainees were assessed using posttest simulator Objective Structured Assessment of Technical Skills (OSATS) scores, OSATS score for initial intraoperative tube insertion, and number of procedures to obtain competency. The effect of simulation training was analyzed using χ tests, Wilcoxon-Mann-Whitney tests, and Cox proportional hazards regression.

Results: A total of 101 residents and 105 raters from 65 institutions were enrolled; however, just 63 residents had sufficient data to be analyzed due to substantial breaches in protocol. There was no difference in simulator pretest scores between intervention and control groups; however, the intervention group had better OSATS global scores on the simulator (17.4 vs 13.7, = .0003) and OSATS task scores on the simulator (4.5 vs 3.6, = .02). No difference in OSATS scores was observed during initial live surgery rating ( = .73 and = .41). OSATS scores were predictive of the rate at which residents achieved competence in performing myringotomy; however, the intervention was not associated with subsequent OSATS scores during live surgeries ( = .44 and = .91) or the rate of achieving competence ( = .16).

Conclusions: A multi-institutional simulation study is feasible. Novices trained using the M&T simulator achieved higher scores on simulator but not initial intraoperative OSATS, and they did not reach sooner than those not trained on the simulator.
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http://dx.doi.org/10.1177/0194599820920833DOI Listing
September 2020

Management of Adult Inpatient Otolaryngologic Consultations During the COVID-19 Pandemic: A Proposed Tier-Based Triage System.

Otolaryngol Head Neck Surg 2020 08 19;163(2):330-334. Epub 2020 May 19.

Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA.

The coronavirus disease 2019 (COVID-19) pandemic has placed tremendous strain on health care systems, leading to unprecedented challenges and obstacles in the delivery of patient care. Otolaryngologists are frequently called on for inpatient consultations for an array of pathologies, ranging from chronic benign conditions to acutely life-threatening processes. Professional otolaryngologic societies across the world have proposed limiting patient care to time-sensitive and urgent matters; however, limited literature is available to describe how this transient change in philosophy may translate to clinical practice. Here we present a structured algorithm that allows for rapid triage of otolaryngologic consults during the ongoing pandemic, in efforts to minimize infectious spread and protect clinicians while preserving high-quality patient care. Considerations for managing these consults are presented, with a commentary on practical and ethical considerations.
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http://dx.doi.org/10.1177/0194599820931011DOI Listing
August 2020

Otolaryngology Education in the Setting of COVID-19: Current and Future Implications.

Otolaryngol Head Neck Surg 2020 07 28;163(1):70-74. Epub 2020 Apr 28.

Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC, USA.

The COVID-19 pandemic continues to garner extensive international attention. The pandemic has resulted in significant changes in clinical practice for otolaryngologists in the United States; many changes have been implemented to mitigate risks identified by otolaryngologists in other countries. COVID-19-induced limitations include social distancing and triaging of patient acuity. Additionally, a recent publication by Stanford University has drawn attention to the risks that otolaryngologists may face with regard to manipulation of the upper airway and mucosal disruption. As a result of COVID-19 recommendations, multiple institutions have overhauled resident clinical rotations and resident education. The result has been a rapid and significant change in resident education at most academic institutions. This commentary outlines the development of the otolaryngology resident education consortiums, with implications for future education within and outside of otolaryngology.
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http://dx.doi.org/10.1177/0194599820923621DOI Listing
July 2020

Extensive Sinonasal and Oropharyngeal Necrosis as a Consequence of Adulterated Cocaine with Mimicry of ANCA-Positive Vasculitis.

OTO Open 2019 Oct-Dec;3(4):2473974X19894239. Epub 2019 Dec 11.

Department of Otolaryngology-Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, District of Columbia, USA.

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http://dx.doi.org/10.1177/2473974X19894239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119445PMC
December 2019

Gender and compensation among surgical specialties in the Veterans Health Administration.

Am J Surg 2020 08 27;220(2):256-261. Epub 2020 Feb 27.

Elson S. Floyd College of Medicine, 412 E. Spokane Falls Blvd, Spokane, WA, 99202, USA.

Background: A gender pay gap has been reported across many professions, including medicine.

Methods: Surgeons employed at complex Veterans Affairs Medical Centers (VAMC) nationwide in 2016 were identified. Data on salary, gender, years since medical school graduation, professorship status, h-index, and geographic location were collected.

Results: Of 1993 surgeons nationwide, 23% were female. On average, female surgeons had significantly lower salaries compared to male surgeons ($268,429 ± 41,339 versus $287,717 ± 45,379, respectively; p < 0.001). Among each surgical specialty, there were no significant differences in salary on univariate analysis. Women were underrepresented in higher paying specialties and more heavily represented in lower paying specialties. On multivariate analysis, gender (p < 0.001), time since medical school graduation (p < 0.001), surgical specialty (p = 0.031), h-index (p < 0.001), and geographic location (p < 0.001) were significant predictors of salary.

Conclusion: Female gender significantly predicted lower salary among VAMC surgeons, however within each surgical specialty, there was no significant gender pay gap.

Sentence Summary: Independent predictors of salary included gender, surgical specialty, experience, h-index, and geographic location. Although female surgeons had lower overall salaries compared to male surgeons in the Veterans Health Administration (VHA), there were no significant gender differences in salary among each surgical specialty. Pay transparency, unique to the VHA, along with the use of rational and objective criteria to establish and adjust salaries, may play a role in reducing the gender pay gap among VHA surgeons.
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http://dx.doi.org/10.1016/j.amjsurg.2020.02.045DOI Listing
August 2020

Peri-Interview Communication in the Otolaryngology Residency Match: The Applicant Perspective.

Laryngoscope 2021 01 17;131(1):28-32. Epub 2020 Feb 17.

Department of Otolaryngology, Medstar Georgetown University Hospital, Washington, District of Columbia, U.S.A.

Objectives/hypothesis: To evaluate peri-interview communication in the otolaryngology Match from the applicant's perspective.

Study Design: Cross-sectional survey study.

Methods: A survey link was emailed to 401 otolaryngology residency applicants from the 2019 Match cycle. Survey items queried peri-interview communication practices and applicants' attitudes toward communication in the postinterview period. Data were collected anonymously. Qualitative analysis was performed for descriptive statistics. Responses from female and male participants were compared using Fisher exact tests.

Results: The survey yielded a 44% (56% male, 44% female) response rate and a 100% completion rate. Of applicants, 18% were told they were ranked to match, and 19% were asked how highly they planned to rank a given program. Interview questions regarding marital status and plans for children were asked to 38% and 12%, respectively. The majority (75%) believe peri-interview communication should be allowed. Most (65%) participants felt obligated to inform top program(s) of their high rank; however, only 45% of applicants found this to be stressful. Peri-interview communication may have altered the rank list for 10% of applicants. Of applicants, 96% created their final rank list based on where they most wanted to match rather than where they would most likely match.

Conclusions: National Resident Matching Program peri-interview communication violations occur in the otolaryngology Match at similar rates when compared to other specialties. Although peri-interview communication can cause significant stress, the majority of otolaryngology residency applicants believe peri-interview communication should be allowed and do not believe it alters applicants' rank lists.

Level Of Evidence: NA Laryngoscope, 131:28-32, 2021.
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http://dx.doi.org/10.1002/lary.28575DOI Listing
January 2021

Contemporary Opinions on Intraoperative Facial Nerve Monitoring.

OTO Open 2018 Jul-Sep;2(3):2473974X18791803. Epub 2018 Aug 7.

New York Otology, New York, New York, USA.

Objective: To examine the current trend in intraoperative facial nerve monitoring (IOFNM) training, performance, and reimbursement by subspecialists.

Study Design: Cross-sectional survey of the American Neurotology Society, American Otological Society, American Society of Pediatric Otolaryngology, and program directors of otolaryngology-head and neck surgery programs accredited by the Accreditation Council on Graduate Medical Education.

Setting: American Academy of Otolaryngology-Head and Neck Surgery Intraoperative Nerve Monitoring Task Force.

Subjects And Methods: The task force developed 2 surveys, which were implemented through Surveymonkey.com: (1) a 10-question survey sent to 1506 members of the societies listed to determine IOFNM practice and reimbursement patterns and (2) a 10-question survey sent to the 107 accredited US otolaryngology residency program directors to examine the state of resident training on facial nerve monitoring.

Results: Response rates were 18% for practicing physicians and 15% for residency program directors. The majority agreed that IOFNM was indicated for most otologic and neurotologic procedures. In addition to facial nerve monitoring, facial nerve stimulation was used in complex skull base and temporal bone procedures. When queried about reimbursement by Medicare, only 4.4% of surgeons responded that they received reimbursement. Program directors indicated universal exposure of residents to IOFNM, with 61% of programs giving residents formal training.

Conclusions: IOFNM is widely used among otologists and neurotologists in the United States. The majority of residents receive formal training, and all residents are exposed to the setup, use, monitoring, and troubleshooting of the device. Reimbursement for IOFNM is reported by a paucity of those surveyed.
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http://dx.doi.org/10.1177/2473974X18791803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6737880PMC
August 2018

Otolaryngology boot camps: Current landscape and future directions.

Laryngoscope 2019 12 28;129(12):2707-2712. Epub 2019 Jan 28.

Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, U.S.A.

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.
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http://dx.doi.org/10.1002/lary.27835DOI Listing
December 2019

Construct validity of a low-cost medium-fidelity endoscopic sinus surgery simulation model.

Laryngoscope 2019 07 21;129(7):1505-1509. Epub 2018 Dec 21.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas, U.S.A.

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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http://dx.doi.org/10.1002/lary.27748DOI Listing
July 2019

Association Between Surgical Trainee Daytime Sleepiness and Intraoperative Technical Skill When Performing Septoplasty.

JAMA Facial Plast Surg 2019 Mar;21(2):104-109

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Importance: Daytime sleepiness in surgical trainees can impair intraoperative technical skill and thus affect their learning and pose a risk to patient safety.

Objective: To determine the association between daytime sleepiness of surgeons in residency and fellowship training and their intraoperative technical skill during septoplasty.

Design, Setting, And Participants: This prospective cohort study included 19 surgical trainees in otolaryngology-head and neck surgery programs at 2 academic institutions (Johns Hopkins University School of Medicine and MedStar Georgetown University Hospital). The physicians were recruited from June 13, 2016, to April 20, 2018. The analysis includes data that were captured between June 27, 2016, and April 20, 2018.

Main Outcomes And Measures: Attending physician and surgical trainee self-rated intraoperative technical skill using the Septoplasty Global Assessment Tool (SGAT) and visual analog scales. Daytime sleepiness reported by surgical trainees was measured using the Epworth Sleepiness Scale (ESS).

Results: Of 19 surgical trainees, 17 resident physicians (9 female [53%]) and 2 facial plastic surgery fellowship physicians (1 female and 1 male) performed a median of 3.00 septoplasty procedures (range, 1-9 procedures) under supervision by an attending physician. Of the 19 surgical trainees, 10 (53%) were aged 25 to 30 years and 9 (47%) were 31 years or older. The mean ESS score overall was 6.74 (95% CI, 5.96-7.52), and this score did not differ between female and male trainees. The mean ESS score was 7.57 (95% CI, 6.58-8.56) in trainees aged 25 to 30 years and 5.44 (95% CI, 4.32-6.57) in trainees aged 31 years or older. In regression models adjusted for sex, age, postgraduate year, and technical complexity of the procedure, there was a statistically significant inverse association between ESS scores and attending physician-rated technical skill for both SGAT (-0.41; 95% CI, -0.55 to -0.27; P < .001) and the visual analog scale (-0.75; 95% CI, -1.40 to -0.07; P = .03). The association between ESS scores and technical skill was not statistically significant for trainee self-rated SGAT (0.04; 95% CI, -0.17 to 0.24; P = .73) and the self-rated visual analog scale (0.19; 95% CI, -0.79 to 1.2; P = .70).

Conclusions And Relevance: The findings suggest that daytime sleepiness of surgical trainees is inversely associated with attending physician-rated intraoperative technical skill when performing septoplasty. Thus, surgical trainees' ability to learn technical skill in the operating room may be influenced by their daytime sleepiness.

Level Of Evidence: NA.
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http://dx.doi.org/10.1001/jamafacial.2018.1171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439798PMC
March 2019

Compensation of Otolaryngologists in the Veterans Health Administration: Is There a Gender Gap?

Laryngoscope 2019 01 27;129(1):113-118. Epub 2018 Aug 27.

Georgetown University School of Medicine, Washington, DC, U.S.A.

Objectives/hypothesis: To determine if gender pay disparity exists amongst otolaryngologists employed by the Veterans Health Administration (VHA).

Study Design: cross-sectional analysis.

Methods: Board-certified otolaryngologists employed at all complex Veterans Affairs Medical Centers (VAMCs) in 2016 were identified. Salaries were collated using the Enterprise Human Resources Integration-Statistical Data Mart dataset. Additional variables, including gender, years since medical school graduation, professorship status, h-index, and geographic location were collected. A multivariate linear regression analysis was performed where salary was the primary outcome of interest and gender was accounted for as an independent predictor while controlling for professional characteristics, geographic location, and seniority.

Results: Sixty-nine VHA surgical programs with an operative designation of "complex" were identified. Two hundred sixty board-certified otolaryngologists, including 197 (75.8%) men and 63 (24.2%) women, were identified. Salary data were available on 210 of these otolaryngologists. In 2016, the mean salary for male and female otolaryngologists was not significantly different ($266,707 ± $31,624 vs. $264,674 ± $27,027, P = .918) nor were salaries in early career ($243,979 ± $31,749 vs. $254,625 ± $24,558, respectively; P = .416). On multivariate linear regression analysis, number of years since graduation (P = .009) and h-index (P = .049) were independent predictors of salary, but gender, geographic location, and faculty rank were not.

Conclusions: Although the gender pay gap persists in many areas of medicine and surgery, otolaryngologists employed at complex VAMCs do not experience gender pay disparity. The use of specific and objective criteria to establish and adjust salaries can reduce and potentially eliminate gender pay disparity. These findings may help to guide institutional policies in other practice environments.

Level Of Evidence: 2b. Laryngoscope, 129:113-118, 2019.
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http://dx.doi.org/10.1002/lary.27311DOI Listing
January 2019

Cultivating and Recruiting Future Otolaryngology Residents: Shaping the Tributary.

Otolaryngol Head Neck Surg 2019 01 21;160(1):8-10. Epub 2018 Aug 21.

9 Department of Otolaryngology, School of Medicine, University of Colorado, Aurora, Colorado, USA.

The future vibrancy, relevancy, and strength of our specialty depend on cultivating a pipeline of resident otolaryngologists who embody what our society wishes to become. In attracting, seeking, and nourishing physicians of all stripes, we offer several considerations regarding medical student education and the residency selection process.
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http://dx.doi.org/10.1177/0194599818797091DOI Listing
January 2019

Educational Resources for Global Health in Otolaryngology.

Otolaryngol Clin North Am 2018 Jun 7;51(3):563-574. Epub 2018 Mar 7.

Department of Otolaryngology-Head and Neck Surgery, Georgetown MedStar Hospital, 3800 Reservoir Road, Northwest, 1 Gorman, Washington, DC 20007, USA.

Advances in modern communications and information technology have helped to improve access to, and quality of, health care and education. These enhancements include a variety of World Wide Web-based and mobile learning platforms, such as eLearning, mLearning, and open education resources. This article highlights the innovative approaches that have fostered improved collaboration and coordination of global health efforts in otolaryngology.
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http://dx.doi.org/10.1016/j.otc.2018.01.005DOI Listing
June 2018

Simulation in Otolaryngology.

Authors:
Sonya Malekzadeh

Otolaryngol Clin North Am 2017 10 2;50(5):xvii-xviii. Epub 2017 Aug 2.

Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, NW, 1 Gorman, Washington, DC 20007, USA. Electronic address:

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http://dx.doi.org/10.1016/j.otc.2017.07.001DOI Listing
October 2017

Boot Camps: Preparing for Residency.

Otolaryngol Clin North Am 2017 Oct 29;50(5):1003-1013. Epub 2017 Jun 29.

Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road, Northwest, Washington, DC 20007, USA.

Simulation-based boot camps are growing in popularity and are effective in onboarding novice residents with new knowledge, skills, and behaviors. These intensive and immersive courses may be used to train residents and allied health professionals in specific procedures, teamwork, and management of rare clinical scenarios. A needs assessment of learners determines the course curriculum. Boot camps are designed to encourage active and hands-on participation with deliberate practice and immediate feedback. As surgical education shifts toward competency-based medical education, there may be an even greater role for simulation-based boot camps as a training and assessment tool.
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http://dx.doi.org/10.1016/j.otc.2017.05.010DOI Listing
October 2017

Are All Manikins Created Equal? A Pilot Study of Simulator Upper Airway Anatomic Fidelity.

Otolaryngol Head Neck Surg 2017 06 25;156(6):1154-1157. Epub 2016 Oct 25.

4 Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

This study evaluates the anatomic fidelity of several commercially available pediatric and adult manikins, including airway task trainers, which could be used in aerodigestive procedure training. Twenty-three experienced otolaryngologists assessed the aerodigestive anatomy of 5 adult and 5 pediatric manikins in a passive state, using rigid and flexible endoscopy. Anatomic fidelity was rated on a 5-point scale for the following: nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, trachea, esophagus, and neck. Mean scores and standard deviations were tabulated for each manikin at each anatomic site. Ratings by survey participants demonstrated variation in the anatomic fidelity of the aerodigestive tract in a range of manikins. Radar chart display of the results allows comparison of manikin fidelity by anatomic site. Differences in scores may allow instructors to select manikins with the best anatomic fidelity for specific educational purposes, and they may contribute to recommendations to improve future manikin design.
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http://dx.doi.org/10.1177/0194599816674658DOI Listing
June 2017

Case-Logging Practices in Otolaryngology Residency Training: National Survey of Residents and Program Directors.

Otolaryngol Head Neck Surg 2017 06 18;156(6):1072-1077. Epub 2017 Apr 18.

2 Department of Otolaryngology, Georgetown University Hospital, Washington, DC, USA.

Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.
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http://dx.doi.org/10.1177/0194599817702622DOI Listing
June 2017

Procedural Skills of the Entrustable Professional Activities: Are Graduating US Medical Students Prepared to Perform Procedures in Residency?

J Surg Educ 2017 Jul - Aug;74(4):589-595. Epub 2017 Jan 23.

Department of Otolaryngology-Head and Neck Surgery, Georgetown University School of Medicine, Washington, DC.

Purpose: Competency-based medical education has been successfully instituted in graduate medical education through the development of Milestones. Consequently, the Association of American Medical Colleges implemented the core entrustable professional activities initiative to complement this framework in undergraduate medical education. We sought to determine its efficacy by examining the experiences and confidence of recent medical school graduates with general procedural skills (entrustable professional activities 12).

Method: We administered an electronic survey to the MedStar Georgetown University Hospital intern class assessing their experiences with learning and evaluation as well as their confidence with procedural skills training during medical school. Simple linear regression was used to compare respondent confidence and the presence of formal evaluation in medical school.

Results: We received 28 complete responses, resulting in a 33% response rate, whereas most respondents indicated that basic cardiopulmonary resuscitation, bag/mask ventilation, and universal precautions were important to and evaluated by their medical school, this emphasis was not present for venipuncture, intravenous catheter placement, and arterial puncture. Mean summed scores of confidence for each skill indicated a statistically significant effect between confidence and evaluation of universal precaution skills.

Conclusions: More advanced procedural skills are not considered as important for graduating medical students and are less likely to be taught and formally evaluated before graduation. Formal evaluation of some procedural skills is associated with increased confidence of the learner.
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http://dx.doi.org/10.1016/j.jsurg.2017.01.002DOI Listing
May 2018

Digging into Debt: The Financial Burden Associated with the Otolaryngology Match.

Otolaryngol Head Neck Surg 2017 06 24;156(6):1091-1096. Epub 2017 Jan 24.

1 Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

Objective To quantify the cost incurred during the match process for otolaryngology applicants, determine sources of expenditures, and highlight potential methods to alleviate financial burden of the match process. Study Design Cross-sectional. Study Setting Online survey. Subjects and Methods An electronic survey was sent via email to those who applied to the otolaryngology residency programs at Dartmouth-Hitchcock Medical Center and MedStar Georgetown University Hospital during the 2016 application cycle. Questions regarding demographics and experiences with the match were multiple choice, and questions regarding cost were open answer. Data were downloaded and analyzed on Excel and Minitab software. Results Twenty-eight percent of the total 370 applicants completed the survey. The mean cost of away rotations was $2500 (95% confidence interval [CI], $2224-$2776). With application fees and the cost of interviewing, the mean total cost of applying for the 2016 otolaryngology match was $6400 (95% CI, $5710-$7090), with a total range of $1200 to $20,000. Twenty-eight percent of students did not have sufficient funds for applying and interviewing despite seeking out additional monetary resources. Conclusion In 2016, otolaryngology applicants spent a mean of $8900 (95% CI, $7935-$9865) on away rotations, applications, and interviewing. Half of the applicants obtained additional funding to cover this cost, while 28% still did not have sufficient funding. Methods of decreasing cost may include instituting a cap on application number, videoconferencing interviews, regionalizing interviews, and adjusting the interview timeline.
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http://dx.doi.org/10.1177/0194599816686538DOI Listing
June 2017

The impact of gross anatomy laboratory on first year medical students' interest in a surgical career.

Clin Anat 2016 Sep 9;29(6):691-5. Epub 2016 May 9.

Department of Biostatistics, MedStar Health Research Institute, Washington, DC.

This study sought to determine the impact of gross anatomy laboratory (GA) on first year medical students' (M1) interest in a surgical career. Secondary objectives included identifying other influences in M1s' career decision making. This prospective study included surveys before and after GA. All M1s enrolled in GA were invited to participate. Sixty students completed both the pre- and post-test surveys. A 5-point Likert-type scale surveyed participants' interests, specific personality traits, experience during the course of GA, and likelihood of pursuing a surgical career. Statistical analysis included Wilcoxon Signed Rank Test and (Polychotomous) Ordinal Logistic Regression Model. Students' desire to work with their hands increased (50 vs. 33.3%) and enjoyment working with instruments and tools similarly increased (50 vs. 41.7%). Likelihood of pursuing a surgical career after gross anatomy increased in 31.7% of students, decreased in 16.7%, and was unchanged in 51.7%. Over 75% of students with a prior interest in surgery and 21% of those who previously felt neutral agreed that they were likely to pursue a career in surgery at the conclusion of the laboratory. Students with a surgeon family member were 0.1976 times as likely to exhibit a positive change in interest (P values 0.024). Gross anatomy may influence up to a third of the class to consider a surgical career, especially those with a prior interest in surgery and those previously feeling ambivalent. Students with a surgeon family member became less likely to enter a surgical career after gross anatomy. Clin. Anat. 29:691-695, 2016. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.22730DOI Listing
September 2016

A Novel Peritonsillar Abscess Simulator.

Simul Healthc 2015 Oct;10(5):320-5

From the Georgetown University School of Medicine (H.B.); and Departments of Surgery (B.M.W.), and Otolaryngology-Head and Neck Surgery (S.M.), MedStar Georgetown University Hospital, Washington, DC; Department of Otolaryngology-Head and Neck Surgery (K.M.M), University of Michigan Health System, Ann Arbor, MI.

Introduction: In response to the growing demand for a peritonsillar abscess simulator, we developed a novel model to teach needle aspiration as well as incision and drainage of this common oropharyngeal disorder. The objectives of this study were to describe the construction of the simulator and to assess its realism and usefulness in the acquisition of drainage skills.

Methods: The training model was created with reusable and readily available materials. During an otolaryngology emergencies boot camp, expert otolaryngologists performed abscess drainage and subsequently instructed novice learners on the techniques of the procedure. Each participant completed a questionnaire using a 5-point Likert-type scale to assess simulator realism and training usefulness.

Results: A peritonsillar abscess drainage model was created using readily available materials. A total of 18 experienced attending otolaryngologists and senior otolaryngology residents (postgraduate year 4 and postgraduate year 5) participated in this study. All participants rated the trainer realistic, and 94% agreed that the model correlates with the essential skills needed for peritonsillar abscess management. All participants felt that this model would be useful in residency training to help develop dexterity, accuracy, and precision with peritonsillar abscess drainage instruments.

Conclusions: An easily reproducible peritonsillar abscess simulator was highly rated as a means of teaching peritonsillar abscess anatomy and provided opportunity for hands-on learning of drainage skills.
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http://dx.doi.org/10.1097/SIH.0000000000000104DOI Listing
October 2015

Simulation Activity in Otolaryngology Residencies.

Otolaryngol Head Neck Surg 2015 Aug 27;153(2):193-201. Epub 2015 May 27.

Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.

Objectives: Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty.

Study Design: Web-based survey.

Setting: US otolaryngology residency training programs.

Subjects And Methods: An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported.

Results: Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives.

Conclusion: Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs.
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http://dx.doi.org/10.1177/0194599815584598DOI Listing
August 2015