Pediatric Otolaryngology fellowship virtual interview sentiments.

BACKGROUND: Interviews for Pediatric Otolaryngology fellowship rapidly transitioned to virtual interviews mid-cycle in March 2020 due to the COVID-19 pandemic. OBJECTIVE: This study aims to describe perspectives on virtual versus in-person interviews for both applicants and program directors. METHODS: Cross-sectional study. Surveys were conducted of all Pediatric Otolaryngology fellowship applicants participating in the San Francisco Match and program directors in 2020 and 2021. RESULTS: Out of 32 U.S. trained fellowship applicants, 24 completed the survey in 2020 and 18 in 2021. While 70% of applicants felt they did not get the same experience with virtual interviews, 75% did not feel it changed how they ranked programs. Applicant perception of virtual interviews improved in 2021, with the majority (56%) preferring virtual interviews if provided an option. Twenty out of 36 fellowship directors completed the survey in 2020, and eighteen in 2021. While fellowship directors continued to prefer in-person in 2021, an increased number (10% in 2020, 30% in 2021) felt continuing with virtual interviews may increase the number of applicants in the future. CONCLUSION: Based on the survey, both applicants and fellowship directors had a less favorable perception of virtual interviews compared to in-person interviews initially; however, applicant perception favored virtual interviews in 2021, while Program Directors continued to prefer in-person.

Predictors of future academic productivity in pediatric otolaryngology fellowship applicants.

OBJECTIVES: To investigate which components of pediatric otolaryngology fellowship applications are more closely predictive of future academic productivity in applicants who go on to complete their fellowship training. METHODS: Applications to our institution's ACGME accredited pediatric otolaryngology fellowship program through the SF Match program for the years 2011-2016 were reviewed. Applicant files on record were utilized to extract independent variables including sex, mean USMLE score, residency program Doximity ranking, military experience, number of national honors/awards, AOA status, total number of publications listed on application, number of first author publications listed on application, and AAOHNS Committee involvement. Academic productivity was determined by number of PubMed indexed publications per year, practice setting, and H-index (Scopus). Statistical analysis consisted of multivariate and univariate regression models, with p < 0.05 being considered statistically significant. RESULTS: Multivariate regression showed that USMLE Step 1 and 2 mean score and number of publications listed on application exhibited statistically significant correlations with a higher number of future post fellowship publications per year. Residency program Doximity rank, applicant number of awards and honors, AOA status, and number of first author publications were not predictive of future academic productivity. No statistically significant associations were found between any variables and the faculty position outcome variable. CONCLUSIONS: Quantifiable criteria in pediatric otolaryngology fellowship applications, such as number of listed publications and mean USMLE scores are strongly correlated with future academic productivity metrics.

Deep Learning for Predictive Analysis of Pediatric Otolaryngology Personal Statements: A Pilot Study.

OBJECTIVE: The personal statement is often an underutilized aspect of pediatric otolaryngology fellowship applications. In this pilot study, we use deep learning language models to cluster personal statements and elucidate their relationship to applicant rank position and postfellowship research output. STUDY DESIGN: Retrospective cohort. SETTING: Single pediatric tertiary care center. METHODS: Data and personal statements from 115 applicants to our fellowship program were retrieved from San Francisco Match. BERT (Bidirectional Encoder Representations From Transformers) was used to generate document embeddings for clustering. Regression and machine learning models were used to assess the relationship of personal statements to number of postfellowship publications per year when controlling for publications, board scores, Alpha Omega Alpha status, gender, and residency. RESULTS: Document embeddings of personal statements were found to cluster into 4 distinct groups by K-means clustering: 2 focused on "training/research" and 2 on "personal/patient anecdotes." Training clusters 1 and 2 were associated with an applicant-organization fit by a single pediatric otolaryngology fellowship program on univariate but not multivariate analysis. Models utilizing document embeddings alone were able to equally predict applicant-organization fit (receiver operating characteristic areas under the curve, 0.763 and 0.750 vs 0.419; P values >.05) as compared with models utilizing applicant characteristics and personal statement clusters alone. All predictive models were poor predictors of postfellowship publications per year. CONCLUSION: We demonstrate ability for document embeddings to capture meaningful information in personal statements from pediatric otolaryngology fellowship applicants. A larger study can further differentiate personal statement clusters and assess the predictive potential of document embeddings.

Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus.

OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN: Blinded modified Delphi consensus process. SETTING: Tertiary care center. METHODS: A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS: The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS: It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE: 5. Laryngoscope, 131:1168-1174, 2021.

Pediatric cochlear implantation: Variation in income, race, payer, and charges across five states.

OBJECTIVES/HYPOTHESIS: Our objectives were to investigate pediatric cochlear implantation (PCI) across representative states within the United States and analyze any geographical differences in age, median household income, race, insurance, and total medical charges. STUDY DESIGN: Cross-sectional. METHODS: Data from children (aged 0.5-18 years) who received cochlear implantation surgery were collected from the 2011 State Ambulatory Surgery and Services Databases from California (CA), Florida (FL), Maryland (MD), New York (NY), and Kentucky (KY) as a part of the Healthcare Cost and Utilization Project. We performed data analysis using a combination of Kruskal-Wallis and Wilcoxon rank sum tests, as well as nominal logistic regression. RESULTS: Five hundred twelve cases of PCI were performed during 2011 across the five states. The overall mean and median age of implantation were 5.6 years and 4 years, respectively. There was no statistical difference in age of implantation across states (P = .85). However, there were statistical differences in primary payer (P < .001), median household income quartiles of patients who received an implant (P < .006), race (P < .001), and total median hospital charges for four of the states, with the exception of CA (P < .001). CONCLUSIONS: Age of PCI appears to be similar across the five states in cross-sectional analysis. Geographic variations in charges, payer, race, and median household income occur with statistical significance in PCI. Further analysis of contributing factors at each state level may help elucidate the root cause of these disparities and improve and justify a uniform approach to healthcare delivery and standards of care. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:954-958, 2018.

Barriers to pediatric cochlear implantation: A parental survey.

OBJECTIVE: This study aims to (1) determine barriers in the pediatric cochlear implantation process specific to publicly insured patients, wherein delayed implantation has been reported, and (2) compare the perceived barriers between publicly and privately insured patients. SETTING: Tertiary care cochlear implantation center at academic pediatric hospital. STUDY DESIGN: Cross-sectional survey, retrospective chart review. METHODS: The validated, 39 item Barriers to Care Questionnaire was administered to the parents of 80 recipients of cochlear implantation by two surgeons between 2013 and 2016. Survey results and diagnosis to implant interval were compared based on public or private insurance status. Two-tailed Mann-Whitney and Fisher's exact test was used for statistical analysis. RESULTS: Of 110 cochlear implants, 27 of 80 (34%) English-speaking parents completed the survey. 15 were privately insured and 12 were publicly insured. 23 of 27 respondents received cochlear implantation for pre-lingual sensorineural hearing loss. Publicly insured patients had significantly longer median time from diagnosis to implant than privately insured (19 vs. 8 mo, p = 0.01). The three worst scoring barrier categories for privately insured families in order were Pragmatics, Expectations, and Marginalization, whereas for publicly insured families it was Pragmatics, Skills, and Expectations. The worst scoring question for privately insured patients was "Having to take time off work". For the publicly insured, it was "Lack of communication." CONCLUSION: Privately insured patients reported more barriers on the Barriers to Care Questionnaire than publicly insured patients did. Although pragmatics was the worst-scoring barrier category for both groups, difficulties found on the survey ranked differently for each group. This information can help providers address disparities and access barriers for vulnerable patients.

Delays in Sound Recognition and Imitation in Underinsured Children Receiving Cochlear Implantation.

Importance: Barriers to early pediatric cochlear implantation in underinsured populations have been previously reported. However, to our knowledge, the effect of this delay on the development of auditory and speech-language objectives has not been evaluated. Objective: To determine if health care insurance status affects the achievement of proficiency in basic sound access and imitation tasks in children with cochlear implants. Design, Setting, and Participants: A retrospective review of 123 children aged 1 to 12 years receiving cochlear implants at the single tertiary referral academic free-standing Children's National Health System in Washington, DC, between January 1, 2008, and December 31, 2015. Main Outcomes and Measures: Auditory function after cochlear implantation, time to proficiency in Ling-6 scores, and number of speech therapy and audiological appointments, as well as current educational setting, were compared with patient age at diagnosis of hearing loss, age at cochlear implantation, cochlear implantation insertion technique, and health care insurance status for recipients of cochlear implants. Results: A total of 123 children aged 1 to 12 years (mean [SD] age, 64.0 [57.4] years) with cochlear implants were included in the study. Of 37 patients with complete and accurate Ling-6 test scores, 23 (62.1%) were able to have proficiency a mean of 5.1 months at follow-up. Despite equal auditory performance on pure-tone audiometry after cochlear implantation, publicly insured recipients had Ling-6 proficiency a mean of 6.0 months (95% CI, 5.5-6.5 months) later than privately insured recipients (11.0 vs 5.0 months). When controlling for patient age, time to cochlear implantation, number of therapy sessions, and cochlear implantation insertion technique, multivariable logistic regression analysis revealed health care insurance status to be the independent variable associated with inadequate Ling-6 discrimination scores (odds ratio, 46.2; 95% CI, 2.9-729.4). Conclusions and Relevance: Despite equal speech detection scores, publicly insured recipients of cochlear implantation had a significant and critical delay in attaining proficiency in a fundamental measure of sound recognition and imitation.

Trends in U.S. Pediatric Otolaryngology Fellowship Training.

IMPORTANCE: Interest in pediatric otolaryngology fellowship training is growing. The workforce implications of this growing interest are unclear and understudied. OBJECTIVES: To analyze trends in pediatric otolaryngology training, determine where fellows who graduated over the past 10 years are currently practicing, and test the hypothesis that graduates from Accreditation Council for Graduate Medical Education (ACGME)­accredited programs were more likely to have academic tertiary positions with faculty appointments. DESIGN, SETTING, AND PARTICIPANTS: We conducted a web-based analysis of pediatric otolaryngology fellowship graduates. The names of all 274 applicants who were matched to pediatric otolaryngology fellowships from May 31, 2003, to May 31, 2014, were obtained from the SF Match website. Accreditation status of each program for each match year was obtained from the ACGME website. We then performed an Internet search for the current practice location of each matched applicant. Analysis was conducted from January 1, 2015, to May 1, 2015. MAIN OUTCOMES AND MEASURES: Practice setting per year of fellowship match and accreditation status of program. RESULTS: For the 2003 to the 2014 match years, there was an increase from 5 to 22 accredited pediatric otolaryngology fellowship programs overall; simultaneously, the number of yearly matched applicants increased from 14 to 35. More graduates with ACGME accreditation practice at academic settings compared with graduates without ACGME accreditation although the difference was not statistically significant (67.1% vs. 50.7%; P = .15). Graduates from accredited programs, however, were significantly more likely to practice at a hospital-based setting compared with those from nonaccredited programs (81.7% vs. 65.5%; P = .003). Fellows trained in the last 10 years are relatively well distributed across the country. CONCLUSIONS AND RELEVANCE: The number of pediatric otolaryngology fellowship applicants as well as total number of matched applicants and ACGME-accredited positions has risen in the last 10 years. It appears that a higher proportion of fellows trained in accredited programs work in academic positions in hospital-based practices. The long-term effect on the pediatric otolaryngology workforce of training more fellows in accredited fellowships remains to be seen.

Choosing a fellow or fellowship: a survey of pediatric otolaryngologists.

IMPORTANCE: The numbers of pediatric otolaryngology fellowship programs and applicants have increased over the past 5 years. However, the qualities desired in programs and applicants have not been explored. OBJECTIVE: To determine the factors that fellowship program directors and applicants believe to be most important in choosing a fellow and the factors most important to fellowship applicants in choosing a program. DESIGN, SETTING, AND PARTICIPANTS: Cohort study using an anonymous online survey of 2012 pediatric otolaryngology fellowship program directors and applicants. Respondents were asked to rank a list of 10 qualities from most to least important for judging the strength of a fellowship applicant. Applicants also assessed the importance of factors in choosing a fellowship. MAIN OUTCOMES AND MEASURES: Rank of each factor by members of each group. RESULTS: Thirty-two of 47 applicants (68%) and 15 of 31 fellowship directors (48%) completed the survey. For applicants, the most important factors when choosing a fellowship program were gaining strong experience in airway management and otology, faculty reputation, and location, whereas Accreditation Council for Graduate Medical Education (ACGME) accreditation, fellowship longevity, and salary were less important. For choosing an applicant, applicants indicated that the interview, prior applicant knowledge (trusted recommendation), and letters of recommendation, sequentially, should be given the greatest weight. Directors reported that they used the same top 3 factors to rank applicants, but knowledge or trusted recommendation of the applicant ranked first. Applicants who successfully matched interviewed at (mean, 9.5 vs 3.0; P = .003), applied at (mean, 11.6 vs 4.3; P = .02), and ranked (mean, 8.3 vs 2.3; P < .001) more fellowship programs than those who did not. United States Medical Licensing Examination scores higher than 230 and AΩA membership status did not significantly affect fellowship match. CONCLUSIONS AND RELEVANCE: Personal knowledge or a trusted colleague's recommendation may be the most important determinant when pediatric otolaryngology fellowship programs choose an applicant. When fellows choose a program, the opportunity to gain surgical experience in both otology and airway management is crucial, but ACGME accreditation status seems less important. Successful applicants ranked and interviewed at more fellowship programs than nonmatching applicants.

Barriers to early pediatric cochlear implantation.

OBJECTIVES: Universal newborn hearing screening has significantly improved the ability to identify patients with congenital sensorineural hearing loss (SNHL), which results in earlier treatment and better hearing and development outcomes. It is recommended that patients born with SNHL who meet criteria receive cochlear implants (CIs) by a target age of 12 months, however many children are being implanted at an older age. This study aims to describe populations of pre-lingual patients with SNHL that are at risk for delayed implantation and to identify and analyze barriers that cause this delay. METHODS: Charts of patients receiving a CI between January 2008 and June 2012 at a tertiary care cochlear implant center were reviewed retrospectively. We looked at patient demographics, age at hearing loss diagnosis, age at implantation, and etiology of hearing loss. Barriers to implantation were identified through surveys completed by team members. RESULTS: Fifty-seven CI recipients were identified of which 42 were in patients with pre-lingual SNHL. SNHL etiology included: cochlear dysplasia (18%), GJB2/GJB6 (17%), acquired (10%) extreme prematurity (9%), and idiopathic (46%). The median age of SNHL diagnosis for pre-lingual patients was 15 months. Compared to private insurance, public insurance status was associated with SNHL diagnosis at a significantly later median age (20.0 vs. 4.0 months, p=0.024), and with a significantly longer median interval from diagnosis to implantation (25.5 vs. 11.0 months, p=0.029). While cochlear implant team members identified delayed insurance approval and medical comorbidities as reasons for delayed implantation, the most significant factor identified was parental, with delayed/missed appointments or reluctance for evaluations or surgery. CONCLUSION: 52% of patients with pre-lingual SNHL that met criteria for CI were implanted more than 12 months after diagnosis. Having public or no insurance was significantly associated with delayed implantation. Parental barriers were most common factors cited for delays in implantation. Overcoming these delays necessitates appropriate identification of at risk patients and creating a system to educate families and chaperone them through the process.

Accreditation Council for Graduate Medical Education accreditation and influence on perceptions of pediatric otolaryngology fellowship training experience.

IMPORTANCE: The American Society of Pediatric Otolaryngology (ASPO) has set a goal of universal accreditation of fellowship programs by the Accreditation Council for Graduate Medical Education (ACGME) by 2014. This study offers data comparing trainee experience at accredited vs nonaccredited programs. OBJECTIVE: To evaluate perceptions of pediatric otolaryngology fellowship training experience and to elucidate differences between those who trained in ACGME-accredited fellowships vs those who did not. DESIGN AND PARTICIPANTS: Web-based survey sent to all members of ASPO, as well as recent fellowship graduate ASPO-eligible physicians. Responses were obtained in an anonymous fashion. The study population comprised 136 ASPO members who recently graduated from pediatric otolaryngology fellowship programs (36 from ACGME-accredited fellowships and 100 from nonaccredited programs). MAIN OUTCOMES AND MEASURES: Difference in perceived fellowship experience between graduates of accredited vs nonaccredited programs, specifically, differences in service vs education perceptions. RESULTS: Overall, a majority (64%) of respondents agreed that standardizing the pediatric fellowship curriculum through ACGME accreditation is a worthwhile goal. Those who attended ACGME-accredited fellowships were more likely to favor accreditation vs non-ACGME graduates (83% vs 58%; P = .006). Graduates of ACGME-accredited programs were also more likely to agree that their fellowship provided adequate preparation for a career in academic medicine (100% vs 89%; P = .04), protected time for research (94% vs 60%; P < .001), vacation and academic time (94% vs 78%; P = .03), and opportunities to formally evaluate their superiors (72% vs 32%; P < .001). Non-ACGME graduates reported higher primary call frequency (0.8 days per week vs 0.2 days per week; P = .01), and attending physician participation in rounds (71% vs 53%; P = .05). CONCLUSIONS AND RELEVANCE: Most respondents were in agreement with universal ACGME accreditation. Those having trained in accredited programs cite increased allowance for research, academic and vacation time, more formal opportunities to evaluate their faculty, and decreased primary call burden.

Orbital and periorbital infections: a national perspective.

OBJECTIVES: To describe the epidemiologic features of pediatric orbital and periorbital infections from a national perspective and to identify predictors of surgery. DESIGN: Analysis of the Kids' Inpatient Database. SETTING: Administrative data set. PATIENTS: Pediatric inpatient admissions with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of orbital cellulitis. MAIN OUTCOME MEASURES: Hospital admission, socioeconomic, and clinical variables were examined and predictors of surgical intervention were evaluated using logistic regression. RESULTS: A total 5440 hospital admissions was noted for pediatric orbital cellulitis; of these, 672 patients (12.4%) underwent surgical intervention. Mean length of stay for all patients was 3.8 days; 90.4% were routinely discharged. Patients who had surgery were older, with a mean (SE) age of 10.1 (0.29) years compared with 6.1 (0.10) years for nonsurgical patients (P < .001). Surgical patients had a significantly longer mean hospital stay (7.1 vs 3.4 days, P < .001) and a higher mean cost of care ($41 009 vs $13 008, P < .001) compared with nonsurgical patients. Demographic predictors of surgical intervention included male sex, admitting characteristics, and hospital location. Except for sex, these variables remained significant in a multivariate model. Clinically, diplopia is a predictor of surgical intervention (odds ratio, 6.3; 95% confidence interval, 3.4-11.7). CONCLUSIONS: This study describes the medical and surgical management of pediatric orbital and periorbital infections from a national perspective. Predictors of surgical intervention include older age, presentation with diplopia, and hospital admission via the emergency department. Knowledge of these variables facilitates analysis of resource utilization for pediatric orbital cellulitis and can be used to optimally triage patients, ultimately reducing costs and lengths of stay while preserving quality of care.

Pediatric otolaryngology in the United States: demographics, workforce perceptions, and current practices.

OBJECTIVES: To evaluate self-reported workforce needs and demands, professional activities, and the clinical practices of pediatric otolaryngologists in the United States for the purpose of better understanding the pediatric otolaryngology workforce and predicting manpower needs. DESIGN: A Web-based survey was sent to all members of the American Society of Pediatric Otolaryngology (ASPO). It achieved a 39.3% response rate, with a total of 99 US member respondents. We compared this sample to the overall US ASPO membership to determine if our respondent cohort was representative of ASPO demographics. PARTICIPANTS: All members of ASPO. MAIN OUTCOME MEASURES: Responses were categorized by demographics and nature of respondent practice (academic vs private practice). RESULTS: Respondents were representative of the US ASPO membership. Most of the respondents practiced in an academic setting (n = 70; 70%). Academicians reported seeing a higher percentage of patients with Medicaid public insurance than did private practitioners (34% vs 25.0%) (P = .03). Academicians spent a greater portion of their time than private practitioners on research (14.4% vs 6.6% of time) (P < .001) and teaching (26.9% vs 12.8% of time) (P = .002). With the exception of choanal atresia repair, there were no differences in the types of airway, otologic, head and neck, and plastic and reconstructive surgery performed by the 2 groups. Although fewer than half of the respondents (47%; n = 44) believed that there presently is a shortage of pediatric otolaryngology manpower, most (68%; n = 63) (P = .01) believed that there would be a shortage in 5 years. CONCLUSIONS: Pediatric otolaryngologists predict an increased demand for their services in the near future. The only differences in the clinical practices of academic and private pediatric otolaryngologists are patient payer mix and the amount of time devoted to teaching.

Improved diagnostic effectiveness with a sequential diagnostic paradigm in idiopathic pediatric sensorineural hearing loss.

OBJECTIVES: To determine whether a stepwise diagnostic paradigm is more diagnostically efficient and cost-effective than a simultaneous testing approach in the evaluation of idiopathic pediatric sensorineural hearing loss (SNHL). DESIGN: Prospective prevalence study. SETTING: Tertiary referral children's hospital. PATIENTS: Consecutive children (n = 150) presenting with idiopathic SNHL in the last 2 years. INTERVENTIONS: All children were evaluated with full diagnostic evaluations including GJB2 screens, temporal bone computed tomography scans, and laboratory investigations. MAIN OUTCOME MEASURES: 1) Diagnostic yields of GJB2 screens, imaging, and laboratory results per SNHL category; 2) Cost analysis comparing a sequential versus a simultaneous testing approach. RESULTS: Overall, 12.0% of patients had biallelic mutations in the GJB2 gene, whereas 30% of patients had an abnormality on temporal bone scan. Laboratory testing did not reveal the SNHL etiology in any patient. While maintaining diagnostic accuracy, significant cost savings were inferred by using a sequential diagnostic algorithm. Our data show children with severe to profound SNHL should first be tested with a GJB2 screen, as opposed to those with milder SNHL, who should undergo imaging as the initial testing step. In patients with initially positive GJB2 or imaging screens, logistic regression analysis significantly predicted negative results on further testing. CONCLUSIONS: A stepwise diagnostic paradigm tailored to the level of the hearing loss in children with bilateral SNHL is more diagnostically efficient and cost effective than the more commonly used full, simultaneous testing approach. Laboratory investigation should not be routine but based on clinical history.

A diagnostic paradigm for childhood idiopathic sensorineural hearing loss.

OBJECTIVE: Our objective was to determine the diagnostic yield of laboratory testing, radiological imaging, and GJB2 mutation screening in a large cohort of patients with differing severities of idiopathic sensorineural hearing loss (SNHL). DESIGN AND SETTING: We undertook a retrospective study of patients presenting with SNHL at our institution from 1993 to 2002. RESULTS: Laboratory testing had an extremely low yield. Patients with unilateral SNHL had a significantly higher imaging yield than those with bilateral. The diagnostic yield of GJB2 screening was significantly higher in patients with severe to profound SNHL than in those with less severe SNHL. However, a relatively large number of patients with mild to moderate SNHL had positive GJB2 screens. CONCLUSIONS: Based on diagnostic yields, we propose a cost-effective stepwise diagnostic paradigm to replace the more commonly used and costly simultaneous testing approach. EBM RATING: C.