Evaluating the impact of an educational intervention on the history of racism in America for teaching structural competency to medical academicians.

BACKGROUND: A challenge facing many Academic Health Centers (AHCs) attempting to revise health professions education to include the impact of racism as a social and structural determinant of health (SSDoH) is a lack of broad faculty expertise to reinforce and avoid undermining learning modules addressing this topic. To encourage an institutional culture that is in line with new anti-racism instruction, we developed a six-part educational series on the history of racism in America and its impact on contemporary health inequities for teaching structural competency to health professions academicians. METHODS: We developed a six-hour elective continuing education (CE) series for faculty and staff with the following objectives: (1) describe and discuss race as a social construct; (2) describe and discuss the decolonization of the health sciences and health care; (3) describe and discuss the history of systemic racism and structural violence from a socio-ecological perspective; and (4) describe and discuss reconciliation and repair in biomedicine. The series was spread over a six-month period and each monthly lecture was followed one week later by an open discussion debriefing session. Attendees were assessed on their understanding of each objective before and after each series segment. RESULTS: We found significant increases in knowledge and understanding of each objective as the series progressed. Attendees reported that the series helped them grapple with their discomfort in a constructive manner. Self-selected attendees were overwhelmingly women (81.8%), indicating a greater willingness to engage with this material than men. CONCLUSIONS: The series provides a model for AHCs looking to promote anti-racism and structural competency among their faculty and staff.

Interview Invitations for Otolaryngology Residency Positions Across Demographic Groups Following Implementation of Preference Signaling.

Importance: Preference signaling is a new initiative in the residency application process that has been adopted by 17 specialties that include more than 80% of applicants in the 2023 National Resident Matching cycle. The association of signals with interview selection rate across applicant demographics has not been fully examined. Objective: To assess the validity of survey-based data on the association of preference signals with interview offers and describe the variation across demographic groups. Design, Setting, and Participants: This cross-sectional study examined the interview selection outcomes across demographic groups for applications with and without signals in the 2021 Otolaryngology National Resident Matching cycle. Data were obtained from a post-hoc collaboration between the Association of American Medical Colleges and the Otolaryngology Program Directors Organization evaluating the first preference signaling program used in residency application. Participants included otolaryngology residency applicants in the 2021 application cycle. Data were analyzed from June to July 2022. Exposures: Applicants were provided the option of submitting 5 signals to otolaryngology residency programs to indicate specific interest. Signals were used by programs when selecting candidates to interview. Main Outcomes and Measures: The main outcome of interest was the association of signaling with interview selection. A series of logistic regression analyses were conducted at the individual program level. Each program within the 3 program cohorts (overall, gender, and URM status) was evaluated with 2 models. Results: Of 636 otolaryngology applicants, 548 (86%) participated in preference signaling, including 337 men (61%) and 85 applicants (16%) who identified as underrepresented in medicine, including American Indian or Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; or Native Hawaiian or other Pacific Islander. The median interview selection rate for applications with a signal (48% [95% CI, 27%-68%]) was significantly higher than for applications without a signal (10% [95% CI, 7%-13%]). No difference was observed in median interview selection rates with or without signals when comparing male (46% [95% CI, 24%-71%] vs 7% [95% CI, 5%-12%]) and female (50% [95% CI, 20%-80%] vs 12% [95% CI, 8%-18%]) applicants or when comparing applicants who identified as URM (53% [95% CI, 16%-88%] vs 15% [95% CI, 8%-26%]) with those who did not identify as URM (49% [95% CI, 32%-68%] vs 8% [95% CI, 5%-12%]). Conclusions and Relevance: In this cross-sectional study of otolaryngology residency applicants, preference signaling was associated with an increased likelihood of applicants being selected for interview by signaled programs. This correlation was robust and present across the demographic categories of gender and self-identification as URM. Future research should explore the associations of signaling across a broad range of specialties and the associations of signals with inclusion and position on rank order lists and match outcomes.

Implementation of a Near-Peer Surgical Anatomy Teaching Program into the Surgery Clerkship.

OBJECTIVE: The objective of this study was to describe the implementation of Clinical Anatomy Mentorship Program (CAMP), a novel near-peer surgical anatomy teaching program, into the KU School of Medicine (KUSOM) Surgery Clerkship curriculum. DESIGN: Prospective qualitative and quantitative study. SETTING: Single institution, tertiary care hospital. PARTICIPANTS: All M3s at KUSOM on their surgery clerkship were eligible for inclusion for the learner cohort, n = 106. A group of M4s self-identified as CAMP mentors were eligible for inclusion for the teacher cohort, n = 40. RESULTS: M3s have statistically significant higher self-efficacy (p < 0.001) scores after participating in CAMP. Among open-ended comments written by M3s, significant themes highlighted that CAMP taught them a much-needed refresher on anatomy, gave them an introduction to surgical anatomy, and felt peer-to-peer teaching created a safe environment to ask questions. M4 mentors reported statistically significant (p < 0.001) increases in self-efficacy and confidence in teaching skills after teaching CAMP sessions. Among open-ended comments written by M4 mentors, significant themes highlighted that CAMP helped them develop their teaching skills and confidence in the operating room. CONCLUSIONS: In line with current medical education practices, KUSOM has significantly decreased anatomy in the curriculum. We responded to this shift by implementing CAMP, designed to address specific medical student needs for a surgically oriented anatomy instruction. CAMP has been effective at addressing student concerns about anatomy knowledge gaps. CAMP has enhanced self-efficacy, anatomy knowledge, and operating room exposure in M3s, and self-efficacy, teaching skills, surgical anatomy knowledge, and surgical confidence in M4s.

A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research.

OBJECTIVE: (1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Google Scholar. REVIEW METHODS: Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. RESULTS: There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. CONCLUSIONS: There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.

The Value of Diversity, Equity, and Inclusion in Otolaryngology.

Diversity impacts performance of our teams, fosters innovation, and improves outcomes of our patients in otolaryngology head and neck surgery. In addition to the moral imperative, increasing the otolaryngology diversity workforce will decrease health care disparities while equity and justice can increase the culture humility to take care of an increasingly diverse patient population. To move toward justice, otolaryngology departments need to end biases in faculty hiring, development, research evaluations, and publication practices. The more intentional our efforts, the more benefit to our patients, providers, staff, learners, and society.

Invisible Spread and Perceived Stress Amidst COVID-19.

INTRODUCTION: There are limited reports on the mental health toll associated with the fear of spreading coronavirus disease 2019 (COVID-19) and the associated stay-at-home orders. The goal of the present study was to characterize the self-reported stress of participants from the Kansas City Metropolitan Area (KCMA) and to examine the relation between potential for asymptomatic spread and perceived stress. METHODS: This prospective convenience sample study enrolled 461 participants from May 4 to May 22, 2020. Participants were consented and surveyed prior to free SARS-CoV-2 testing. Measures employed included the Perceived Stress Scale-10 and a comprehensive COVID-19 questionnaire. During the study period, testing resources were limited. In the community, only symptomatic individuals or close contacts of known positives could be tested. Our program aimed to reach those who were unable to access testing resources due to their asymptomatic status or other barriers to care. RESULTS: Worry about asymptomatic spread was associated significantly with greater perceived stress (p < 0.001). Higher stress was reported among women (p < 0.001), Hispanic/Latinx (p = 0.001), non-Black/ African American individuals (p < 0.001), and those reporting the presence of COVID-19 symptoms (p = 0.001). CONCLUSIONS: The COVID-19 pandemic has caused significant economic, social, and health disruptions around the world. Distress is significantly related to concern over unintentionally contributing to the spread of SARS-CoV-2 through asymptomatic transmission. In addition to examining outcomes like distress, future research should characterize the modifiable psychotherapeutic processes that might be targeted through intervention among those experiencing distress.

Discontinuation and nonpublication of pediatric otolaryngology clinical trials.

OBJECTIVES: Randomized controlled trial (RCT) discontinuation and nonpublication are potential mechanisms of waste in resources and lead to decreased advancement of medical science and compromised ethical issues in all specialties. However, the prevalence of discontinued or unpublished RCTs regarding common pediatric otolaryngology disorders and interventions remains unclear. STUDY DESIGN: Cross-sectional analysis. METHODS: Retrospective analysis of common pediatric otolaryngology RCTs registered in ClinicalTrials.gov up until November 2, 2018. Data were collected from the registry, and publication status was identified. If a reason for trial discontinuation or nonpublication was not identified through a systematic search, corresponding trialists were contacted through email. RESULTS: After exclusion, 260 RCTs were included for analysis. Analysis found 198 (76%) RCTs were completed, and 62 (24%) trials were discontinued. The most commonly reported reasons for RCT discontinuation were program termination by sponsor or management (7/24; 29.2%), lack of participant enrollment, difficulty recruiting, or slow accrual (7/24; 29.2%). A total of 192 (192/260; 73.8%) published RCTs and 68 (68/260; 26.2%) unpublished RCTs were identified. Twenty-six (26/62; 42%) of the discontinued RCTs reached publication, while 36 (58%) remained unpublished. Regarding the completed RCTs, 166 of 198 (83.8%) completed trials reached publication, while 32 (32/198; 16.2%) remained unpublished after trial completion. CONCLUSIONS: Approximately 1 in 4 of included RCTs were discontinued or did not reach publication. Findings suggest further guidance is needed for RCTs regarding common pediatric otolaryngology disorders and interventions. LEVEL OF EVIDENCE: NA.

Diversity and Inclusion-Why Does It Matter.

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

African American Otolaryngologists: Current Trends and Factors Influencing Career Choice.

OBJECTIVES: 1) Identify factors that influence African American physicians to choose a career in otolaryngology; 2) determine the predominant practice setting for African American otolaryngologists who can be role models; and 3) determine if the presence of an African American otolaryngologist in academic setting influences career choice. METHODS: Survey methodology included a 15-item survey to determine trends in practice and factors that influenced choice of specialty. RESULTS: The results were reviewed for trends influencing career choice and practice location and stratified by age group. Most African American otolaryngologists are in academic practice and have subspecialty fellowship training. Enjoying medical student clerkship was the most frequently cited reason why African Americans chose otolaryngology as a career regardless of age. Early exposure was a driving factor in those 30 to 40 years old. Receiving mentorship was less influential in career choice for all age groups, but there was a positive association between those who were mentored in training and those who mentor faculty. CONCLUSION: The findings suggest the continued need for initiatives to increase African Americans in our specialty. Encouraging early exposure, intentional mentoring of students, and development of African American role models who can be mentors may help increase the number of African American otolaryngologist faculty. This can help our specialty achieve racial parity in a percentage that matches the number of African Americans in the United States workforce. LEVEL OF EVIDENCE: 5 Laryngoscope, 130:2336-2342, 2020.

Steroid Versus Antibiotic Drops in the Prevention of Postoperative Myringotomy Tube Complications.

OBJECTIVES: To determine the incidence of early postoperative tympanostomy tube insertion otorrhea and obstruction in pediatric patients receiving antibiotic ear drops with or without steroid perioperatively. METHODS: A retrospective chart review was performed on patients who underwent outpatient myringotomy and tube placement. Patients from June 2013 to February 2014 received ciprofloxacin/dexamethasone perioperatively while patients from May 2014 to April 2015 received ofloxacin. Statistical analysis was performed to compare outcomes between the cohorts. RESULTS: One hundred thirty-four patients received topical ciprofloxacin/dexamethasone, and 116 patients received topical ofloxacin. The rate of postoperative otorrhea was 5.2% for the ciprofloxacin/dexamethasone group and 8.2% for the ofloxacin group. Tube obstruction was seen in 6.0% of the ciprofloxacin/dexamethasone group and 5.2% in the ofloxacin group. Neither outcome had a statistically significant difference ( P = .21 and .85, respectively). There was no difference in the rate of effusion at the time of tube placement between the 2 cohorts ( P = .16), and this included subgroup analysis based on effusion type (mucoid, purulent, serous). Patients with a mucoid effusion at the time of surgery were more likely to experience otorrhea/obstruction than patients with dry ears (odds ratio = 2.23, P = .02). CONCLUSION: No significant difference in the incidence of immediate postoperative tympanostomy tube otorrhea or obstruction was seen between the antibiotic-steroid and antibiotic alone cohorts, regardless of effusion type. Overall, patients with mucoid effusions are more likely to develop tube otorrhea or obstruction at follow-up. Cost-effective drops should be used when prescribing topical therapy to prevent complications after ear tubes.

Pediatric sialadenitis.

Sialadenitis in the pediatric population accounts for up to 10% of all salivary gland disease. Viral parotitis and juvenile recurrent parotitis are the two most common causes. Multiple factors, independently or in combination, can result in acute, chronic, or recurrent acute salivary gland inflammation. Sialendoscopy has emerged as the leading diagnostic technique and intervention for pediatric sialadenitis. Sialendoscopy is a safe and effective gland-preserving treatment of pediatric sialadenitis. Investigational studies are needed to address the impact of steroid instillation, postoperative stenting, and long-term outcomes of pediatric sialendoscopy. This article presents a comprehensive review of pathophysiology, clinical presentation, diagnosis, and treatment of pediatric sialadenitis.

Salivary endoscopy in a pediatric patient with HLA-B27 seropositivity and recurrent submandibular sialadenitis.

Patients with human leukocyte antigen (HLA)-B27 seropositivity have a genetic predisposition to form spondyloarthropathies, especially ankylosing spondylitis. Other related inflammatory or autoimmune disorders include reactive arthritis, uveitis, psoriatic arthritis, and Crohn's disease. Although juvenile recurrent parotitis is not uncommon, recurrent submandibular sialadenitis is rare in pediatric patients. Sialadenitis is typically caused by salivary stones, infection, or duct stricture. To our knowledge, there has not been report of HLA-B27 positivity and recurrent sialadenitis described previously. We describe a patient with HLA-B27 seropositivity and multiple episodes of left submandibular sialadenitis who underwent diagnostic and therapeutic sialendoscopy. Previous treatment included antibiotics, sialogogues, warm compresses, and hydration before he underwent definitive sialendoscopy treatment at a tertiary care medical center. Salivary endoscopy showed salivary stasis and sludging within the left submandibular gland duct, with no salivary stones. Topical steroid was applied to the duct. At one year following his surgery, he has not had any recurrent episodes of sialadenitis. HLA-B27 seropositivity is associated with many inflammatory disorders; we report a case in which the patient had coexisting recurrent sialadenitis. In the pediatric population, sialadenitis is traditionally managed with antibiotics and supportive care, however our patient underwent salivary endoscopy. Sialendoscopy is an emerging modality that potentially avoids radiation exposure from CT or sialography and should be considered as another preferred treatment option. More investigation is required to prove a possible correlation between existing HLA-B27 and the propensity to develop this clinical problem.

18F-fluorodeoxyglucose and 131I radioguided surgical management of thyroid cancer.

OBJECTIVE: To describe a technique that assists in the surgical management of recurrent local regional well-differentiated thyroid cancer (WDTC). STUDY DESIGN: Case series with chart review. SETTING: Two academic health centers from 2001 to 2009. SUBJECTS AND METHODS: Patients operated upon by the senior surgeon (BCS) for recurrent WDTC. RESULTS: Thirteen patients with recurrent WDTC were operated upon with radioguided surgical (RGS) technique to indentify recurrence for excision. Eight patients had iodine avid disease and were candidates for RGS with (131)I. The remaining 5 patients had cancer with a proven loss of iodine avidity and were, therefore, operated upon with a fluorodeoxygluocose (FDG) RGS technique. CONCLUSION: RGS is a feasible approach to identify recurrent disease in an operated field and ensure its successful excision. Although focal disease may be identified with this technique, this is not a tool for limited excisions ("berry picking").

Intralesional steroid injection for proliferative parotid hemangiomas.

OBJECTIVE: To evaluate the efficacy of proliferative phase intralesional steroid injections in the treatment of parotid hemangiomas. DESIGN: Retrospective analysis of pediatric patients with parotid hemangiomas treated with intralesional steroid injections during the proliferative phase. SETTING: Vascular Anomalies Center, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA. PATIENTS: Twenty-one pediatric patients, ages 4-39 months. METHODS: Between 2001 and 2006, 21 patients received steroid injections for 23 parotid hemangiomas (bilateral in 2 patients). A total of 1-3 injections over the first year of life were given at 6-25 week intervals. RESULTS: Main outcome measures included softening, decreased growth rate, and/or decrease in size. After injection, achievement of outcome measures occurred with all lesions. No incidence of tissue atrophy or facial nerve injury was seen. Four of 21 (19%) patients developed failure to thrive (FTT). CONCLUSION: Parotid hemangiomas can be effectively controlled with proliferative phase intralesional steroid injections. Injections may limit the need for future extensive surgery. Further prospective randomized trials are needed to support these claims. Failure to thrive may be a potential complication of intralesional steroid injection. Endocrine/growth monitoring should be considered when treating with intralesional steroids.