Integration of 3D-printed middle ear models and middle ear prostheses in otosurgical training.

BACKGROUND: In otosurgical training, cadaveric temporal bones are primarily used to provide a realistic tactile experience. However, using cadaveric temporal bones is challenging due to their limited availability, high cost, and potential for infection. Utilizing current three-dimensional (3D) technologies could overcome the limitations associated with cadaveric bones. This study focused on how a 3D-printed middle ear model can be used in otosurgical training. METHODS: A cadaveric temporal bone was imaged using microcomputed tomography (micro-CT) to generate a 3D model of the middle ear. The final model was printed from transparent photopolymers using a laser-based 3D printer (vat photopolymerization), yielding a 3D-printed phantom of the external ear canal and middle ear. The feasibility of this phantom for otosurgical training was evaluated through an ossiculoplasty simulation involving ten otosurgeons and ten otolaryngology-head and neck surgery (ORL-HNS) residents. The participants were tasked with drilling, scooping, and placing a 3D-printed partial ossicular replacement prosthesis (PORP). Following the simulation, a questionnaire was used to collect the participants' opinions and feedback. RESULTS: A transparent photopolymer was deemed suitable for both the middle ear phantom and PORP. The printing procedure was precise, and the anatomical landmarks were recognizable. Based on the evaluations, the phantom had realistic maneuverability, although the haptic feedback during drilling and scooping received some criticism from ORL-HNS residents. Both otosurgeons and ORL-HNS residents were optimistic about the application of these 3D-printed models as training tools. CONCLUSIONS: The 3D-printed middle ear phantom and PORP used in this study can be used for low-threshold training in the future. The integration of 3D-printed models in conventional otosurgical training holds significant promise.

[Open educational resources for otorhinolaryngology : A pilot study on needs assessment and implementation]. / Open Educational Resources für die HNO-Heilkunde : Ein Pilotprojekt zur Bedarfsanalyse und Implementierung.

BACKGROUND: Open educational resources (OER) are educational materials licensed openly by authors, permitting usage, redistribution, and in some instances, modification. OER platforms thereby serve as a medium for distributing and advancing teaching materials and innovative educational methodologies. OBJECTIVE: This study aims to determine the present state of OER in otorhinolaryngology and to examine the prerequisites for seamlessly integrating OER into the curricular teaching of medical schools, specifically through the design of two OER blended learning modules. METHODS: OER content in the field of otorhinolaryngology was analyzed on OER platforms, ensuring its relevance to the German medical curriculum. Data protection concerns were addressed with legal counsel. The blended learning modules were developed in collaboration with medical students and subsequently published as OER. RESULTS AND CONCLUSION: This project yielded the first OER from a German ENT department, tailored to the German medical curriculum. One significant barrier to OER use in medicine, more than in other fields, is data protection. This challenge can be navigated by obtaining consent to publish patient data as OER. OER hold the promise to play a pivotal role in fostering cooperation and collaboration among educators, aiding educators in lesson preparation, and simultaneously enhancing didactic quality.

[Is the use of virtual reality in otorhinolaryngology teaching automatically positively rated by students? : A questionnaire-based evaluation among students]. / Wird der Einsatz der virtuellen Realität in der HNO-Heilkunde-Lehre von Studierenden automatisch positiv bewertet? : Eine Fragebogenevaluation bei Studierenden.

BACKGROUND: Analogous to the situation in other disciplines, digital ENT teaching made significant progress during the pandemic. Most ENT clinics nationwide were able to offer a complete virtual teaching program in time. Innovative teaching methods were also used early on. This was recognized in student teaching evaluations. Due to the expansion of virtual reality (VR) in medical teaching, even greater satisfaction should be expected through improved teaching quality. MATERIALS AND METHODS: Surveys were performed with students (n = 180) of the ENT block internship in the summer semester of 2023. The aim of the evaluation was to determine the students' satisfaction with and subjective effectiveness of the newly implemented VR digital teaching method for teaching ear anatomy and coniotomy. A survey was also carried out among resident physicians. RESULTS: The ENT teaching was perceived favorably by the students, with an average rating of 11.7 out of 15. The learning effectiveness and the value of VR in the ENT learning portfolio was evaluated varyingly by the students. The physicians' assessment was different, with a more positive perception. CONCLUSION: Virtual reality represents an innovative component in the teaching portfolio of otolaryngology. This new teaching method is viewed and accepted as a future-oriented tool. Remarkably, the physicians involved voted consistently positively, while the students gave more critical assessments and pointed out limitations in the individual and subjective areas. These findings are in contrast to the further development of innovative teaching methods demanded by student interest groups.

[Virtual training of practical competences in sonography]. / Sonographie als Gegenstand virtuellen Wissenstransfers zum praktischen Kompetenzerwerb.

OBJECTIVE: During the COVID-19 pandemic, a particular challenge in the transition to digital teaching was to teach practical skills such as sonography of the head and neck online. The aim of this study was to validate the digital sonography course for medical students established at the Freiburg University Hospital ENT Department. METHODS: Participants were 178 students of human medicine. The study group simulated the sonography examination at home with a dummy transducer using the Peyton method under the guidance of a tutor via video seminar. In a subsequent learning success check, the results of the students in the online course were compared with those of the control group, who learned sonography in the classroom. RESULTS: Students of the online course achieved comparable results to the classroom group. CONCLUSION: This study shows that practical skills which require extensive equipment such as a sonography machine can be taught to a certain extent digitally or at least in a hybrid form.

[Views of assistant professors on digital transformation in otorhinolaryngology education : Current status and perspectives in undergraduate and advanced training]. / Ansichten von Lehrbeauftragten zur digitalen Transformation in der HNO-Lehre : Aktueller Stand und Perspektiven in Aus- und Weiterbildung.

BACKGROUND: Digital transformation in curricular teaching in medicine comprises the use of digital teaching and learning formats as well as the transfer of digital skills for medical staff. Concepts of knowledge transfer and competency profiles also have to be adapted and transferred in advanced training due to necessary changes. OBJECTIVE: The aim of this study was an evaluation of the current state of digital transformation in otorhinolaryngology teaching in undergraduate and advanced training at otorhinolaryngology departments of university medical centers in Germany. MATERIALS AND METHODS: A questionnaire with nine questions on digital transformation was sent to the assistant professors of 37 national university ENT departments. The anonymous survey was conducted online via the online platform SurveyMonkey®. RESULTS: Of the contacted assistant professors, 86.5% participated in the survey. Teaching sessions on digital skills for medical students are part of the curriculum in only 25% of ENT departments. Digital teaching formats are used by half of the departments in undergraduate training. Only 56.25% of the assistant professors receive support to realize the changes required by digital transformation. In 40.62% of departments, the issue of digital transformation is broached during advanced training, but only 28.12% use digital teaching methods to train junior doctors. CONCLUSION: Aspects of digital transformation are implemented mainly in undergraduate education, partly driven by the COVID 19 pandemic. Overall, there is still considerable backlog in undergraduate and advanced training in ENT.

[Communication training in otorhinolaryngology education : Comparison of an online and a classroom-based training course]. / Vermittlung kommunikativer Kompetenzen in der Lehre der HNO-Heilkunde : Vergleich zwischen einer Online- und Präsenzveranstaltung.

BACKGROUND: Communication skills are among the most important key qualifications of the medical profession. To what extent these can also be acquired online in medical education in otolaryngology is investigated in this study. OBJECTIVE: A voluntary online training for the teaching of communication skills was compared with a corresponding face-to-face format. The question of the extent to which acceptance of the two formats and students' self-assessment of their communicative skills differed was investigated. MATERIALS AND METHODS: In the online training, students were prepared for the topic asynchronously via a video. Thereafter, they were able to conduct consultations with simulation patients online and synchronously. The face-to-face training was comparable in structure and duration and took place in an earlier semester. The acceptance of both seminars was assessed by a questionnaire with 19 items on a five-point Likert scale. Self-assessment of communication skills was measured by a 10-cm visual analog scale pre/post with 16 items. RESULTS: Both formats achieved high acceptance with an average score (M) of 2.08 (standard deviation, SD = 0.54) for the online format and M = 1.97 (SD = 0.48) for the face-to-face event. Students' self-assessments of communication skills showed a twofold increase in the online group (M = 1.54, SD = 0.94) compared to the face-to-face group (M = 0.75, SD = 0.87). CONCLUSION: This study shows that teaching communication skills in the online format was well accepted and resulted in significant changes in students' self-assessment of communication skills.

LGBTQIA+ Outness in Otolaryngology Residency Applications.

Lesbian, gay, bisexual, transgender, queer, intersex, and asexual/aromantic (LGBTQIA+) providers improve health outcomes of sexual and gender minority (SGM) patients, which demonstrates the importance of understanding the state of LGBTQIA+ representation at all levels of medical training. The U.S. does not systematically collect sexual orientation and gender identity (SOGI) data from applicants, trainees, and attending physicians, prompting us to wonder whether SGM representation in surgical fields, such as otolaryngology, is adequate. Personal statements submitted to an otolaryngology program from 2019 to 2021 were searched for LGBTQIA+ terms, and those containing LGBTQIA+ terms underwent full text review to determine whether applicants identified themselves as LGBTQIA+. Across these 2 application cycles, the sampled residency program received 928 applications. Only 2 applicants of 928 (0.2%) self-disclosed their LGBTQIA+ identities in their personal statements. These results signify a scarcity of SGM diversity in otolaryngology and warrant deeper exploration into factors preventing residency applicants from self-disclosure of LGBTQIA+ identities.

[Online training for hearing implant surgery : A new approach to otological training. German version]. / Online-Training für Hörimplantatchirurgie : Ein neuer Ansatz in der otologischen Ausbildung.

OBJECTIVE: Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is a need to broaden education facilities in an on-line format. Therefore, a first basic on-line training for otosurgery was developed. MATERIALS AND METHODS: The system consists of an artificial temporal bone model together with a set of basic surgical instruments and implant dummies. As an essential part of the training kit, a high-resolution camera set is included that allows for connection to a video streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, a pre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. RESULTS: Over the three courses held to date, 28 participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of a questionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. CONCLUSION: The presented program of an otosurgical online training allows for basal education in practical exercises on a remote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.

Gender Disparity in Non-ACGME (Accreditation Council for Graduate Medical Education) Otolaryngology Fellowship Leadership.

OBJECTIVE: Women are underrepresented among practicing otolaryngology physicians with increasing disparities in leadership roles and higher levels of professional attainment in academic medicine. The purpose of this study is to determine the gender gap among fellowship directors within specific otolaryngology subspecialties, and how this compares to disparities among all academic appointments held by otolaryngologists. Additionally, we seek to better understand how years practiced, H-index, professorship status, and academic productivity differ between men and women in fellowship director roles. DESIGN: Cross-sectional. Publicly available data from non-ACGME accredited otolaryngology fellowships was collected from department websites and Doximity including gender, years of practice, and professor status of fellowship directors. Scopus was used to find H-index for identified fellowship directors. Fisher's Exact tests were used to determine if significant gender disparity existed between each fellowship and academic otolaryngology as whole. H-index and years of practice were plotted for men and women comparing the slope of lines of best fit as a measure of academic productivity. SETTING: Non-ACGME accredited otolaryngology fellowships in the US. PARTICIPANTS: Fellowship directors in non-ACGME accredited otolaryngology fellowships. RESULTS: Among 174 fellowship positions in our analysis, head and neck (17.3% women), laryngology (17.2% women), rhinology (5.7% women), and facial plastics (8.1% women) had significantly lower overall women representation compared to academic otolaryngology (36.6% women) (p < 0.05). As fellowship directors, women were significantly more productive than men given years practiced and H-index (p = 0.008). CONCLUSIONS: Gender disparities among otolaryngologists are amplified in the role of fellowship directors compared to broader academic otolaryngology. This is true despite women in these roles demonstrating higher academic productivity.

Racial and Ethnic Disparities in Otolaryngology Applicants and Residents: Recruiting a Diverse Workforce.

OBJECTIVE: The purpose of this study is to examine the racial and ethnic representation of otolaryngology applicants and residents and determine if there have been any improvements in recruiting a diverse workforce over the past several years. METHODS: A retrospective study was conducted on self-reported race and ethnicity data of otolaryngology applicants to United States residency programs from 2016 to 2022 from the Association of American Medical Colleges (AAMC) and residents from 2011 to 2022 from the Accreditation Council for Graduate Medical Education (ACGME). The changes in proportions of applicants and residents by race and ethnicity separately was compared as well as the proportion of applicants to residents. Descriptive analyses and chi-square tests were used to compare proportions of groups by race and ethnicity. RESULTS: There was no statistically significant difference in the proportion of applicants by race or ethnicity from 2016-2017 to 2021-2022. There was a decrease in the proportion of White residents from 58.1% to 54.5% from 2011-2012 to 2018-2019. There were higher proportions of White residents than applicants and lower proportions of Black residents than applicants in the two cycles analyzed. In the most recent cycle analyzed, the proportion of Hispanic or Latino residents was higher than the proportion of Hispanic or Latino applicants. CONCLUSION: While there may be improvements to increase representation of otolaryngology applicants and residents, there continues to be inequalities and a lack of diversity. Further initiatives are needed to ensure diversity in the field improves moving forward.

[Multidimensional formats of surgical anatomy in otorhinolaryngology student teaching-a comparison of effectivity]. / Multidimensionale Formate chirurgischer Anatomie in der studentischen Ausbildung der HNO-Heilkunde ­ ein Effektivitätsvergleich.

BACKGROUND: Technological change in healthcare and the digital transformation of teaching require innovations in student teaching in medicine. New technologies are needed to enable the delivery and use of diverse teaching and learning formats by educational institutions independent of time and place. The aim of this study is to analyze the effectiveness of different multidimensional formats in student teaching in surgical ENT medical anatomy. MATERIALS AND METHODS: During the summer semester 2022 and winter semester 2022/2023, the digital teaching and learning program was expanded by testing different visualization formats (3D glasses, cardboards, or VR glasses) with students in the context of a highly standardized surgical procedure, namely cochlear implantation. A pre- and post-intervention knowledge assessment was carried out in all groups, followed by an evaluation. RESULTS: Of 183 students, 91 students fully participated in the study. The post-intervention knowledge assessment showed a significant increase in correct answers regardless of visualization format. In a direct comparison, the operating room (OR) group answered correctly significantly more often than the cardboard group (p = 0.0424). The majority of students would like to see 3D teaching as an integral part of the teaching program (87.9%) and more streaming of live surgeries (93.4%). They see the use of the various technologies as a very good addition to conventional surgical teaching (72.5%), as good visualization (89%) increases retention (74.7%) and motivation (81.3%). CONCLUSION: Application and use of new visualization technologies in everyday clinical practice is a promising approach to expanding student training. Mobile, interactive, and personalized technical formats can be adapted to the learning behavior of students. Last but not least, the use of new media influences learning motivation. An expansion of digital teaching and learning formats can be expressly recommended on the basis of this study.

[Interactive electronic visualization formats in student teaching]. / Interaktive elektronische Visualisierungsformate in der studentischen Ausbildung.

BACKGROUND: In the context of contact restrictions, conventional teaching is currently in need of optimization and expansion. The range of digital teaching formats in student training is very heterogeneous and their effectiveness uncertain. This study aims to investigate the extent to which an electronic ward round can be used as an alternative to the conventional ENT attendance practical course, and whether the use of electronic teaching formats has an influence on the quality of teaching. MATERIALS AND METHODS: Instead of regular attendance practicals, bedside teaching took place once a week in real time as a video stream via tablet. A total of 43 students in the seventh semester (winter semester 2020/2021) were included in the prospective study. Evaluation forms were used to examine the subjective didactic value of different visualization formats for the students. Examination results from previous years were used for comparison. RESULTS: The majority of students reported knowledge gain from the electronic rounds (93.02%) and that they were a good alternative to the traditional attendance clerkship (69.77%). The quality of the video and audio transmission as well as the comprehensibility of the case studies presented were consistently rated as good to very good. The students' examination results tended to be slightly worse in the test group compared to the control students of previous years. CONCLUSION: Integration of innovative interactive visualization options into teaching shows promising prospects as a supplement to conventional face-to-face teaching. The results of this study can contribute to the further expansion of digital teaching. Scaling up this model could be considered especially in countries with limited availability of face-to-face teaching.

Application of the combination of CBL teaching method and SEGUE framework to improve the doctor-patient communication skills of resident physicians in otolaryngology department.

BACKGROUND: To explore the feasibility and effectiveness of applying CBL teaching method and SEGUE Framework in the doctor-patient communication skills of resident physicians in the department of otolaryngology. METHODS: This is an observational study to compare the score changes in doctor-patient communication skills of 120 resident physicians, before and after using CBL combined SEGUE Framework teaching method. The effects of gender, age, grade, educational background and marital status on SEGUE score were analyzed. RESULTS: Through the combined application of CBL teaching method and SEGUE Framework, the SEGUE score of 120 resident physicians was significantly improved. There was no significant difference in SEGUE score among different sex and marital status of resident physicians. SEGUE score is positively correlated with age; Different grades and educational backgrounds have significant effects on SEGUE score. CONCLUSION: The combination of CBL teaching method and SEGUE Framework is feasible and effective in the education program of doctor-patient communication skills for resident physicians in the department of otolaryngology, and worthy of popularization and application in other medical specialties.

[How much digitization do ENT curricula need? : Opportunities and limits from the perspective of students and teachers]. / Wieviel Digitalisierung braucht die HNO-Lehre? : Chancen und Grenzen aus Sicht von Studierenden und Lehrenden.

BACKGROUND: Digitalization has long been an integral part of students' everyday lives and increasingly also of their medical training. It seems to be an unwritten law that "digital natives" want as much digitalization as possible. This study aims to shed more light on how students in the clinical phase of medical studies perceive the increasing digitalization of teaching and what they need for good education. MATERIALS AND METHODS: This study analyzed two surveys that were conducted using an online questionnaire. On the one hand, students in the 5th-9th semesters of the medical faculty at the University of Hamburg (n = 282) were surveyed (survey 1). Another survey addressed all employees of ENT clinics in Germany (n = 175; survey 2). RESULTS: A total of 76 students took part in survey 1 and 123 lecturers in survey 2. The results show that both students and lecturers do not want face-to-face teaching to be completely replaced by digital formats. A total of 72.7% of students reject the possibility of teaching practical skills through digital formats. The majority of students surveyed stated that offline formats improve their concentration (61.1%), participation probability (63.9%), and motivation to learn (76.6%). In contrast, 40.2% of lecturers see digitalization as a way to reduce the workload without any relevant loss in teaching quality. CONCLUSION: Digital teaching formats have a negative impact on the medical education of the students surveyed. Interaction and physical presence are needed to increase the motivation to learn. This leads to the first conclusion that students are critical of the increasing digitalization of medical studies.

Outcomes of Short-Term Surgical Trips in Otolaryngology-Head and Neck Surgery: A Scoping Review.

OBJECTIVE: This scoping review aims to explore the current body of literature to characterize how short-term surgical trips (STSTs) in Otolaryngology-Head and Neck Surgery (OtoHNS) contribute to surgical, educational, and sustainability-based outcomes in low- and middle-income countries (LMICs). We aim to use these data to synthesize aspects of STSTs that are successful with the hopes of shaping future global efforts. DATA SOURCES: Data sources included Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. REVIEW METHODS: A comprehensive search was conducted on several databases from inception to October 14, 2021. We included primary studies exploring any surgical or educational outcomes of global short-term surgical endeavors within LMICs. Data were then extracted to evaluate the heterogenous body of literature that exists, characterizing the surgical, educational, and sustainability-based outcomes. RESULTS: Forty-Seven studies were included in the final analysis. Most publications were focused on surgical interventions (39 of 47; 82.9%); 13 (27.7%) studies included education as the primary aim and 12 (25.5%) considered sustainability a significant aim. Of the 94 first and last authors, there were zero first authors and only one last author with an LMIC affiliation. Twenty-six studies (55%) mentioned that any patients were seen in follow-up, ranging from one day to five years. CONCLUSION: Our scoping review demonstrates that most STSTs have focused primarily on surgical procedures with a lack of appropriate long-term follow-up. However, the available outcome-based information presented helps identify factors that characterize a strong short-term global surgical program. LEVEL OF EVIDENCE: NA Laryngoscope, 134:32-39, 2024.

Building a competitive application: exploring the entry routes and educational choices of otolaryngology higher surgical trainees in the UK.

BACKGROUND: This cross-sectional study investigates the educational background and entry routes of otolaryngology higher surgical trainees in the UK. METHOD: A survey was disseminated to trainees through training programme directors and 60 responses were received. RESULTS: Most trainees decided to pursue otolaryngology early in their training, with 50 per cent making the decision four or more years before applying for a higher surgical traineeship. Similarly, 68.3 per cent of trainees undertook otolaryngology-themed core surgical training, while two-thirds had an otolaryngology rotation during their foundation training. Most trainees (86.7 per cent) were accepted into core surgical training on their first attempt, and 71.7 per cent gained entry to higher surgical training on their first attempt. CONCLUSION: The findings highlight the importance of early exposure to otolaryngology and the pursuit of themed core surgical training programmes for building a competitive application. However, unsuccessful first attempts at core surgical training or higher surgical training should not discourage candidates from pursuing a career in otolaryngology.

Does Geographic Region of Away Rotations Predict Otolaryngology Match Outcomes?

OBJECTIVE: To assess whether the geographic region where medical students complete an away rotation predicts the same site, region-specific, or overall interview offers and match success in otolaryngology. STUDY DESIGN: Cross-sectional. SETTING: US medical schools. METHODS: We queried the Texas Seeking Transparency in Application to Residency database to analyze outcomes of otolaryngology applicants during the 2018 to 2020 and 2022 match cycles. Outcomes included a number of interviews offered, geographic location of interviews, and match results, including region-specific and overall match success rate. RESULTS: Of 455 otolaryngology applicants, 402 (90.3%) completed an away rotation. Among these, 368 (91.8%) were offered an interview and 124 (30.9%) matched to the program where they completed an away rotation. Applicants who completed away rotations outside their home region received more interview offers from that region than those who did not (Northeast: 4.2 vs 2.9; South: 4.3 vs 3.0; Central: 4.8 vs 3.0; West: 3.8 vs 1.6, P < .01 for all). Completing a remote away rotation increased the odds of receiving an interview from and matching within that region. After excluding programs where an away rotation was completed, a remote away rotation increased the odds of receiving an interview in the central and western regions (Central: odds ratio [OR]: 1.2 [1.1, 1.5]); West OR: 1.9 [1.7, 2.2]; and the odds of matching in the western region (OR: 2.9 [1.2, 7.4], all P < .01). CONCLUSION: Away rotations are associated with increased odds of interviewing and matching at that away program, with possible associations across the region, most evident for the West coast.

Knowledge and attitudes surrounding breastfeeding in pediatric otolaryngology: A survey study.

OBJECTIVE: This survey study seeks to understand the knowledge and attitudes of pediatric otolaryngologists around breastfeeding to potentially inform future educational efforts. METHODS: This cross-sectional survey recruited 59 pediatric otolaryngologists from an international WhatsApp group comprising 213 members over a four-week period. Demographics, knowledge, attitudes, and experiences with breastfeeding were investigated using Likert scales. Descriptive statistics and correlational analyses were conducted. Statistical significance was set at p < 0.05. RESULTS: The majority of participants were women (59%) and had children (86%). Most participants and/or their partners breastfed for 4-12 months (67%). Previous breastfeeding education was limited in both medical school (20%) and residency (15%). Most agreed that otolaryngologists should be knowledgeable about breastfeeding (83%), however men respondents felt significantly less comfortable counselling (p < 0.003), addressing difficulties (p < 0.044), and suggesting means to change milk supply (p < 0.007). Knowledge gaps were identified with assessing aspiration risk and airway anomalies. Breastfeeding experience did not significantly influence attitudes and comfort around breastfeeding, or the knowledge of participants. CONCLUSION: While attitudes towards breastfeeding amongst pediatric otolaryngologists are very positive, degrees of comfort and knowledge are more limited, especially amongst men otolaryngologists. Future research should consider exploring the efficacy of educational efforts in Otolaryngology for improving the support offered to breastfeeding dyads.

Language Patterns in Letters of Recommendation for Residency Applicants in Otolaryngology.

OBJECTIVE: Assess for gender and race patterns in agentic and communal language used in letters of recommendation for Otolaryngology-Head and Neck Surgery (OHNS) residency applicants. STUDY DESIGN: Retrospective content analysis. SETTING: Applications from OHNS applications at a single training institution for the 2019 and 2020 match cycles. METHODS: A total of 2283 letters of recommendation for 611 OHNS applicants were analyzed. Applicant and letter writer gender, applicant race and ethnicity, and applicant characteristics including United States Medical Licensing Examination® Step 1 score, research productivity, and medical school rank were extracted. Agentic and communal word use from the letters of recommendation was compared across applicant and writer characteristics using multilevel negative binomial regression modeling. RESULTS: Letter writers use a greater rate of agentic terms when describing applicants who self-identify as Asian (incidence rate ratio [IRR] = 1.16, p < .01) or "Other/not reported" (IRR = 1.23, p < .01) as compared to white applicants. Further, standardized letters of evaluation had significantly more communal language and less agentic language. Although there was an increase in communal language in letters for female applicants compared to male applicants, these gender differences disappeared in the multivariate model. CONCLUSION: Multivariate analysis demonstrated no significant gender-based patterns in the communal or agentic language in letters of recommendation for OHNS residency applicants. However, letters for applicants identifying as Asian or "other/not reported" had more frequent use of agentic terms. Future studies should investigate other components of residency applications to assess how gender and race bias might unfairly influence an applicant's chances at a given program.