For those of you who are avid students of philosophy, you’ll recognize the statement “Life is flux”, which has been attributed to Heraclitus. For the rest of us, we know this because it is something we see every day, ancient philosophers aside. This is certainly apparent to the members of SUO, AADO, and OPDO on a daily basis. We see this everywhere, from our personal to professional lives. Sometimes these are minor adjustments, and other times they are major shifts. If we are not affecting change, then we are adapting to it. For a number of reasons, this seems to be even more prevalent and rapid than in the past.
In recognition of the different ways we affect and adapt to change, this year’s Annual Meeting theme will be, “Paradigm shifts, unified as Otolaryngologists”
Otolaryngologists are among the most innovative and thoughtful members of the House of Medicine. We work with each other, work in concert with other disciplines, have a healing presence in the clinic, treat people with our surgical skills, and lead in different arenas. We are necessarily the agents of change in many aspects of medicine, and often beyond our own specialty. This year’s program will explore how all of us are – or can be – the agents of change in affecting paradigm shifts within and outside of our specialty.
We have already been working towards some paradigm shifts in SUO, as well as AADO and OPDO. Some of these were mentioned in my President’s address from the last newsletter. I’ll outline a few actions below that are in one way or another demonstrative.
One paradigm shift has been to broadly gauge the interest and expertise of our members. I continue to be impressed and amazed at the skills, energy, and engagement of our membership. Our first-ever call for Committee and Program interest was very robust, and we were met with an overwhelming positive response from the membership. We have taken this sizeable list of individuals and their interests, distributed them to the Committee Chairs and Program Committee members, and will use this information to broaden engagement and involvement. If you are not eventually asked to participate in some way or another in this cycle, rest assured that we are seeking ways to have as many members contribute in different ways, and as time progresses.
To encourage an even wider exchange of information and ideas, we are exploring international membership in SUO. There are many ways that our organization could be a resource to academic colleagues in other countries, and ways that we could learn from them. Having international members would not change our focus on issues specific to academic departments in the United States, and we would frame international membership and involvement accordingly. We will keep you apprised.
I would also like to mark another shift by sharing some points from the 2018 Annual Meeting’s Post-meeting Survey, and briefly discuss how we use the information. The overall evaluation of the Annual Meeting was a 4.44, with 92% of respondents reporting either an Excellent (51%) or Good (41%) rating. A score of Average was the lowest score (8%). These scores reflect very positively on the meeting and are mirrored in the free text comments. Content, overall, was very favorably rated. Any areas that were lower in score are evaluated against any free text feedback to learn more. We review these scores and the specific content scores, coupled with free-text feedback, and discuss this with the Executive Committee and Program Committee. The results are also shared with other leaders in the organization who need this information for their roles. Of note, we used and compared the feedback from the 2017 meeting to not only build the content for 2018, but also address aspects of the meeting such as food choices, meeting amenities, and other meeting characteristics. We had some lower scores on food and amenities in the past, and made changes that were met with significant improvement in the scores by respondents. As mentioned, we received excellent feedback on the content from this past meeting, on areas to explore further, and ways that we can improve for the next meeting. We also sought feedback on the newsletter and website, and what we can do to improve them. We continue to seek feedback from all of you, and continue to make changes over the coming year.
With this in mind, another paradigm shift: this year we are planning to offer CME at the Annual Meeting. The membership and leadership of our societies have asked for this, and we plan to offer CME through our partnership with ACS. While there are many opportunities for CME in academia, adding CME further justifies people spending their effort and resources on attending the SUO/AADO/OPDO Annual Meeting. We don’t anticipate that this will change our planned content.
As you peruse this installment of the newsletter, you will see content from within the organization, as well as the first from outside our organization, which reflects the collaborations we are building. This is only the beginning.
These and other shifts will help us continue to grow and evolve as an organization, with the overarching goal to best serve all of you. Furthermore, I hope that you see how much we value your time spent in giving us feedback, answering surveys (on top of so many other surveys), and how your time spent leads to actions on your behalf.
Thank you, again, for your involvement with SUO and for your attention. As always, if I can be of service to you or if you have suggestions for the Society, please do not hesitate to contact me at firstname.lastname@example.org.
Anand K. Devaiah, MD, FACS
President, Society of University Otolaryngologists
Communications Committee Update
Surveys, surveys, surveys…
I am pleased to report on the results of the survey completed after our annual meeting.
Almost 110 individuals responded to the post meeting survey. The majority of attendees were members of one of the societies. Interestingly, the new newsletter was ranked “good” or “average” by 80% of respondent's. This begs the question of what can we do to improve it or is it is been worthwhile. We will be asking the membership that question again later on this month. Some ideas that were generated and that will be addressed and upcoming issues are a forum for discussion concerning the match, committee updates, new initiatives, the ACGME and RRC updates, to list a few. There seems to be a desire for a more in-depth discussion of particular aspects that face us all, such as burnout, wellness, recruitment, and retention. Thanks and a shout out to those that provided these awesome suggestions! The last thing we all need is something else cluttering our email box. We received over three printed pages of suggestions for how to improve the meeting. Your Program Committee and executive leadership groups are studying these and will be integrating many of the excellent suggestions into the upcoming program.
Finally, you will all receive a survey in the near future about membership and communications. This survey is to determine how the SUO can best serve our academic community and our current membership. We are looking to see how we can facilitate the needs of the membership and identify and address current gaps that we have. How can we improve the overall experience of membership?
Furthermore, the Communications Committee which produces this newsletter plans to determine what membership wishes to get out of our endeavor. What is it that you as a member wish to have communicated? Should we proceed with just updates, or should we expand to topics of the month? Would you prefer we not clutter your inbox? While many suggestions and ideas were put forward in the post-meeting survey, we hope to have a fresh appraisal following the membership survey
We all suffer from survey fatigue, but completing the forthcoming membership survey will help determine in which direction we will proceed.
I am pleased to announce that the AAO/AHNS will be coordinating with OPDO and SUO to provide a forum for discussion in an informal setting during a lunch hour break. This is intended for medical students to talk with program directors about the application process of otolaryngology residency and the issues that they may encounter. AADO leadership will be in attendance to discuss with residents and junior faculty members, issues that pertain to the world of academia, promotion, tenure and other concerns that may arise in an informal setting. There will be three to four roundtable open to attendance discussions on Sunday, Monday, and Tuesday during the meeting. Depending on the feedback we receive from attendees, we may consider integrating it as a feature of the annual meeting.
Mark K Wax MD FACS FRCS(C)
Communications Committee, Chair
Gender Disparity Committee Update
The lack of otolaryngology women in senior positions in academics and leadership is not a situation unique to our specialty, although the only surgical specialty with worse statistics is orthopedics. In 2018, for the first time the number of women entering medical school exceeded men and the number of women in Otolaryngology residencies is above 33%, yet there are many departments that have no women on staff and few full professors or Chairs of Otolaryngology that are women.
A recent study, Women in the Workplace 2018, conducted by McKinsey in partnership with LeanIn.Org in its 4th year probes the issues, draws on data from 279 companies employing more than 13 million people, as well as surveys of over 64,000 employees and a series of qualitative interviews. This year the study concluded that, “Progress on gender diversity at work has stalled. To achieve equality, companies must turn good intentions into concrete action”. While the study is business oriented, the findings are applicable to our specialty.
Based on 4 years of data, there were 2 findings became clear. Women remain underrepresented and there needs to be a change in the way women are hired and promoted. Women are underrepresented at every level, and women of color are the most underrepresented group of all, lagging behind white men, men of color, and white women.
Attrition does not explain the underrepresentation of women. Women and men are leaving positions at similar rates, with similar intentions to remain in the workforce. Over half of all individuals plan to stay at their institutions for five or more years, and among those who intend to leave, 81% say they will continue to work. It’s also worth noting that remarkably few women and men say they plan to leave their positions to focus on family.
The two biggest drivers of gender disparity are hiring and promotions. Institutions are disadvantaging women in these areas from the beginning. Although women are completing otolaryngology residencies, they are less likely to be hired in academic positions. At the first critical opportunity for promotion, the disparity widens further. Women are less likely to be promoted into the next level. In business, for every 100 men promoted to manager, 79 women are. Largely because of these gender gaps, men end up holding 62% of manager positions, while women hold only 38%.
This early inequality has a profound impact on the talent pipeline. Starting at the instructor level, there are significantly fewer women to promote from within and significantly fewer women at the right experience level to hire in from the outside. So even though hiring and promotion rates improve at more senior levels, women can never catch up—we’re suffering from a “hollow middle.” This should serve as a wake-up call: until departments close the early gaps in hiring and promotion, women will remain underrepresented.
Full report at https://www.mckinsey.com/featured-insights/gender-equality/women-in-the-workplace-2018?reload
Kathleen Yaremchuk MD, MSA
Gender Disparity Committee, Chair
Spring traditionally signifies new growth. I am excited about the synergistic collaborative opportunities surfacing between the Academy and SUO. President Anand Devaiah, MD and I have identified several areas that can make an immediate impact. The AAO-HNS will provide administrative support for the regional “boot camps” so valuable in onboarding new otolaryngology residents. The academic community will be represented at our Specialty Unity Summit at our spring leadership forum and Academy representatives will be attending this year’s SUO meeting, providing updates on our activities including our clinical data registry Reg-ent.
The last six months have been very busy for Reg-ent. Participation of our academic community has become a reality for those centers using Epic following the introduction of the Orchard app and successful pilot testing at several university sites. We have 22 centers under contract and another 20 in the pipeline to join the registry. We are still working with Cerner to identify a solution for their PHR. Reg-ent is actively seeking out industry partners with data analytic platforms and skills as we move into the next phase of operation that will allow clinical research projects as well as clinical trials. Reg-ent recently submitted an RFP for our first clinical trial and we are finalizing our research infrastructure that will evaluate potential projects for the registry. This is an exciting time for those interested in clinical research projects.
James C. Denneny III, MD
The Association of Academic Departments in Otolaryngology is an organization composed of Departments of Otolaryngology in North America and member Departments are represented by the Chairs. AADO is pleased to offer mentorship to new chairs, assist with leadership development, monitor and maintain relationships with ERAS regarding the Otolaryngology-HNS match, represent Departments in companion organizations and support faculty development by collaboration with SUO and OPDO in program and educational development. The upcoming program of SUO-OPDO-AADO will concentrate on Paradigm Shifts in Academic Otolaryngology and the rapidly evolving clinical and academic environment. In times of rapid change, Academic Otolaryngologist across the continuum of academic rank and title must develop leadership skills to experience success individually and at the organizational level. This year’s program will feature the AADO panel on “The Art of Negotiation.” The panel will explore negotiation of faculty with chair, chair with dean, departments with the academic health center and other facets of negotiation, with the aim of enhancing this important skill for attendees. The SUO-AADO-OPDO Annual Meeting is a true highlight for academic Otolaryngologist. We look forward to learning and expanding our horizons with you in Chicago, November 22-23, 2019!
Jeffrey M. Bumpous, MD, FACS
Update from the Otolaryngology Review Committee
- The review committee name has been changed to the Otolaryngology – Head and Neck Surgery Review Committee to reflect consistency with the newly named American Board of Otolaryngology – Head and Neck Surgery and with the term many of us use describe ourselves.
- John Rhee, MD, MPH and David Terris, MD will complete their terms on the review committee as of June, 2019.
- Boyd Gillespie, MD and Vishad Nabili, MD, have been appointed to the committee as new members and begin their terms on July 1, 2019.
- Liana Puscas, MD, MHS, MA will become chair of the committee as of July 1, 2019 and Alan Micco, MD, will become vice-chair.
- Citali Meza, MPA, is our new accreditation administrator replacing Deidre Williams.
- The ACGME instituted a policy admitting public members to the review committees to help represent the viewpoint of patients and others who are impacted by resident and fellow education. Our new public member is Thomas Worsley, MBA. Mr. Worsley is President of the Spearfish Hospital and Hills Market for Regional Health in Rapid City, South Dakota. He is familiar with graduate medical education having worked in administration at the Medical College of Wisconsin Hospital.
- The review committee continues to work on editing the current case log system for otolaryngology trainees. The updated organization will be anatomically based, classified along progressive categories of complexity, simplified by removal of duplicate codes and expanded to include newer technology. Especially when viewed along subheadings, it will better reflect the operative experience of residents and fellows.
- The review committee is also consolidating plans to capture data regarding clinical management of such diagnoses as newborn hearing loss and complications of otitis media to gain a sense of trainees’ exposures to the workup and treatment of patients whose interventions may not be operative. In the same vein, the review committee is interested in trainees’ performance of in- office procedures such as ultrasound and Epley maneuvers. Final determinations will be made at the April meeting, and the trainees and programs will be notified of these decisions and the process for capturing these data.
Liana Puscas, MD, MHS
Residency Review Committee, Vice Chair
Educational Innovation Committee Update
Since 2014, applications for Otolaryngology-Head and Neck Surgery (OHNS) residency training had been dropping. In fact, in 2017, for the first time in recent memory, the number of applications fell below the number of available spots and 14 available training spots went unfilled after the initial match process. Clearly that trend has changed with the 2018/2019 application pool but it is hard to say whether this past year’s match heralds a resurgence of interest or a blip in the overall down swing of interest. Given the trend since 2014, the Education Innovation Committee was tasked by then SUO president, Howard Francis to put together a panel to discuss medical student recruitment strategies. At the last Society of University Otolaryngologist’s meeting in November of 2018 a panel presentation/discussion was convened consisting of Maxwell Bergman, a 4th year medical student from Georgetown University, Carrie Nieman, MD, MPH - Assistant Professor of – Assistant Professor of Otolaryngology – Head and Neck Surgery, Department Director of Diversity & Inclusion Efforts, Johns Hopkins School of Medicine, Carrie L. Francis, MD – Associate Professor of Otolaryngology – Head and Neck Surgery, Assistant Dean for Student Affairs, University of Kansas and Charles A. Elmaraghy, MD – Associate Professor of Otolaryngology – Head and Neck Surgery and Chief, Division of Pediatric Otolaryngology, The Ohio State University. I had the good fortune to moderate the panel and lead the discussion. Below is a summary of the main discussion points from each of the panelists and Figure 1 presents the audience response to several specific questions related to the topic.
Max presented on the medical student’s perspective on how interest fostered and what resources he used to gather information regarding potential OHNS training programs outside his home institution. Max noted that he had exposure in the first year of medical school to a shadowing opportunity and what sold him on the specialty was interaction with the residents at Georgetown. He felt he, “fit” with the personalities and work ethic of the residents. He outlined the electronic media he accessed to gather information including blog posts, online interviews and “Headmirror” (http://www.headmirror.com) an online resource for interested medical students and residents. Headmirror’s website states, “The goal of headmirror.com is to provide otolaryngology residents and interested medical students a centralized resource for information on specialty and subspecialty choice, tips on a successful match, educational links and resources, as well as dates of important upcoming meetings and events.” Lastly, on advice from his advisor, Sonya Malekzadeh, he gathered additional information and applied for away rotations. Some obstacles that Max encountered involved finding reliable resources for individual programs including information on day to day lives of the residents and the culture of individual departments. He relied on word of mouth for this type of information which was not always easy to obtain. Additional issues included knowing how strong an applicant he was compared to his peers and a sense of how strong geographical ties played in program selection.
In addition to the overall drop in OHNS resident applications, another persistent issue is the lack of underrepresented minority (URM) residents in surgical specialties. OHNS residency programs have some of the lowest numbers of URM residents across surgical specialties, which has largely been unchanged over the past decades. With increasing national diversity and persistent health disparities, increasing the racial/ethnic diversity of physicians, including surgical specialists, is a public health imperative. Mentored clerkship opportunities that target URM medical students may increase the odds of applying to residency in a surgical specialty. Carrie Neiman presented on the unique URM rotation that is available at John’s Hopkins. The Johns Hopkins Department of OHNS was one of the first in the country to create a mentored clerkship diversity initiative in OHNS. This first-in-kind program has been in existence for 10 years and 29 URM medical students from 20 different schools participated in the clerkship since 2008. The clerkship pairs each student with a faculty mentor and students receive a small monthly stipend and registration fees are waived. Based on post-clerkship evaluations, Carrie reported the clerkship was well-received and increased students’ interest in not only applying to an OHNS residency program but also in academic medicine. Of the first 22 students, at least 11 applied to OHNS residency programs and 10 matched successfully with the last 7 students applying to OHNS and 6 successfully matched. Over the past 10 years of the department's diversity efforts, from 2008 to 2018, URM representation increased from 9% in to 15% of total residents within the Hopkins residency, with African American representation increasing from 0% to 8% and Hispanic representation remaining at 8%. The mentored clerkship was so well-received that now all visiting students are assigned a faculty mentor. Overall, a dedicated mentored clerkship in OHNS provides a critical pathway to the needed mentorship and research opportunities for successfully matching in an OHNS residency and supporting the development of future clinician scientists.
Carrie Francis provided information regarding an Assistant Dean’s perspective on making Otolaryngology more visible for the medical students at Kansas. Carrie outlined how they were able to incorporate OHNS exposure into the school of medicine by integrating exposure within the context of their “ACE” curriculum that emphasizes early engagement of students with clinicians. Carrie highlighted the importance of faculty involvement, noting that the OHNS department at KU provided significant academic as well as professional activities within the overall ACE curriculum. She credits this faculty involvement in the more generalized curriculum process as providing early awareness and student integration into the department. Being available to provide career mentoring and coaching to students provided a basis to not only recruit students but also to encourage strong applicants to apply to OHNS as well as target URMs.
Charles Elmaraghy described a unique mentorship program he and colleagues introduced at The Ohio State University several years ago along with data on the effectiveness of this program for engaging medical students at OSU. The program was designed to provide a longitudinal experience over several years with early exposure to the specialty, opportunities for research and development of professionalism. He noted that the program consisted of an application process which involved senior students already in the program, a “match” process to link students with attendings, 8 hours per month of clinic/OR experience, a short didactic series on basic OHNS topics and lifestyle aspects of being an otolaryngologist. This culminated with a final presentation for each student involved in the program to the faculty during one of the grand rounds sessions for the department. Data presented included survey results on student attitudes regarding the experience, anonymous program evaluations and match results over the 3 years the program was in place. 17 faculty members were engaged in the program, survey/evaluations results showed great interest and perceived success of the program and a dramatic increase in interested students and successful matches into Otolaryngology.
Overall, the discussion provided the audience with a diverse overview of the current issues in medical student recruitment, a student’s perspective on the process and several successful programs for engaging students in the field. The audience response was engaging. Time will tell if the 2018/2019 match statistics are an aberration in the downward trend in applications seen since 2014 or an indication that OHNS is back to enjoying its previous steady state as one of the most popular specialties in medicine. Regardless of the trends, it behooves the academic community in OHNS to continue to foster interest among future physicians to keep our specialty thriving. The SUO will continue to provide an excellent forum to discuss this topic and
Gregory J. Wiet, MD, FACS, FAAP
Educational Innovation Committee, Chair
Otolaryngology Program Coordinators Organization Update
The academic cycle continues, and the work truly never ends for good reason. Just as soon as, and in many cases before, the Match concludes coordinators and directors start looking towards sub-internship season and the next batch of prospective residents. Medical student rotations of all types provide a unique opportunity for program coordinators to get a more holistic view of candidates that would otherwise be missed. Don’t be fooled, prospective residents, and current residents, know how to and actively put their best foot forward around the people that will eventually be their colleagues, and department chairs. However, around coordinators they may let their guard down.
Clerkship/Medical student coordinators interact with medical students over a longer period of time, and thus get to see their communication patterns, the frequency of special requests, how they respond to those requests being denied, and the level of support they expect. All these things are good predictors of the kind of residents and professionals these trainees will become. It’s good practice to ask your coordinator to record their impressions of medical students as this information will be invaluable come interview season.
This part of the year can also be one of the busiest and stressful for coordinators as they juggle administratively on-boarding new residents, off-boarding graduating ones, organizing orientation, graduation, summer rotations, and coordinating next the next year’s schedule. It’s also bittersweet as they watch the people they’ve spent years supporting and connecting with graduate. Coordinators will rarely ask their directors for help with their work, because they know that while they may consider themselves busy, it’s no comparison to the workload of a program director. Directors and faculty looking to help their coordinators survive this season can advocate for more support for their coordinator within their department, and convey their genuine appreciation for the work they do. Both of these small acts can go a long way.
Otolaryngology Program Coordinators Organization