Comparison of scholarly impact among surgical specialties: An examination of 2429 academic surgeons

Objectives/Hypothesis

The h‐index, a bibliometric indicator that objectively characterizes the impact of an author's scholarship, is an effective tool that may be considered by academic departments for decisions related to hiring and faculty advancement. Our objective was to characterize the scholarly productivity of academic surgeons from different specialties relative to otolaryngologists.

Study Design

Analysis of a bibliometric database.

Methods

The h‐indices of 2,429 faculty members within surgical specialties at 20 randomly selected academic institutions were calculated using the Scopus database and were examined to determine relationship with academic rank and comparison among surgical subspecialties.

Results

The h‐index statistically increased with academic rank. Mean h‐indices were as follows: assistant professor, 4.37 (range, 2.73–6.69); associate professor, 8.70 (6.53–11.02); professor, 16.44 (13.39–20.45); and chairperson, 20.79 (14.81–27.89). Mean increase between academic rank was 5.47, with the largest increase between the levels of associate professor and professor. Further examination demonstrated statistically significant increases through all academic ranks for most, but not all, individual specialties. Urologists, general surgeons, and neurosurgeons had the highest mean h‐indices.

Conclusions

h‐indices among the different surgical specialties vary and are potentially impacted by the number of practitioners as well as research emphasis within a field. The mean h‐index of academic otolaryngologists falls in the lower values for academic surgeons. Because this metric varies among different fields, it is most relevant for comparison when examining values within a field. H‐indices reliably increase with increasing academic rank through professor and offer a quantifiable and objective alternative to other metrics when evaluating faculty members for academic advancement.     

Is NIH funding predictive of greater research productivity and impact among academic otolaryngologists?

Objectives/Hypothesis:

The h‐index is an accurate and reliable indicator of scholarly productivity that takes into account relevance, significance, and influence of research contributions. As such, it is an effective, objective bibliometric that can be used to evaluate academic otolaryngologists for decisions regarding appointment and advancement. In this study, we evaluate the impact of NIH funding on scholarly productivity in otolaryngology.

Study Design:

Analysis of bibliometric data of academic otolaryngologists.

Methods:

Funding data for the 20 otolaryngology departments with the largest aggregate total of NIH grants for the fiscal years (FY) 2011 and 2012 was obtained using the National Institutes of Health Research Portfolio Online Reporting Tools Expenditures and Reports (RePORTER) Database. H‐indices were calculated using the Scopus online database, and then compared to funding data at both the departmental and individual level.

Results:

Faculty members in otolaryngology departments who received NIH funding had significantly greater research productivity and impact, as measured by the h‐index, than their nonfunded peers. H‐indices increased with greater NIH funding levels, and investigators with MD degrees tended to have higher mean NIH funding levels than those with PhDs. While there was no correlation between average h‐index and NIH funding totals at the level of departments, there was greater correlation upon examination of NIH funding levels of individual investigators.

Conclusions:

The h‐index has a strong relationship with, and may be predictive of, grant awards of NIH‐funded faculty members in otolaryngology departments. This bibliometric may be useful in decisions regarding appointment and advancement of faculty members within academic otolaryngology departments. Laryngoscope, 2013     

Burnout in academic faculty of otolaryngology-head and neck surgery

Objective/Hypothesis: To characterize burnout in academic faculty of otolaryngology—head and neck surgery. To identify associated modifiable factors to reduce burnout and improve the health of the field. Study Design: Mailed survey. Methods: A cross section of US academic otolaryngologists was sampled through a mailed survey. Content included the Maslach Burnout Inventory‐Human Services Study (MBI‐HSS) and questions assessing potential burnout predictors such as demographic information, professional stressors, satisfaction, self‐efficacy, and support systems. Results: Burnout was common among academic otolaryngologists. High burnout was observed in 4% of faculty, moderate burnout in 66%, and low burnout in 30%. Women experienced a statistically higher level of emotional exhaustion than men. In addition, associate professors were significantly more burned out than full professors and microvascular surgeons were notably more burned out than all other subspecialists. The strongest predictors of burnout were dissatisfaction with the balance between personal and professional life, low self‐efficacy, inadequate research time, and inadequate administration time. A significant association was seen between high burnout and likelihood to leave academic medicine within the next 1 to 2 years. Conclusions: Burnout was prevalent among US academic otolaryngologists, although levels were lower than those of otolaryngology chairs and residents. Modification of risk factors, such as allowing sufficient faculty time for research and administrative activities, should be undertaken to curb the development of burnout and its deleterious sequelae.     

Geographic differences in academic promotion practices,fellowship training,and scholarly impact

Purpose

Previous literature described how clinical fellowship training impacts scholarly production among academic otolaryngologists, finding that fellowship-trained practitioners had higher research productivity than their non-fellowship-trained peers, and head and neck (H&N) surgeons and otologists had the highest scholarly impact. In this analysis we investigate whether geographic differences in academic promotion and scholarly impact exist, and whether such differences are associated with emphasis on regional fellowship training patterns.

Methods

The Scopus database was used to determine scholarly impact (as measured by the h-index) of 1109 academic otolaryngologists from 97 departments. Online faculty listings were organized by fellowship training, academic rank, and location.

Results

Fellowship-trained practitioners had greater research productivity than non-fellowship-trained otolaryngologists (H = 9.5 ± 0.26 SEM vs. 6.5 ± 0.43, p < 0.001), a finding that persisted throughout except in the Mountain and East South Central Regions. H&N surgeons and otologists had the highest h-indices. Practitioners in the West had the highest h-index, with differences persisting upon examination of junior faculty. The West (62.1%) and Midwest (60.5%) had the highest proportions of senior faculty. Regional differences in scholarly impact and academic promotion were further noted upon organizing faculty by subspecialty fellowship training.

Conclusions

Geographic differences in academic promotion and scholarly impact exist, most markedly among junior faculty. Practitioners in the West had high impact and were more represented at senior ranks. Upon examination by fellowship training status, fellowship-trained otolaryngologists had higher impact in most, but not all, geographic regions. Regional variations in promotion were noted upon organizing faculty by subspecialty, although association with scholarly impact differs by region.     

Tobacco intervention teachable moments for pediatric otolaryngologists: Atopy and second hand smoke exposure among children

Objectives

Pediatric otolaryngology clinics have tremendous access to children with allergic conditions, yet no research has evaluated in this setting environmental tobacco smoke and the occurrence of atopic diseases.

Methods

Caregivers or parents of 201 consecutive patients in a Hungarian pediatric otolaryngology clinic were queried on otolaryngologic conditions; self-reported diagnoses of atopic diseases; and tobacco smoke exposure.

Results

A history of asthma was reported in 10.3% of children; 38.7% had at least one parent who smoked. Fifteen out of the 20 children with asthma (75.0%) had at least one parent who smoked. Having a diagnosis of hay fever and having a parent who smoked greatly increased the odds of having a diagnosis of asthma.

Conclusions

Second hand smoke exposure among children in an otolaryngology clinic was common, and was associated with co-existing atopic conditions. Pediatric otolaryngologists have an important opportunity to address parental smoking as part their care of children.     

Pectus excavatum in children with laryngomalacia

Background

Laryngomalacia is the most common congenital laryngeal anomaly and is associated with several disorders including gastric reflux, sleep apnea, hypotonia and failure to thrive. Pectus excavatum (PE) is the most common chest wall deformity affecting 1–300/1000 individuals. Though many authors presume a relationship between PE and laryngomalacia, there is no published data to establish this association.

Goal

To test the hypothesis that patients referred to our pediatric otolaryngology clinic for evaluation of laryngomalacia exhibit higher rates of PE than the general population.

Methods

Retrospective review of prospectively enrolled children who presented with laryngomalacia (January 2008–June 2012) to a tertiary care, hospital based, pediatric otolaryngology practice. Each chart was examined for a concurrent diagnosis of pectus deformity.

Results

Of the 137 laryngomalacia patients, 9 (6.6%) had documented PE. This represents a significantly increased rate of PE when compared to children without laryngomalacia (p = 0.001). Four of the 9 children with PE underwent supraglottoplasty for laryngomalacia, a significantly greater proportion than the 9/128 of the children with isolated laryngomalacia who underwent supraglottoplasty (p = 0.004).

Conclusions

This study suggests an association between laryngomalacia and PE. Pediatric otolaryngologists should be cognizant of this relationship, though further studies are needed to elucidate the nature of this association.     

Otolaryngology sleep medicine curriculum objectives as determined by sleep experts

Purpose

(1) Ascertain the most important concepts and topics for otolaryngology resident education in sleep medicine and surgery, as determined by faculty who teach sleep medicine to otolaryngology residents. (2) Create learning objectives within the area of otolaryngologic sleep medicine in order to design a sleep medicine curriculum for otolaryngology residents.

The financial impact of clinic no-show rates in an academic pediatric otolaryngology practice

Purpose

To investigate determinants of no-show rates in an academic pediatric otolaryngology practice including appointment time, age, sex, new patient status, payer mix, and median household income by zip code.

Otolaryngology consultation tracheostomies and complex patient population

Purpose

To assess for the differences in patients undergoing tracheostomy by the otolaryngology consult service versus other specialties.

Factors predictive of an academic otolaryngologist’s scholarly impact

ObjectivesDescribe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact. Identify which otolaryngology subspecialties are the most scholarly. Describe if NIH funding to one’s choice of medical school, residency, or fellowship has any impact on one’s scholarly output. Determine other factors predictive of an academic otolaryngologist’s productivity.Study designAnalysis of bibliometric data of academic otolaryngologists.MethodsActive grants from the National Institutes of Health (NIH) to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database. Faculty listings from these departments were gleaned from departmental websites. H index was calculated using the Scopus database.ResultsForty-seven otolaryngology programs were actively receiving NIH funding. There were 838 faculty members from those departments who had a mean h index of 9.61. Otology (h index 12.50) and head and neck (h index 11.96) were significantly (P < 0.0001) more scholarly than the rest of subspecialists. H index was significantly correlative (P < 0.0001) with degree of NIH funding at a given institution. H index was not significantly higher for those that attended medical school (P < 0.18), residency (P < 0.16), and fellowship (P < 0.16) at institutions with NIH funding to otolaryngology departments.ConclusionsH index is a bibliometric that can be used to assess scholarly impact. Otology and head and neck are the most scholarly subspecialists within otolaryngology. NIH funding to an individual’s medical school, residency, or fellowship of origin is not correlative with one’s scholarly impact, but current institutional affiliation and choice of subspecialty are.     

The accuracy of citation and quotation in otolaryngology/head and neck surgery journals1

A high rate of errors of citation and quotation has been reported in the publications of many medical specialties. The aim of this study was to determine the prevalence of citation and quotation errors in otolaryngology/head and neck surgery journals. A retrospective analysis was performed based on the first issue for 1997 of each of four journals: Laryngoscope;Annals of Otology, Rhinology and Laryngology;Clinical Otolaryngology; and Journal of Laryngology and Otology. A sample of 50 references from each journal was randomly selected and each was checked for accuracy against the original referenced paper. Citation errors were categorized as major, intermediate or minor and quotation errors as major or minor. Citation errors occurred in 37.5% of the references, 11.9% of which were considered major errors. Quotation errors occurred in 17%, with 11.1% major errors. This prevalence is similar to the established error rate in medical literature.     

Impact of the pediatric tonsillectomy and polysomnography clinical practice guidelines

Objective

To evaluate the effect of the recently published guidelines on Tonsillectomy in Children and Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children on physician practice patterns.

Study design

Cross-sectional survey.

Method

Survey of members of the American Academy of Otolaryngology—Head and Neck Surgery.

Setting

Academic tertiary referral center.

Results

A total of 280 physicians completed the survey, with a response rate of 41.7%. 93% of respondents had read the clinical practice guidelines. Many respondents had completed a pediatric otolaryngology fellowship (46%). A large group of physicians (46%) continue to prescribe antibiotics within 24 h after surgery. One-third of respondents stopped prescribing antibiotics because of the guidelines. Discord between severity of symptoms and tonsil size was the most common reason cited for ordering a polysomnogram prior to tonsillectomy (76%). The most common reason cited for admission post-tonsillectomy was age less than 3 (40%). Less than half of physicians prescribe NSAIDs for pain control (43.8%) despite its safety profile, and only 23% reported that the guidelines influenced their use of NSAIDs postoperatively. Most respondents use intra-operative steroids (90%) as recommended.

Conclusion

The guidelines are intended to provide evidence based direction in tonsillectomy practices and improve referral patterns for polysomnography prior to tonsillectomy. The majority of the surveyed otolaryngologists reviewed these guidelines and some have changed their practice secondary to the guidelines. However, many physicians continue to prescribe post-operative antibiotics and do not use NSAIDs.     

Additional heterozygous 2507A>C mutation of WFS1 in progressive hearing loss at lower frequencies

Objectives/Hypothesis:

To describe the audiological profiles in a Japanese family with autosomal dominant hereditary sensorineural hearing loss (SNHL) and to identify the causative gene.

Study Design:

A family study at an academic tertiary referral center.

Methods:

A family with autosomal dominant hereditary SNHL was enrolled. Hearing loss (HL) of affected members showed mid‐frequency SNHL in childhood and progressed at lower frequencies with age, resulting in low‐frequency SNHL. To understand the pathology of HL of this family, we performed a genetic analysis of WFS1, TECTA, and GJB2 by direct sequencing, and further audiovestibular examinations, including speech audiometry, distortion product otoacoustic emissions, electrocochleography, auditory brainstem responses, and electronystagmography for some affected members.

Results:

A heterozygous A‐to‐C nucleotide transversion (c.2507A>C), resulting in a lysine‐to‐threonine substitution at codon 836 (K836T) was identified in exon 8 of WFS1. K836T was segregated with HL in the 15 participants in the genetic study but was not detected in the 212 normal chromosomes. Only polymorphic changes were detected in TECTA and GJB2. Audiovestibular examinations indicated purely cochlear HL and normal vestibular function. The summating potential/action potential ratios in electrocochleography increased in the bilateral ears of the proband.

Conclusions:

The family described with autosomal dominant inheritance of K836T of the WFS1 gene demonstrates a progressive hearing loss in the lower frequencies. Laryngoscope, 2010     

The rhinology experience in otolaryngology residency: a survey of chief residents

Objectives: The development of rhinology as a distinct subspecialty is based on recent advances in the research, clinical, and surgical aspects of the field. The impact of this evolution on the rhinologic experience in otolaryngology residency programs is not currently understood. Methods: An anonymous, web‐based survey of chief residents in otolaryngology residency programs was performed. Participants were asked to rate their residency experience in rhinology in terms of didactics, research opportunities, mentorship availability, clinical care, and surgical experience on an ordinal 5‐point Likert scale with higher scores representing more favorable responses. Results: Forty‐eight respondents completed the survey, yielding a response rate of 17.6%. The overall experience in rhinology was reported as positive (4.3 points). The individual items with statistically lower scores included availability of basic science research (P = .04), comfort level with the medical management of unusual rhinologic issues (P = .0006), and comfort level with advanced sinus procedures (P < .0001). However, overall ratings were high, and even the poorer‐scoring items were still rated favorably. In programs with rhinology fellowships, basic science opportunities were reported as being higher (P = .04) than programs without fellowships. There were no other statistically significant differences in programs with rhinology fellowships. There was no correlation between responses and future career choice. Conclusion: The overall residency training experience in rhinology appears to be positive, and presence of a rhinology fellowship appears not to have a negative impact on resident rhinologic training.     

Burnout and well‐being in otolaryngology trainees: A systematic review

ObjectiveTo comprehensively review the recent published literature to characterize current trends of burnout and well‐being among otolaryngology trainees.MethodsStudy design: systematic review and meta‐analysis. A comprehensive literature review from 2000 to 2021 of studies related to otolaryngology resident burnout and well‐being, as well as the general topic of well‐being among surgical residents was completed. All included studies were summarized qualitatively. For the quantitative analysis, only articles reporting a Maslach burnout inventory (MBI), modified MBI or Mini‐Z‐ Burnout assessment were included.ResultsTwenty‐five articles were included in the qualitative summary and nine articles in the quantitative analysis. In the qualitative summary, trainees were reported to have increased levels of distress and emotional hardening compared to attending otolaryngologists. Total hours worked per week and female gender were associated with worsened well‐being. Residency program strategies to improve trainee well‐being include program‐sponsored wellness activities, dedicated wellness champions, and assistance with clerical burden. Implementation of protected nonclinical time has been shown to decrease burnout and increase well‐being among trainees. Moreover, formal trainee mentorship programs have also been shown to reduce trainee burnout and stress. In the quantitative analysis, rates of trainee burnout ranged from 29.7% to 86% with an overall trend towards reduced rates of burnout from 2006 to 2021. Utilizing a weighted average, the overall burnout among otolaryngology residents was 58.6%.ConclusionsRates of burnout remain high among otolaryngology trainees. Implementing formal mentorship programs and providing protected time during regular work hours appear to be effective tools to improve resident well‐being.     

Factors predictive of an academic otolaryngologist’s scholarly impact

ObjectivesDescribe the h index as a bibliometric that can be utilized to objectively evaluate scholarly impact. Identify which otolaryngology subspecialties are the most scholarly. Describe if NIH funding to one’s choice of medical school, residency, or fellowship has any impact on one’s scholarly output. Determine other factors predictive of an academic otolaryngologist’s productivity.Study designAnalysis of bibliometric data of academic otolaryngologists.MethodsActive grants from the National Institutes of Health (NIH) to otolaryngology departments were ascertained via the NIH Research Portfolio Online Reporting Tools Expenditures and Reports database. Faculty listings from these departments were gleaned from departmental websites. H index was calculated using the Scopus database.ResultsForty-seven otolaryngology programs were actively receiving NIH funding. There were 838 faculty members from those departments who had a mean h index of 9.61. Otology (h index 12.50) and head and neck (h index 11.96) were significantly (P < 0.0001) more scholarly than the rest of subspecialists. H index was significantly correlative (P < 0.0001) with degree of NIH funding at a given institution. H index was not significantly higher for those that attended medical school (P < 0.18), residency (P < 0.16), and fellowship (P < 0.16) at institutions with NIH funding to otolaryngology departments.ConclusionsH index is a bibliometric that can be used to assess scholarly impact. Otology and head and neck are the most scholarly subspecialists within otolaryngology. NIH funding to an individual’s medical school, residency, or fellowship of origin is not correlative with one’s scholarly impact, but current institutional affiliation and choice of subspecialty are.     

Historical patterns in presentations at the American Society of Pediatric Otolaryngology (ASPO): Using a searchable database of the ASPO Program to show the trends of an otolaryngology subspecialty

Objectives

•

To describe the development of American Society of Pediatric Otolaryngology (ASPO).

•

To utilize a searchable database of meeting programs to demonstrate content presented at a major meeting since its inception.

•

To utilize a searchable database of meeting programs to show trends of pediatric otolaryngology.

Methods

Programs of ASPO meetings from 1986 to 2011 were reviewed using a searchable database. Number of podium presentations and length of podium presentations per meeting were collected. Podium presentations were placed into broad categories from reviewing presentation title. Broad categories included tonsils and adenoid, otology, airway, head and neck masses, and sinus disease. First author, location of first author, length of presentation, and publication status were collected for each podium presentation.

Results

An average of 49 (range 31–76) podium presentations were presented at each meeting. The average length of podium presentation was 8.3 min (range of 5–20 min). Tonsil and adenoids made up 9% (range 0–22%) of the program, otology made up 26% (range 15–44%) of the program, airway made up 34% (18–48%) the program, head and neck masses made up 8.7% (0–18.5%) of the program, sinus disease made up 6.2% (0–23%) of the program. Fifty-four percent (54%) of podium presentations were published.

Conclusion

This is a unique example of utilizing searchable databases constructed from published programs of a major otolaryngology meeting to assess topics presented and areas of emphasis. The areas of emphasis at ASPO over its 26 years are airway, otology, tonsil and adenoid issues, head and neck masses, and sinus disease in the pediatric population. Percent of time given to each topic has changed from ASPO's beginning to today.     

The otolaryngologic manifestations in children with eosinophilic esophagitis

Objectives

(1) To describe the incidence of eosinophilic esophagitis (EoE) in the population of patients undergoing esophagoscopy with biopsy by a pediatric otolaryngology service. (2) To elucidate the demographics, presenting symptoms, and endoscopic findings in children with EoE.

Design

Case series.

Patients/methods

The reports of esophageal biopsy specimens taken over 5 years in 2429 patients were reviewed. Ninety-two patients who received their initial diagnosis of EoE by the pediatric otolaryngology service with specimens showing 15 or greater eosinophils per high power field (HPF) were included.

Interventions

The demographic data, history, presenting symptoms, and endoscopic findings were reviewed retrospectively for the patients.

Main outcome measure

The percentage of children diagnosed with EoE of all children undergoing esophageal biopsy.

Results

A total of 92 children were diagnosed with EoE (3.8% of total children biopsied). The mean age at biopsy was 4.4 years, much lower than previously reported in the literature (approximately 8 years); 73% were boys and 27% girls. The main presenting symptom was cough (46%) followed by hoarseness, throat clearing, burping/vomiting, and abdominal pain. Forty three percent had a history of asthma and 17% a history of GERD. Half of patients had esophageal edema, a third were normal, and only a quarter had mucosal furrowing on endoscopic examination.

Conclusions

EoE is increasingly diagnosed as a clinical entity with a distinct symptom profile and etiology. Increased understanding of EoE and its predisposing factors requires a multidisciplinary approach to diagnosis and management involving the pediatric otolaryngologist.