Factors that inform the career choice of medical students: implications for otolaryngology

Knowledge of the factors that inform the career choice of medical students may help plan the workforce for medical specialties. To determine which factors inform the career choice of medical students we carried out a survey of medical students at the start of their educational block in Otolaryngology. Of 202 questionnaires handed out 169 were returned (84 per cent). Students were asked to rank factors according to their importance in their career choice. The single most important factor was career progression. Other factors include on-call commitment, teachers as role models, and the interest for a particular subject. At the present time progression from senior house officer grade to specialist registrar grade in Otolaryngology is delayed. If this issue is not addressed the influx of applicants into Otolaryngology training programmes will be reduced, limiting the pool from which candidates can be chosen for a career in Otolaryngology.     

Clinical assessment of balance: normative data, and gender and age effects

The purpose of this study was to provide age specific normative data of clinical gait and balance tests and to determine to what extent gender contributes to differences in postural control. Standing balance and walking performance was tested in 318 asymptomatic adults. The logistic regression, using both 10- and 30-second time limits as a dichotomization point, revealed a significant age effect for standing on foam with eyes closed, tandem Romberg with eyes closed (TR-EC), and one leg stance (eyes open and closed). The actual effect of decline was different for each test. Both tandem gait and dynamic gait index showed a ceiling effect up to 60 years of age, with a rapid decline of performance for subjects in their seventies. Linear regression equations indicated that for both men and women, timed up and go test (TUG) times increased with age, but even older subjects should perform the TUG in 10 seconds or less. Women performed significantly poorer on the TUG and TR-EC (30-second time limit).     

The gender gap in a surgical subspecialty: analysis of career and lifestyle factors

BACKGROUND: Although the percentage of women in surgical subspecialties is increasing, little is known about the experiences of these women compared with their male counterparts. OBJECTIVE: To identify career and lifestyle factors that distinguish female otolaryngologists. DESIGN, SETTING, AND PARTICIPANTS: Otolaryngologists were asked to respond to a confidential 119-item questionnaire. The instrument was sent to all 502 female members of the American Academy of Otolaryngology-Head and Neck Surgery who had finished their residency training and were practicing medicine. For response comparison, the survey was mailed to 2 male otolaryngologists who were matched to each female survey recipient for years since completion of training, geographic region, and practice type. RESULTS: Of the 673 respondents (52.6% response rate), women were more likely to be divorced or separated (P =.001) and have fewer children (P <.001). In contrast to men, women reduced their work hours in conjunction with having more children (P <.001). Controlling for professional hours and hours spent in the operating room per week, type of practice, and years since completion of residency, women earned 15% to 20% less per year than men (P <.001). Men relied more on their spouse or partner for household responsibilities and child care (P <.001), and 34.3% of the women (compared with 7.1% of the men) spent 21 to 40 h/wk on household management (P <.001). CONCLUSION: Although male and female otolaryngologists receive equal training opportunities, women earn less money for performing similar jobs and have increased family responsibilities, which may effect their career advancement.     

Influence of age and gender in the sensory analysis of balance control

Postural control is achieved through the integration at the central nervous system level of information obtained by the visual, somatosensory and vestibular systems. Computerized dynamic posturography and the Sway Star system are both used to carry out sensory analysis. The purpose of this study was to determine the influence of sex and age on sensory analysis, measured with these two systems, and to compare their results. A prospective trial was conducted with 70 healthy individuals (average age: 44.9 years) uniformly distributed in seven age groups, who underwent postural study with both systems. We used SPSS 16.0 for statistical study: comparison of means test for influence of gender and age and Pearson’s correlation test (p < 0.05). Gender variable had no influence. The influence of age in vestibular input was found to be significant with both posturography systems, while visual input was only found to be significant with the Sway Star. The results with the two systems were not comparable. Sensory contribution does not remain stable throughout life. Visual information decreases with age, reaching a minimum at 40–49 years, and may correspond to the deterioration of eyesight with age. Propioceptive information showed no statistically significant changes, and several forms of treatment might correct the deterioration of this system. Vestibular information reaches a maximum in the 40–49 years age group in an attempt to compensate for visual deterioration, and decreases again in subsequent decades. This may be due to aging of the vestibular system and the difficulty in its correction.     

Letters of recommendation to an otolaryngology/head and neck surgery residency program: their function and the role of gender

Objectives/Hypothesis: To ascertain common features and gender differences in letters of recommendation (LORs) for applicants to an otolaryngology/head and neck surgery (OHNS) residency program. Study Design: Retrospective review. Methods: Seven hundred sixty‐three LORs submitted to one OHNS residency program in 2006 were reviewed. Results: All 763 letters “recommended” the applicant for OHNS residency. Ninety‐one percent of letters were written by men, 68.4% by male otolaryngologists (OTOs), 4.2% by female OTOs, and 33% by OHNS department chairs or division chiefs (100% men). A comparison of female and male letter writers revealed five categories with significant differences: female letter writers were more likely to call an applicant a “team player” (P = .000), “compassionate,” (P = .001) and use strings of adjectives (P = .024). In contrast, they were less likely when compared with male letter writers, to mention an applicant's personal life (P = .003), or write “letters of minimal assurance” (P = .035). Evaluation of the letters by applicant gender revealed two findings: letter writers were more likely to use a gender term in letters for male applicants (P = .004), and male letter writers were more likely to make reference to a female candidate's physical appearance (P = .040). Conclusions: LORs for OHNS residency universally advocate for the applicant. The letters are writtenpredominately by the highest‐ranking male OTOs in academic medicine. In the LORs, male and female applicants are described similarly. Male and female letter writers, however, often describe applicants in different ways regardless of applicant gender.     

Shared decision-making in pediatric otolaryngology: Parent,physician and observational perspectives

ObjectiveTo describe physician and parent behavior during pediatric otolaryngology surgical consultations, and to assess whether perceptions of shared decision-making and observed behavior are related.MethodsParents of 126 children less than 6-years of age who underwent consultation for adeontonsillectomy or tympanostomy tube insertion were prospectively enrolled. Parents completed the Shared Decision-Making Questionnaire-Patient version (SDM-Q-9), while surgeons completed the Shared Decision-Making Questionnaire-Physician version (SDM-Q-Doc) after the consultation. Visits were video-recorded and analyzed using the Roter Interaction Analysis System to quantify physician and parent involvement during the consultation.ResultsPerceptions of shared decision-making between parents (SDM-Q-9) and physicians (SDM-Q-Doc) were significantly positively correlated (p = 0.03). However, there was no correlation between parents' perceptions of shared decision-making and observations of physician and parent behavior/involvement (proportion of physician socioemotional talk, task-focused talk, or proportion of parent talk). Surgeons' perceptions of shared decision-making were correlated with physician task-focused talk and proportion of parent talk.ConclusionsParents and physicians had similar perceptions of the degree of shared decision-making to be taking place during pediatric otolaryngology consultations. However, there was variability in the degree to which parents participated, and parent perceptions of shared decision-making were not correlated with actual observed involvement.     

Research in otolaryngology: Nih support and other considerations

The National Institutes of Health continue to provide support for a major portion of biomedical research in this country. Research serves as the keystone to the continued health of Otolaryngology, but there are clear indications that otolaryngologists' direct involvement in research is diminishing at a dangerous pace. Some of the causes of this problem are identified. Solutions include, first and foremost, more general recognition of the importance to the speciality of biomedical research; currently available mechanisms offered by the National Institute of Neurological and Communicative Disorders and Stroke for the support of investigator training might be utilized more extensively and collaborative research between clinician and basic science investigators should be encouraged.     

Management of Jehovah's Witnesses in otolaryngology, head and neck surgery

It is imperative that surgeons should have some knowledge and understanding of the beliefs of Jehovah's Witnesses to respect the patient's wishes and effectively minimize and manage blood loss. The objective of this review was to provide a management strategy for Jehovah's Witness patients undergoing otolaryngology, head and neck surgery, because there is paucity of information regarding this within our literature. A systematic review of medical literature was conducted. Articles were identified using MEDLINE (1966-2007). The search strategy used Medical Subject Heading terms Jehovah's Witnesses, Beliefs, Ethical and Legal issues, Blood transfusion alternatives, ENT, Head and Neck surgery in Jehovah' witnesses. There is a broad range of nonblood surgical management strategies available in other specialities, making major surgery possible within this population. This review suggests recommendations in elective surgery, trauma, and emergencies.     

Food hypersensitivity in otolaryngology. Manifestations, diagnosis, and treatment.

Diet hypersensitivity may be "allergic," that is, caused by some form of immunologic reaction, or nonallergic. The latter includes chemical pharmacologic, enzymatic, or dietary disorders. Food allergies may be immediate Gell and Coombs type I reactions (5%), or delayed "serum sickness" type reactions (95%). The latter type is influenced by frequency of exposure. Any inflammation of the intestinal tract allows abnormal absorption of more allergenic food megamolecules. Manifestations of food allergy seen frequently by the otolaryngologist are legion, afflicting all areas of the discipline's concern. Diagnostic techniques rely on singly or some combination of history taking, challenge testing, and skin testing. The intracutaneous progressive dilution food test is the standardized skin test procedure now taught by the American Academy of Otolaryngic Allergy. Treatment techniques include specific dietary abstinence, a rotary diversified diet, and neutralization immunotherapy.