Otolaryngology Training Examination Research Articles

Flipping the Otolaryngology Didactics Curriculum: Results of a Novel Resident Course Structure.

To assess the impact of a novel flipped-classroom (FC) otolaryngology resident didactic curriculum on resident learning. Based on the preferences elicited in a survey of preferred learning styles of residents, a hybrid web-based and in-person FC otolaryngology didactic curriculum was implemented over a 6-month period in 2020-2021. Resident reactions to the new curriculum were assessed via a second survey. Kruskal Wallis tests were used to compare mean stanine scores on the Otolaryngology Training Examination (OTE) exam for topics taught in the new format with topics delivered in the old format. After instituting the curriculum reform, engagement in at least a moderate amount of the pre-didactic work and synchronous case discussions was reported by 67% and 88% of the residents, respectively. After the curriculum change, residents in years PGY2 and above reported statistically significant increases in self-reported ability to retain information from didactics, to feel prepared for the OTE, and to feel confident in fund of knowledge (p < 0.001, p=0.004, and p=0.004, respectively). Compared to the prior year, mean stanine increased on OTE scores for residents in years PGY2-PGY5 to a statistically significant degree (5.45 vs. 4.41, p=0.001) for the topics delivered in the new format compared to topics delivered in the traditional format (5.13 vs. 4.70, p=0.07). By organizing a didactic curriculum through online modules that incorporate pre-recorded lectures and external resources, residents reported and demonstrated improved knowledge retention. NA Laryngoscope, 133:2129-2134, 2023.

Fellow selection protocols in sleep surgery: a national survey of sleep surgery program directors.

To determine the factors that sleep medicine/surgery fellowship program directors look for in applicants. Program directors from 9 sleep medicine/surgery fellowship programs in the USA were sent an anonymous online survey. They were asked to select the five most important academic factors (of a list of 17) when evaluating potential fellowship candidates, then rank those five in order of importance. They were then asked to do the same for the most important subjective criteria (of a list of 12). Eight of 10 survey responses met inclusion criteria. Of the academic factors, strength of letters of recommendation, reputation of letter writer, and letters from sleep surgeons ranked highest. As for the subjective criteria, faculty assessment of the applicant on interview was ranked highest, followed by initiative and personality "fit" with the program. The reputation of an applicant's residency was ranked as more important than the reputation of their medical school. An applicant's performance in residency was assessed as more predictive of their performance in fellowship than performance during the interview process or position on the rank order list for the match. Only one program has a United States Medical Licensing Examination (USMLE) Step, and a different program has an Otolaryngology Training Examination (OTE) score cutoff. Letters of recommendation and interview are the most important factors in the selection process for hybrid sleep medicine and surgery fellowship programs, followed by research and residency program reputation. Sleep surgery-specific experience is helpful.

Otolaryngology Resident Well-Being and Perceptions of the Clinical Learning Environment

To measure the current state of organizational and well-being factors in otolaryngology residency programs and associate these perceptions with demographics, pursuit of subspecialty fellowships, and performance on the Otolaryngology Training Examination (OTE). Anonymous mail and online survey study of otolaryngology residents from the Southern, Mid-Atlantic, and East South-Central Regions of the United States. A total of 46 otolaryngology residents across 14 residency training programs (22% resident response rate) completed our survey. Residents who scored above the 80th percentile on the OTE perceived greater organizational support (median = 3.84) than residents who scored below the 40th percentile (median = 3.31), U = 48.00, P = .047, η2 = 0.14. Residents interested in fellowship reported less burnout (median = 2.44) compared to those who did not plan to pursue fellowship (median = 3.56), U = 105.00, P = .010, η2 = 0.05. Residents pursuing fellowship also reported less work-life strain (median = 2.56) than those forgoing fellowship (median = 2.89), U = 126.00, P = .044, η2 = 0.10. Residents with children reported greater work-life strain (median = 3.11) compared to those without (median = 2.56), U = 60.50, P = .008, η2 = 0.15. For otolaryngology residents in this survey sample, the perception of organizational support and well-being may influence resident performance (on OTE examinations) and ultimate career goals (fellowship applications). Program directors and coordinators can use this information to strengthen the perceptions of organizational support as well as improve the clinical learning environment to optimize training conditions for their residents. Residency program directors can also use the identified study measures to assess resident perceptions of the clinical learning environment and well-being for annual evaluation and improvement purposes.

Are Otolaryngology Milestones Predictive of Otolaryngology Training Examination Scores?

Otolaryngology residents take the otolaryngology training examination (OTE) yearly to assess their fund of knowledge. The Accreditation Council for Graduate Medical Education (ACGME) milestone evaluations are also conducted semiannually. Accurate prediction of training examination performance allows identification of residents who are performing well and those who need targeted remediation. Prior studies in other specialties have attempted to use milestone evaluations to help predict in-training examination scores. In this study, we aim to identify whether ACGME milestone evaluation scores predict OTE performance. Milestone ratings and OTE scores for residents at 2 US otolaryngology residency programs were collected. Multivariate analysis was achieved using linear mixed modeling. We considered a 2-tailed P value of ≤ .05 as statistically significant. Two US otolaryngology residency programs. Forty-eight otolaryngology residents postgraduate years 2 to 5. Otolaryngology training examination scores and ACGME milestone evaluations were collected from 48 residents from postgraduate year 2 to 5 between the years 2014 and 2017. One hundred eight OTE scores were available. Linear mixed-effect models were constructed, and after adjusting for level of training and OTE year, the total milestone rating made a negligible impact in estimating OTE percentage correct (β = -.01, P = .9). Similarly, total milestone rating demonstrated a minimal contribution in approximating OTE national stanine score after adjusting for the level of training (β = -.003, P = .9). In our study, ACGME milestone evaluations are not predictive of residents' OTE performance. What these milestone evaluation data mean and how they should be used continues to be an unanswered question. We should aim to identify the most effective applications of the milestone data collected yearly by otolaryngology programs.

Junior otolaryngology resident in-service exams predict written board exam passage.

The purpose of this study was to assess the association between the Otolaryngology Training Examination (OTE) taken during residency and the passage rate of first-time examinees on the American Board of Otolaryngology-Head and Neck Surgery Written Qualifying Examination (WQE). Retrospective cohort study using a de-identified database containing information on examinees who took the WQE in 2007 through 2014, and examinees who took the OTE exam 2005 through 2014. A total of 2,214 otolaryngology residents took the WQE for the first time in 2007 through 2014 after taking the OTE during residency training. Data were analyzed using one-way frequencies and table analyses. Logistic regression was used to model the relationship between the pass/fail WQE result and the OTE stanine. Data transformations were used to analyze WQE passage as a function of OTE scores. There is a significant relationship between OTE score and passage of the WQE on the first attempt, evident even for junior residents. The probability of passing the WQE on the first attempt is 97% if the resident scores in the top six stanines of the OTE during residency training compared to 71% to 79% if the examinee scores in the bottom three stanines. There is a significant relationship between performance on the OTE and passing the WQE on the first attempt. Because this relationship is evident even in the first years of residency, it allows early identification of those with a higher chance of failing the WQE so that extra efforts can be undertaken to prepare for the WQE. 3 Laryngoscope, 129:124-128, 2019.

The impact of a resident-run review curriculum and USMLE scores on the Otolaryngology in-service exam

ObjectiveDescribe the association of USMLE Step 1 scores and the institution of a dedicated board review curriculum with resident performance on the Otolaryngology training examination. Study designRetrospective cross sectional study. MethodsWe reviewed American Board of Otolaryngology Training Examination (OTE) scores for an otolaryngology residency program between 2005 and 2016. USMLE Step 1 scores were collected. In 2011 a resident-run OTE review curriculum was instituted with the goal of improving test preparation. Scores were compared before and after curriculum institution. Linear regression was performed to identify predictors of OTE scores. Results47 residents were evaluated, 24 before and 23 after instituting the curriculum. There was a moderate correlation between USMLE step 1 scores and OTE scores for all years. For PGY-2 residents, mean OTE scores improved from 25th percentile to 41st percentile after institution of the review curriculum (p = 0.05). PGY 3–5 residents demonstrated no significant improvement. On multivariate linear regression, after controlling for USMLE step 1 scores, a dedicated board review curriculum predicted a 23-point percentile improvement in OTE scores for PGY-2 residents (p = 0.003). For other post-graduate years, the review curriculum did not predict score improvement. ConclusionUSMLE step 1 scores are moderately correlated with OTE performance. A dedicated OTE review curriculum may improve OTE scores for PGY-2 residents, but such a curriculum may have less benefit for intermediate- and senior-level residents. Level of evidence4.

National trends in otolaryngology intern curricula following Accreditation Council for Graduate Medical Education changes.

In 2016, Accreditation Council for Graduate Medical Education (ACGME) requirements for curriculum and resident experiences were modified to require entering postgraduate year (PGY)-1 residents to spend 6 months of structured education on otolaryngology-head and neck surgery (ORL-HNS) rotations. We aimed to determine how ORL-HNS training programs have adapted curricula in response to 2016 ACGME curriculum requirement changes. Survey study. A national survey of ACGME-accredited ORL-HNS programs was distributed via the Otolaryngology Program Directors Organization. Thirty-seven program directors responded (34.9%). Most common ORL-HNS rotations included general otolaryngology (80.6% of programs, up to 6 months) and head and neck oncology (67.7%, up to 4 months), though more months are also spent on other subspecialty rotations (laryngology, otology, rhinology, and pediatrics) than previously. All programs continue at least 1 month of anesthesiology, intensive care unit, and general surgery. Programs have preferentially eliminated rotations in emergency medicine (77% decrease) and additional months on general surgery (48% decrease). Curricula have incorporated supplemental teaching modalities including didactic lectures (96.3% of programs), simulation (66.7%), dissection courses (63.0%), and observed patient encounters (55.5%), to a greater degree following ACGME changes. More interns are involved in shared call responsibilities than in previous years (70.4% vs. 51.8%). A stable minority of interns take the Otolaryngology Training Examination (approximately 20%). New ACGME requirements have challenged ORL-HNS training programs to develop effective 6-month rotation schedules for PGY-1 residents. Significant variation exists between programs, and evaluation of first-year curricula and readiness for PGY-2 year is warranted. NA Laryngoscope, 1811-1816, 2018.

Association of Fellowship Training With Otolaryngology Training Examination Scores

No prior studies have evaluated whether residents who pursue fellowship training achieve higher performance on the Otolaryngology Training Examination (OTE) and whether a specific fellowship will demonstrate a correlation with the corresponding specialty-specific OTE score. To determine whether residents pursuing fellowship training achieve higher performance on the OTE and whether fellowship choice is correlated with higher scores on the related subspecialty section of the OTE. This retrospective analysis included 35 residents training in an academic otolaryngology residency program from July 1, 2003, to June 30, 2014. The OTE scores for postgraduate years 2 through 5 and the type of fellowship were collected for all residents meeting inclusion criteria. Data were collected from September 1 to October 15, 2014, and analyzed from October 16 to December 1, 2014. Residents were divided by whether they pursued fellowship training and by the type of fellowship chosen. Outcome measures included comparison of scores between residents who pursued vs those who did not pursue fellowship training and comparison of subspecialty OTE scores between residents who pursued the corresponding fellowship and those who did not. Of the 35 residents who met the inclusion criteria (24 men and 11 women), 17 (49%) pursued fellowship training. The 3 most common fellowship choices were facial plastic and reconstructive surgery, pediatric otolaryngology, and rhinology (4 residents each [24%]). For all residents, mean scores on the OTE improved each subsequent training year, but this difference was only significant between postgraduate years 2 and 3 (from 60.9% to 68.6% correct; P < .001). Residents who pursued fellowship training did not perform better than those who did not (mean correct responses in postgraduate years 2-5, respectively, 59.6% vs 62.6% [P = .40]; 67.6% vs 71.2% [P = .33]; 71.2% vs 72.0% [P = .71]; and 71.4% vs 73.7% [P = .20]). Among residents who pursued the most common fellowships, no correlation was found between postgraduate year 5 scores on the related subspecialty section compared with the rest of the study group (mean correct responses for facial plastic and reconstructive surgery, 72.5% vs 74.7% [P = .67]; for pediatric otolaryngology, 72.9% vs 71.3% [P = .79]; and for rhinology, 72.2% vs 71.2% [P = .91]). Residents who pursued fellowship training did not achieve higher scores on the OTE in any examination year compared with residents who did not pursue fellowship training and did not achieve higher scores within the OTE section that matched their chosen subspecialty in their last year of training. Fellowship choice does not appear to influence OTE scores among residents.

Free online otolaryngology educational modules: a pilot study.

Otolaryngology residents need concise, easily accessible modules to expand educational opportunities between surgical cases. These modules should be inexpensive to create and improve learning outcomes. The purpose of this pilot study was to assess whether otolaryngology residents at multiple institutions used online video modules to supplement their studying for the Otolaryngology Training Exam, whether the modules had any effect on their Otolaryngology Training Examination Scores, and to obtain survey feedback about the modules. This randomized trial was conducted in 3 academic departments of otolaryngology in the United States among 37 residents enrolled in 3 otolaryngology residency programs. Residents were randomized into 2 groups, one with access to the educational modules and the other with no access. Otolaryngology training examination scores were obtained from the year prior to the intervention (2012) and the year following module access (2013). Residents with access to the modules were also surveyed to assess use and obtain feedback about the modules. Otolaryngology training examination scores improved significantly from 2012 to 2013 among both residents who had access to the modules and those who did not in the sections of head and neck, laryngology, and sleep medicine. However, scores in the sections of pediatric otolaryngology (8% increase, P = .03), otology (7% increase, P = .02), and facial plastic surgery (10% increase, P = .02) improved from 2012 to 2013 only among residents with access to the modules. All respondents rated the videos as very helpful, with a rating of 4 of 5 on a Likert scale. Online otolaryngology educational modules are an inexpensive way to expand resident learning opportunities. Despite the lack of quantifiable improvement in otolaryngology training examination scores in this study, use of online modules sends a message to otolaryngology residents that their education is a priority; self-study outside the hospital and clinics is necessary and expected; and that instructors are willing to try more nontraditional or progressive forms of education to increase resident knowledge.

A learner‐centered educational curriculum improves resident performance on the otolaryngology training examination

To examine the effects of a learner-centered educational curriculum for Johns Hopkins otolaryngology-head and neck surgery residents in improving their otolaryngology training examination (OTE) scores. We hypothesized that trainees who attend a learner-centered program demonstrate improved performance on OTEs. Prospective longitudinal study. In September 2008, a resident-designed educational curriculum was implemented to better prepare residents for their OTE. These mandatory sessions, led by faculty members, were held for an hour every week, during in which residents were tested on their knowledge of high-yield topics. Residents were expected to be prepared on pathophysiology, diagnosis, and treatment of the selected diseases. In 2011, residents were given responsibility to lead these sessions. OTE scores from 2002 to 2012 were analyzed to see whether there was any improvement after the implementation of this curriculum. Clustered linear regression analysis revealed significant improvement of OTE scores with subsequent interventions. During a 3-year period (2009-2011) after the first intervention, there was a significant increase (P = .01) of 0.69 in mean national and 0.78 in mean group stanine scoring. Similarly, after the second intervention in 2011, a further increment of 1.36 in mean national and 1.58 in mean group stanine scoring was seen (P = .001). Residents OTE stanines improved significantly after the implementation of a learner-centered educational curriculum. This finding suggests that trainees are able to perform better when involved in planning and implementing the educational curriculum.

Early detection of factual knowledge deficiency and remediation in otolaryngology residency education

Within otolaryngology residency training, the annual Otolaryngology Training Examination (OTE) is the primary method used to assess, quantify, and compare the factual knowledge acquired by each resident. The objective of this study was to develop a more frequent method for tracking of factual knowledge to prevent educational delay. Retrospective analysis of educational scores. For each didactic lecture within a single otolaryngology residency training program, multiple choice questions were provided before and after each lecture. Questions were based on lecture objectives that were derived from the American Board of Otolaryngology curriculum. Scores were tracked over the course of 1 academic year and compared to the scores of residents on the OTE administered in that year to determine correlation with a validated measure of factual knowledge. The effect of remedial measures on improvement in OTE scores was determined. Over the course of 1 academic year, there were 328 questions presented to 12 residents before and after 32 lectures in the didactic program. Ten residents completed an average of 244 questions. Overall OTE scores demonstrated a significant and very strong correlation to lecture question scores (Pearson r = 0.86, P = .002). Remedial measures for residents during the previous 5 years who had inadequate OTE scores were successful in improving scores (P = .002). A structured didactic program that uses review questions to assess knowledge can be used to track acquisition of factual knowledge. Early identification of residents with deficiencies facilitates the development of individualized learning plans that result in successful remediation.

USMLE step one, otolaryngology in-training examination scores, and the American Board of Otolaryngology examination performance

To determine if U. S. Medical Licensure Examination (USMLE) Step One scores have a positive correlation with performance on the annual Otolaryngology Training Examination (OTE) and subsequent performance on the American Board of Otolaryngology (ABOto) examination. A retrospective cohort study of 70 residents completing Otolaryngology residencies from 2005-2009. 103 otolaryngology training programs were contacted and USMLE Step 1 scores, OTE scores, and performance on the ABOto examination were collected for the graduating chief residents from 2005-2009 from a limited number of residency programs. The associations between the examinations were evaluated using Spearman\'s rank correlation coefficient and Pearson’s correlation. USMLE Step 1 scores and board performance were provided for 70 residents from 7 Otolaryngology residency programs. Positive correlations were found using Pearson’s and Spearman’s correlation to be significant for USMLE Step 1 scores compared with scores on the OTE-2, OTE-3, OTE-4, OTE-5 (p

Otolaryngology Resident In‐Service Examination Scores Predict Passage of the Written Board Examination

The purpose of this study was to assess the association between the Otolaryngology Training Examination (OTE) and the passage rate of first-time examinees on the American Board of Otolaryngology (ABOto) Written Qualifying Examination (WQE). Historical cohort study. De-identified database containing information on examinees who took the WQE in 2007 to 2011 and the OTE in 2005 to 2011. One thousand three hundred nine otolaryngology residents took the WQE for the first time in 2007 to 2011 and the OTE in their final and penultimate years of training in 2005 to 2011. Data were analyzed using 1-way frequencies and table analysis. Logistic regression was used to model the relationship between the pass/fail WQE result and the OTE percentile score in the final and penultimate years of training. Data transformation was used to analyze WQE passage as a function of OTE scores by deciles and quartiles. There is a significant relationship between OTE score and passage of the WQE on the first attempt. The probability of passing the WQE on the first attempt is 97% if the resident scores in the upper 3 quartiles of the OTE in the final and penultimate years of training compared with 70% if the examinee scores in the bottom quartile both years. Residents who score in the bottom quartile in both their final and penultimate years of training are at significantly higher risk of failing the WQE on the first attempt. Remediation efforts should be focused on these individuals.

Inservice Exam Predicts Written Board Passage

Objective: Determine if there is any association between the Resident Otolaryngology Training Examination (OTE) score and the pass rate on the American Board of Otolaryngology (ABOto) Written Qualifying Examination. Method: Data from the 2005 to 2009 OTE and the 2007 to 2010 ABOto Written Examination were available for comparison. Odds ratio, chi-squared test of independence, and logistic regression were used to determine the relationship between OTE score and passage of the written ABOto examination. Results: The proportion of Board examination failures for those whose OTE score was in the bottom 10th percentile is 25%. Proportion of Board examination failures for those whose OTE score was above the 10th percentile is 7.29% ( P = &lt; .0001). Odds ratio analysis revealed that every 10 point increase in percentile corresponds to an estimated 50% increase in odds of passing the examination on the first attempt (OR = 1.54, SE = 0.08; CI = 1.39, 1.71). Logistic modeling showed no significant association for year of exam or cohort of residents. Conclusion: There is a significant association between a lower score on the OTE and increased failure rate on the first attempt at the ABOto Written Qualifying Examination.

Four years of accreditation council of graduate medical education duty hour regulations: Have they made a difference?

Measure compliance with the Accreditation Council of Graduate Medical Education (ACGME) residents' work hour regulations and evaluate their impact on patient care and residents' performance on the Otolaryngology Training Examination (OTE). Retrospective review of an otolaryngology residency program's resident duty hours violations and OTE scores, and review of the associated hospital's benchmark patient data. Residents' duty hour violations were compiled and analyzed for individual violation, postgraduate year (PGY), and service in the program. Annual OTE scores and the department's hospital benchmark measures (inpatient mortality, inpatient length of stay, 30-day readmission rate) were compared before and after the institution of the ACGME duty hours mandate. The 10-hour rule was most frequently violated; residents on the oncology service and PGY-2 year were most commonly in violation. There was no difference before and after institution of the ACGME duty hours mandate in 30-day hospital readmission rates (P = .42), hospital mortality index (P = .55), length of stay (P = .55), OTE scores (P = .11, Student's t test), and graduating resident's operative volume. Institution of the ACGME duty hour regulations did not improve patient care as measured by the 30-day readmission rate, inhospital mortality, and patient's length of stay. Residents' performance on the OTE did not change after implementation of the ACGME rules. Further studies are warranted to assess the impact of the ACGME work hour regulations on patient care and resident-physicians' training.