Abstract
The field of otolaryngology–head and neck surgery is rapidly changing, and surgical education must keep pace. In the face of recent advances in medical knowledge, surgical technique, and novel technology, educators may find it increasingly difficult to identify the evolving educational needs of otolaryngology residents. To better align training activities with modern practice patterns, we propose conducting a longitudinal needs assessment by designing a standardized specialty-specific survey for practicing otolaryngologists. This recurring survey could be implemented alongside accreditation or other continuing medical education activities. The outcomes would report what contemporary otolaryngologists see and do in everyday practice to guide educational reforms to better prepare trainees for future practice.
Keywords
The goal of surgical education is to prepare trainees for independent practice, but the scope of otolaryngology practice has expanded dramatically over the past 2 decades. Robotic, endoscopic, and various other minimally invasive surgical techniques have become increasingly commonplace. Novel devices and broadening indications for both surgical and medical therapies have been discovered in every subspecialty domain. The landscape of medical practice has also evolved as employment patterns have trended toward practice consolidation. 1 These changes have created new learning opportunities but also new challenges as the time for surgical training is limited. As a result, educators must continually change program curricula to match both changing standards of care as well as residents’ educational needs.
Increasingly, surgical educators may find it hard to answer the following question: what are the educational needs of modern otolaryngology residents? Presently, training program metrics such as the Accreditation Council for Graduate Medical Education’s Common Program Requirements and board certification requirements focus on the activities of training with no specific correlates to future practice. How can we know that training programs’ internally and externally designed milestones and requirements are consistent with trainees’ future practice success? As the model of residency training shifts toward competency-based medical education, we propose that a foundational needs assessment for otolaryngology training must be conducted to better align training activities with future practice.
Data on the following should be collected:
Where do graduates practice and in what settings?
Which patient populations do they serve?
What diagnoses do they encounter and routinely manage?
What procedures are performed?
What is the balance of patient care, research, and administrative time?
How do practices change over time (with support from which sources of continuing medical education)?
Implementing a Novel Needs Assessment Survey
Cross-sectional surveys have been conducted in other fields, including plastic surgery, 2 occupational medicine, 3 and ophthalmology. 4 These efforts have led to improved understandings of the strengths and weaknesses of each specialty’s training in preparing graduates to transition to clinical practice. For example, in 2007, a survey of early career ophthalmologists found that 60% of respondents felt poorly prepared for nonclinical aspects of practice such as practice management or knowledge of different practice setting models. 4
Although they are informative, one-time surveys are not sufficient. We need a more rigorous way to assess training outcomes as our specialty evolves to inform ongoing process improvement strategies for surgical education. Looking for inspiration in other specialties, the Association of Family Medicine Residency Directors and the American Board of Family Medicine have jointly implemented a nationalized graduate survey since 2016. 5 By incorporating a short questionnaire into the Board’s maintenance of certification activities, diplomates are surveyed 3 to 4 years after graduating from training and then approximately every 5 years thereafter. The survey was designed by diverse stakeholders through multiple rounds of pilot testing. 5 Questions focused on 4 content areas: practice and work schedule, adequacy of training and scope of practice, satisfaction, and professional activity. In 2017, residency-specific results were shared with training programs from the inaugural survey.
Otolaryngology could benefit from a similar survey to show residency programs, specialty medical organizations, and educational researchers how to better serve trainees by aligning their educational experiences with modern practice patterns. Although trainees will need to remain knowledgeable regarding a broad range of diagnoses and procedures, a more nuanced understanding of what is essential to the training of comprehensive otolaryngologists may be helpful in designing educational reforms. Similarly, identifying which areas of our specialty might be considered elective and better delegated to fellowship training, or continuing medical education may streamline core educational experiences during residency.
All stakeholders would benefit from access to comprehensive assessments of the outcomes of training. Programs would receive continuous feedback from graduates to improve curricula, and current residents would benefit from training that is more tailored to their projected future practices. Trainees would also receive information about modern practice settings, helping them formulate career plans in the presence of shifting opportunities within the job market. Specialty societies would be able to better advocate for their constituents and organize continuing medical education opportunities that target emerging needs. Medical education researchers could also access anonymized data to conduct novel interventions.
Challenges
Although a standardized survey of graduates has significant potential to improve otolaryngology surgical education, the paucity of similar surveys in other surgical fields to reference may make it challenging to design. A call for such assessments has been discussed for various medical specialties, 6 but each specialty will need to invest resources to create custom surveys that adequately capture the workplace experiences of their graduates across practice settings. Once such a survey is created, distribution must be linked to accreditation or another mandated activity such that high response rates can minimize sampling bias. Once collected, survey results may be sensitive in nature, and care must be taken to preserve respondent confidentiality. In the future, the analysis of survey outcomes could correlate the practices experiences of otolaryngology graduates with the broader societal needs of patients and communities, but determining the latter may be an even more challenging endeavor than the present proposal.
Conclusion
A recurring survey of graduates of otolaryngology training programs would serve as an ongoing needs assessment for postgraduate education in our field. A comprehensive data source that reports what contemporary otolaryngologists see and do in day-to-day practice will help guide educational reform to better prepare trainees to transition from training to independent practice.