Otolaryngology Away Subinternships: An Analysis of the Application Process and Survey of Current Applicants' Perspectives

Objective: To assess the availability and uniformity of application information for away subinternships and survey 4th-year medical students on their experiences obtaining away subinternships in otolaryngology-head and neck surgery (OHNS) during the 2022 to 2023 application cycle. Study Design: Cross-sectional study. Setting: Online survey. Methods: The Association of American Medical College's Visiting Student Learning Opportunities (VSLO) program was queried for information on OHNS away subinternship applications. A survey assessing 4th-year medical students' perceptions of the away subinternship application process was distributed via OHNS residency program directors and Otomatch. Results: Of 129 OHNS residency programs, 103 (80%) offered away subinternship opportunities on VSLO. Variability in application release dates (January 18 to June 3, 2022), offer release dates (January 27 to August 7, 2022), and estimated cost (22-5,500 dollars) were found. The most common application requirements were a transcript (98.1%) and a CV/resume (90.3%). There were 64 survey respondents, for a 13% response rate. The most common concerns include applying to too few programs (80%) and not knowing offer release dates (77%). The most common stressors include choosing a number of programs to which to apply (48%) and cost (35%). The majority (76%) reported difficulty finding updated information on program websites. Among the proposed changes, the greatest support was found for having all applications on VSLO (88%), uniform application release date (84%), and uniform application requirements (82%). Conclusion: The OHNS away subinternship application process is a significant source of anxiety for medical students due to the tremendous variability in application and acceptance procedures. Having all applications on VSLO, uniform application requirements, and uniform application opening and offer release dates would better facilitate this process.</p

Regional distribution in female representation in US otolaryngology faculty

Objectives: To quantify the current proportion of women in otolaryngology at different levels of professorship and determine whether these proportions differ by US region. Methods: Academic rank and gender at all ACGME-accredited otolaryngology programs in the United States were determined from departmental websites, Doximity, and LinkedIn from November 2021 to March 2022. Individuals were then further organized using US Census Bureau-designated regions. Results: Among the 2682 faculty positions at 124 ACGME-accredited programs, women held 706 (26.3%) of these positions. Female representation was highest at the assistant professorship level, with women holding 286 (37.2%) positions out of a total 769. At the associate professorship level, women held 141 (27.6%) of the 511 total positions. The largest gender disparity is seen at the full professorship level; only 69 (13.6%) positions out of 508 were held by women. Out of every region and rank, only assistant professorship in the West had no significant difference in percentages of men and women (p = .710). Female representation of professors in the Northeast was significantly lower than that of our reference group (the South; β = −10.9, p = .020). Conclusions: Otolaryngology has exhibited great progress in increasing female representation, with assistant professorship in the West reaching gender parity. However, the gender gap at other faculty levels still leaves much to be desired, particularly in senior ranks. The lack of otolaryngologists at senior ranks is detrimental to mentorship of junior faculty, residents, and medical students. Renewed efforts should be made to decrease the gender disparity in the South, Northeast, and particularly at the professorship level.</p

Advice and perspectives from navigating the couples match in otolaryngology: A qualitative pilot study

Introduction: There is a lack of qualitative analysis of the personal experiences within Couples Matching. In this qualitative study, we aim to record personal attitudes, reflections, and advice on experiences with the Couples Match process. Methods: Our survey, consisting of two open-ended questions regarding the experience of Couples Matching, was distributed from January 2022 to March 2022 via email to 106 otolaryngology program directors across the nation. Survey responses were analyzed iteratively using the constructivist grounded theory to construct themes related to pre-match priorities, match-related stressors, and post-match satisfaction. Themes were developed inductively and refined iteratively as the dataset evolved. Results: 18 Couples Match residents responded. In response to the first question: “What was the most difficult part of the process for you and/or your partner?”, we identified the following themes: cost and financial burden, increased stress on the relationship, sacrificing top choices, and finalizing the match list. In response to the second question: “Using your experience as a previous applicant, what advice would you give to another couple planning on couples matching?”, we identified four common themes: compromise, advocacy, dynamic conversations, and applying broadly. Conclusion: We sought to understand the Couples Match process through the perspective of previous applicants. Analyzing the views and attitudes of Couples Match applicants, our study captures the most challenging aspects of the experience and highlights possible areas to improve advising for couples, including important factors to consider when applying, ranking, and interviewing.</p

Intestinal Tissues Induce an SNP Mutation in <i>Pseudomonas aeruginosa</i> That Enhances Its Virulence: Possible Role in Anastomotic Leak

The most feared complication following intestinal resection is anastomotic leakage. In high risk areas (esophagus/rectum) where neoadjuvant chemoradiation is used, the incidence of anastomotic leaks remains unacceptably high (∼10%) even when performed by specialist surgeons in high volume centers. The aims of this study were to test the hypothesis that anastomotic leakage develops when pathogens colonizing anastomotic sites become in vivo transformed to express a tissue destroying phenotype. We developed a novel model of anastomotic leak in which rats were exposed to pre-operative radiation as in cancer surgery, underwent distal colon resection and then were intestinally inoculated with Pseudomonas aeruginosa, a common colonizer of the radiated intestine. Results demonstrated that intestinal tissues exposed to preoperative radiation developed a significant incidence of anastomotic leak (>60%; pP. aeruginosa compared to radiated tissues alone (0%). Phenotype analysis comparing the original inoculating strain (MPAO1- termed P1) and the strain retrieved from leaking anastomotic tissues (termed P2) demonstrated that P2 was altered in pyocyanin production and displayed enhanced collagenase activity, high swarming motility, and a destructive phenotype against cultured intestinal epithelial cells (i.e. apoptosis, barrier function, cytolysis). Comparative genotype analysis between P1 and P2 revealed a single nucleotide polymorphism (SNP) mutation in the mexT gene that led to a stop codon resulting in a non-functional truncated protein. Replacement of the mutated mexT gene in P2 with mexT from the original parental strain P1 led to reversion of P2 to the P1 phenotype. No spontaneous transformation was detected during 20 passages in TSB media. Use of a novel virulence suppressing compound PEG/Pi prevented P. aeruginosa transformation to the tissue destructive phenotype and prevented anastomotic leak in rats. This work demonstrates that in vivo transformation of microbial pathogens to a tissue destroying phenotype may have important implications in the pathogenesis of anastomotic leak.</p

Intestinal Tissues Induce an SNP Mutation in <em>Pseudomonas aeruginosa</em> That Enhances Its Virulence: Possible Role in Anastomotic Leak

<div><p>The most feared complication following intestinal resection is anastomotic leakage. In high risk areas (esophagus/rectum) where neoadjuvant chemoradiation is used, the incidence of anastomotic leaks remains unacceptably high (∼10%) even when performed by specialist surgeons in high volume centers. The aims of this study were to test the hypothesis that anastomotic leakage develops when pathogens colonizing anastomotic sites become <em>in vivo</em> transformed to express a tissue destroying phenotype. We developed a novel model of anastomotic leak in which rats were exposed to pre-operative radiation as in cancer surgery, underwent distal colon resection and then were intestinally inoculated with <em>Pseudomonas aeruginosa,</em> a common colonizer of the radiated intestine. Results demonstrated that intestinal tissues exposed to preoperative radiation developed a significant incidence of anastomotic leak (>60%; p<0.01) when colonized by <em>P. aeruginosa</em> compared to radiated tissues alone (0%). Phenotype analysis comparing the original inoculating strain (MPAO1- termed P1) and the strain retrieved from leaking anastomotic tissues (termed P2) demonstrated that P2 was altered in pyocyanin production and displayed enhanced collagenase activity, high swarming motility, and a destructive phenotype against cultured intestinal epithelial cells (i.e. apoptosis, barrier function, cytolysis). Comparative genotype analysis between P1 and P2 revealed a single nucleotide polymorphism (SNP) mutation in the <em>mexT</em> gene that led to a stop codon resulting in a non-functional truncated protein. Replacement of the mutated <em>mexT</em> gene in P2 with <em>mexT</em> from the original parental strain P1 led to reversion of P2 to the P1 phenotype. No spontaneous transformation was detected during 20 passages in TSB media. Use of a novel virulence suppressing compound PEG/Pi prevented <em>P. aeruginosa</em> transformation to the tissue destructive phenotype and prevented anastomotic leak in rats. This work demonstrates that <em>in vivo</em> transformation of microbial pathogens to a tissue destroying phenotype may have important implications in the pathogenesis of anastomotic leak.</p> </div

Scanning electron microscopy (SEM) images of anastomosis tissues.

<p>Blue arrows indicate healed anastomosis (30x), intact intestinal epithelium (300x), and macrophages on epithelial surface (3,500x) in group II. Orange arrows indicate discontinuity near or at the anastomosis (30x), disrupted intestinal epithelium (300x), and a high degree of bacterial colonization/adherence at the edge of non-healed anastomoses (5,000x). 50 images from each group of 5 mice were obtained, and representative images are displayed.</p

Wound healing assay.

<p>The P2 strain recovered from anastomotic tissues (<i>in vivo</i>) and the P2 strain recovered after co-incubation of MPAO1 with anastomotic tissues (<i>ex vivo</i>) similarly destroy wounded epithelial IEC-18 monolayers.</p

SNP mutation in <i>MexT</i> is responsible for P2 phenotype.

<p>(A) Genome DNA sequence comparative map of <i>P. aeruginosa</i> MPAO1-P1 and MPAO1-P2 at the DSM-1707 backbone annotated with the MexT locus. Grey and teal bands: annotated coding regions; red tick: location of MexT locus; green ticks: tRNAs; black ticks: rRNAs; inner circle GC content. (B–D) swarming motility in (B) MPAO1-P1 (P1), (C) MPAO1-P2 (P2), and (D) MPAO1-P2 in which <i>mexT</i> was replaced by <i>mexT</i> gene amplified from MPAO1-P1 (P2/<i>mexT</i>_P1). (E) Growth curves at 100 µg/ml chloramphenicol demonstrating acquisition of chloramphenicol resistance in P2/<i>mexT</i>_P1. (F) Collagenase activity measured by fluorescence of fluorescent labeled gelatin as a substrate. n = 6, *p<0.01. Results are representative of 3 independent experiments.</p

Anastomotic leak in rats exposed to pre-operative radiation and intestinal <i>P. aeruginosa</i>.

<p>(A) Sketch of anastomosis model and treatment groups. Treatment groups: I, anastomosis only; II, anastomosis + cecal injection of <i>P. aeruginosa</i> MPAO1, 10⁷ CFU; III, radiation + anastomosis; IV, radiation +anastomosis + cecal injection of <i>P. aeruginosa</i> MPAO1 (10⁷ CFU). Black arrows indicate the anastomotic site. (B) Excised and exposed suture lines of anastomotic sites. All suture lines are grossly intact except for group IV where ulceration/dehiscence is noted by the black arrow. (C) H&E staining of anastomotic tissues. Arrows and brackets indicate width of tissue apposition at suture line. (D, D’, E) Methylene blue assessment of anastomotic integrity demonstrating rare to no leaks in groups I–III (D) and gross extravasation in group IV (D’). Arrows indicate the site of anastomosis. (E) Incidence of anastomotic leak between groups. n = 12 (group I), n = 16 (group II), n = 9 (group III), n = 18 (group IV), *p<0.01.</p

P1 and P2 phenotypes of <i>P. aeruginosa</i> MPAO1.

<p>(A) Pyocyanin production seen as green color pigmentation on solid PIA and liquid TSB media. (B) Kaplan-Meyer survival curves of <i>C. elegans</i> N2 feeding on P1 and P2. Cumulative survival is represented of 2 experiments, n = 7/dish, 5 dishes/experiment, p<0.01. (C) Swarming motility. (D) Wound healing assay. Wound width was calibrated and measured using the MicroSuite software for imaging applications (Olympus SZX16). Wound healing of −100% indicates a 2 fold increase in the wound width compared to the baseline width. n = 12, *p<0.01. (E,F) Collagenase activity of P1 and P2 measured by degradation of fluorescent labeled collagen I (E) and collagen IV (F) as substrates. n = 6, *p<0.01. Fluorescence values were normalized to cell density measured by absorbance at 600 nm. Results are representative of 3 independent experiments. (G) RAPD fingerprint analysis demonstrating a similar genetic background of the P1 and P2 phenotype strains.</p