Abstract
Objective
Otolaryngology–Head and Neck Surgery (OHNS) experiences vary across medical schools and are often elective. Early exposure may play a role in shaping medical students' career and subspecialty interests. This study examined the associations of OHNS exposures during medical school with career and subspecialty interests among OHNS residency applicants.
Study Design
Cross‐sectional survey study.
Setting
National cohort of medical students applying to OHNS residency in the 2024 and 2025 National Resident Matching Program application cycles.
Methods
A 29‐item survey assessing demographics, exposure to OHNS subspecialties (clinical, operative, didactic, mentorship, and research), and career interests was distributed via Qualtrics™ to OHNS residency applicants through program directors, Otomatch.com, and direct outreach. Bivariate analyses (t‐tests and chi‐square) assessed associations between exposures and career/subspecialty interests.
Results
Study cohort included 143 respondents (age, mean [SD] 27.5 [2.9] years; 56% female) across 37 US states with a response rate of 12.8%. In this cohort, 58.7% reported an interest in fellowship training. The highest reported subspecialty interests included Facial Plastics and Reconstructive Surgery (23.1%), Pediatric Otolaryngology (14.0%), and Head and Neck Surgery (12.6%). Clinical, mentorship, and research exposures were each associated with significantly greater interest scores in corresponding subspecialties.
Conclusions
Early exposure to OHNS may play a formative role in shaping medical students' career and subspecialty interests. Structured and equitable exposure may better inform career and subspecialty interest and support a more diverse and balanced OHNS workforce.
Keywords: career planning, fellowship interest, medical education, otolaryngology, subspecialty exposure
Otolaryngology–Head and Neck Surgery (OHNS) is a diverse surgical field encompassing Comprehensive Otolaryngology and subspecialties including: Facial Plastic and Reconstructive Surgery (Facial Plastic), Pediatric Otolaryngology, Head and Neck Surgery, Otology, Neurotology and Lateral Skull Base Surgery (Otology/Neurotology), Rhinology and Anterior Skull Base Surgery (Rhinology), Allergy and Immunology, Laryngology, and Sleep Surgery. Fellowship training among OHNS residents has been gradually increasing, reflecting the growing availability of fellowship positions and the heightened demand within the job market. 1 , 2 , 3 , 4 While studies have examined career/fellowship interests among OHNS residents, no study to date has investigated how these interests may initially form among medical students. 2 , 3 , 4 While career/subspecialty preferences are refined throughout surgical residency, early interest may form during medical school and be critical in career decision‐making. 4 Insight into the development of early comprehensive and subspecialty OHNS interest may help to inform the refinement of educational initiatives for medical students to ensure they are equitable and reflective of the full breadth of OHNS. Furthermore, intentional and equitable exposure during medical school may be an avenue to mitigate existing workforce disparities in OHNS and diversify historically underrepresented subspecialties. 5 , 6 , 7
The documented variability in medical students' exposure to OHNS underscores the need for systematic scrutiny and refinement of early educational experiences. Of the 203 accredited United States medical education schools (160 MD and 43 DO), approximately 139 offer OHNS residency programs, collectively providing just under 400 positions each year. 8 , 9 Many medical schools lack a home OHNS residency program, and some residency programs operate independently of a medical school, resulting in inconsistent OHNS exposure for students. 10 , 11 Most medical schools offer some degree of preclinical OHNS exposure, most commonly through head and neck anatomy instruction. However, clinical rotations in OHNS are largely elective, with only 7% to 33% of medical schools requiring a rotation. 10 , 11 Even among institutions that offer OHNS rotations, there is considerable variability in faculty and resident composition, operative volume, didactic structure, and research opportunities. 12 , 13 These differences are noteworthy, as exposure to these facets of training have been shown to influence medical students' decision to pursue OHNS. 14 , 15 However, the extent to which these exposures are associated with career/subspecialty interests has not been well characterized.
This study seeks to examine career and subspecialty interests among medical students applying to OHNS residency and understand their associations with different exposures during medical school, including clinical, didactic, research, mentorship, and operative experiences.
Methods
This study was reviewed and approved by the University of Southern California Institutional Review Board (UP‐24‐00123).
Comprehensive and Subspecialty OHNS Exposure Survey
The survey was created and reviewed by a multidisciplinary team consisting of board‐certified physicians and residents in OHNS and medical students. The 29‐question survey is available as Supplement S1, available online. The survey includes demographics (age, gender, race, ethnicity, marital status, generation of physician, and educational debt), exposure to comprehensive and subspecialty OHNS experiences, and career intentions. Participants were asked about the availability of and their participation in various forms of OHNS subspecialty exposure, specifically clinical, operative, didactic, mentorship, and research opportunities. Due to a survey distribution error, availability and participation in Rhinology were not assessed in the 2024 cohort and were only included in the 2025 cohort.
The survey was conducted online via Qualtrics™ (Qualtrics) and distributed to medical students participating in the 2024 and 2025 National Resident Matching Program application cycles. The survey was disseminated to program directors and coordinators to distribute to current applicants, publicly posted on Otomatch.com, and emailed to matched applicants when contact information was available. Because of these distribution methods, the exact number of applicants who received the survey invitation is unknown. Data collection occurred between February and March of each cycle year. Respondents who completed the full survey were eligible to participate in a raffle to receive a $15 gift card.
Statistical Analysis
Respondent characteristics were summarized using descriptive statistics. Continuous variables were reported as means with standard deviations (SD), while categorical variables were presented as frequencies and percentages. Differences between groups were assessed using independent sample t‐tests for continuous variables and chi‐square tests for categorical variables. Fellowship pursuit was analyzed using multivariable logistic regression adjusting for age, gender, presence of a home OHNS department, race, ethnicity, marital status and educational debt. Variance inflation factors indicated no multicollinearity exceeding predefined criteria. Statistical analyses were conducted using StataNow/SE 18.5 (StataCorp), with a two‐sided P < .05 considered statistically significant.
Results
Demographic Characteristics
143 respondents completed the survey over two application cycles, with response rates of 12.0% (n = 61) in 2024 and 14.9% (n = 81) in 2025 (12.8% cumulative). In 2024, 513 students applied for 382 resident positions, while 552 students applied for 394 positions in 2025. 5 , 6 Respondent demographics are summarized in Table 1. Respondents represented 38 medical schools and 37 states across the United States (Figure 1). The mean age was 27.5 years (SD 2.9), with 55.9% identifying as female. Most individuals (53.1%) identified as White, followed by Asian (24.5%), Black (6.3%), and mixed race (9.1%). Most respondents (60.1%) were unmarried, and 69.2% identified as first‐generation physicians. Educational debt was common, with 75.5% reporting some level of debt and 21.0% reporting greater than $250,000 in debt. Most respondents reported having a home OHNS department (90.9%).
Table 1.
Demographics of Survey Respondents
| Category | N (%) (n = 143) |
|---|---|
| Age, mean (SD) | 27.5 (2.9) |
| Gender | |
| Female | 80 (55.9) |
| Male | 62 (43.4) |
| Non‐binary/third gender | 1 (0.7) |
| Race | |
| White only | 76 (53.1) |
| Asian only | 35 (24.5) |
| Black only | 9 (6.3) |
| Other | 10 (7.0) |
| Mixed Race | 13 (9.1) |
| Ethnicity | |
| Hispanic or Latino | 17 (11.9) |
| Not Hispanic or Latino | 126 (88.1) |
| Marital status | |
| Never married | 86 (60.1) |
| Married | 43 (30.1) |
| Living with partner | 13 (9.1) |
| Divorced | 1 (0.7) |
| Generation physician | |
| First‐gen physician | 99 (69.2) |
| Second‐gen physician | 33 (23.1) |
| Third+ gen physician | 11 (7.7) |
| Debt | |
| None | 35 (24.5) |
| <$50 K | 13 (9.1) |
| $50K‐$100 K | 8 (5.6) |
| $100K‐$150 K | 21 (14.7) |
| $150K‐$200 K | 17 (11.9) |
| $200K‐$250 K | 19 (13.3) |
| >$250 K | 30 (21.0) |
| Presence of home otolaryngology department | |
| Yes | 130 (90.9) |
Figure 1.
Geographic distribution of medical schools represented by survey respondents across the United States. Red and blue border highlights indicate states without medical schools and states with no responses, respectively.
Career and Fellowship Interests
Overall, 58.7% of respondents indicated interest in pursuing fellowship, with no statistically significant difference by gender (P = .54), race (P = .42), or ethnicity (P = .99). The most cited motivations for pursuing a fellowship included an interest in operative cases (75.5%), lifestyle considerations (53.8%), and a perceived personality fit (37.8%). Females were more likely than men to cite clinical case interest (P = .03) and alignment with patient personalities and complaints (P = .02) as motivating factors for pursuing fellowship (Table 2). Regarding intended future practice setting, 43.3% of respondents expressed interest in an academic career.
Table 2.
Association of Gender on Subspecialty and Fellowship Interest and Planning
| Category | Total Cohort | Female | Male | P‐value |
|---|---|---|---|---|
| N (%) | 143 (100%) | 80 (55.9%) | 62 (43.4%) | |
| Age, mean (SD) | 27.5 (2.93) | 27.0 (1.99) | 28.1 (3.75) | .02 |
| Interest in fellowship | ||||
| Yes | 84 (58.7) | 50 (62.5) | 33 (53.2) | .75 |
| No | 4 (2.8) | 2 (2.5) | 27 (43.6) | |
| Undecided | 55 (38.5) | 28 (35.0) | 2 (3.2) | |
| Subspecialty most interested in | ||||
| Head and Neck Surgery | 18 (12.6) | 11 (13.8) | 7 (11.3) | .66 |
| Otology, Neurotology, and Lateral Skull Base Surgery | 17 (12.0) | 6 (7.5) | 11 (17.7) | .06 |
| Rhinology and Anterior Skull Base | 14 (9.8) | 6 (7.5) | 8 (12.9) | .28 |
| Facial Plastic and Reconstructive Surgery | 33 (23.1) | 22 (27.5) | 11 (17.7) | .17 |
| Laryngology | 4 (2.8) | 1 (1.3) | 3 (4.8) | .20 |
| Pediatric Otolaryngology | 20 (14.0) | 16 (20.0) | 4 (6.5) | .02* |
| Sleep Surgery | 3 (2.1) | 2 (2.5) | 1 (1.6) | .72 |
| Allergy and Immunology | 0 (0) | 0 (0) | 0 (0) | ‐ |
| Comprehensive | 16 (11.2) | 8 (10.0) | 8 (12.9) | .59 |
| Undecided | 18 (12.6) | 8 (10.0) | 9 (14.5) | .41 |
| Intended future practice setting | ||||
| Academic | 62 (43.4) | 36 (45.0) | 25 (40.3) | .58 |
| Hospital (community) | 8 (5.6) | 3 (3.8) | 5 (8.1) | .30 |
| Combined | 20 (14.0) | 11 (13.8) | 9 (14.5) | .90 |
| Military | 1 (0.7) | 1 (1.3) | 0 (0) | .38 |
| Private | 16 (11.2) | 6 (7.5) | 10 (16.1) | .11 |
| Unsure | 35 (24.5) | 23 (28.8) | 12 (19.4) | .20 |
| Reasons for fellowship pursuita | ||||
| Operative cases of interest | 108 (75.5) | 56 (70.0) | 52 (83.9) | .09 |
| Lifestyle as an attending (eg, work hours, call) | 77 (53.8) | 42 (29.4) | 35 (24.5) | .77 |
| Personality (fit) | 54 (37.8) | 30 (37.5) | 24 (38.7) | 1.00 |
| Mentorship (received) | 42 (29.4) | 23 (28.8) | 18 (29.0) | 1.00 |
| Clinical cases of interest | 42 (29.4) | 30 (37.5) | 12 (19.4) | .03* |
| Anticipated financial status | 27 (18.9) | 12 (15.0) | 14 (22.6) | .35 |
| Family planning | 24 (16.8) | 15 (18.8) | 9 (14.5) | .66 |
| Geography | 19 (13.3) | 11 (13.8) | 8 (12.9) | 1.00 |
| Research opportunities | 17 (11.9) | 6 (7.5) | 10 (16.1) | .18 |
| Patient Personalities and Complaints | 15 (10.5) | 12 (8.4) | 3 (2.1) | .02* |
Abbreviation: No., number of participants.
P < .05.
Participants were able to select all that apply.
When asked to select one top subspecialty of interest, including Comprehensive Otolaryngology and undecided, the most frequently selected was Facial Plastic (23.1%), followed by Pediatric Otolaryngology (14.0%), Undecided (12.6%), Head and Neck Surgery (12.6%), Otology/Neurotology (12.0%), Comprehensive Otolaryngology (11.2%), Rhinology (9.8%), Laryngology (2.8%), and Sleep Surgery (2.1%). Subspecialty preferences varied by gender, with female participants significantly more likely to express interest in Pediatric Otolaryngology (P = .02) (Table 2).
In multivariable logistic regression, respondents who were never married had higher odds of interest in fellowship compared to married respondents (OR 5.37, 95% CI: 1.39‐9.09). Compared with respondents reporting <$50,000 of educational debt, those with $100,000 to $150,000 (OR 11.75, 95% CI: 2.10‐65.74) and >$250,000 debt (OR 5.51, 95% CI: 1.13‐26.87) had higher odds of fellowship interest. The presence of a home OHNS program and other demographic characteristics were not associated with fellowship interest.
Exposure and Participation Across Subspecialties
Among OHNS subspecialties, Head and Neck Surgery consistently had the highest reported availability and participation across clinical, operative, didactic, mentorship, and research experiences. In contrast, Allergy and Immunology had the lowest availability and participation (Table 3). Based on Likert‐scale ratings where 1 represented no interest and 5 represented highest interest, Facial Plastics had the highest overall mean (SD) interest rating of 4.03 (1.00), followed by Comprehensive Otolaryngology with 3.99 (0.91), Rhinology (only 2025 cohort) with 3.68 (0.99), Pediatric Otolaryngology with 3.58 (1.22), Head and Neck Surgery with 3.56 (1.18), Otology/Neurotology with 3.41 (1.15), Laryngology with 3.33 (0.99), Sleep Surgery with 3.20 (0.94), and Allergy and Immunology with 2.76 (0.98) (Figure 2).
Table 3.
Status of Availability and Exposure to Subspecialities Within Otolaryngology
| Subspecialty | Status | n (%) (N = 143) | ||||
|---|---|---|---|---|---|---|
| Clinical | Mentorship | Operative | Didactics | Research | ||
| Head and Neck Surgery | Available | 130 (90.9%) | 124 (86.7%) | 131 (91.6%) | 112 (78.3%) | 121 (84.6%) |
| Participated | 127 (88.8%) | 96 (67.1%) | 128 (89.5%) | 105 (73.4%) | 85 (59.4%) | |
| Otology, Neurotology, and Lateral Skull Base Surgery | Available | 126 (88.1%) | 118 (82.5%) | 127 (88.8%) | 107 (74.8%) | 106 (74.1%) |
| Participated | 117 (81.8%) | 73 (51.1%) | 114 (79.7%) | 85 (59.4%) | 49 (34.3%) | |
| Rhinology and Anterior Skull Base Surgerya | Available | 77 (95.1%) | 72 (88.9%) | 78 (96.3%) | 77 (95.1%) | 69 (85.2%) |
| Participated | 74 (92.5%) | 46 (57.5%) | 76 (95.0%) | 67 (83.8%) | 40 (50.0%) | |
| Facial Plastic and Reconstructive Surgery | Available | 117 (81.8%) | 110 (76.9%) | 122 (85.3%) | 98 (68.5%) | 101 (70.6%) |
| Participated | 105 (73.4%) | 62 (43.4%) | 113 (79.0%) | 83 (58.0%) | 43 (30.1%) | |
| Laryngology | Available | 126 (88.1%) | 118 (82.5%) | 127 (88.8%) | 108 (75.5%) | 110 (76.9%) |
| Participated | 118 (82.5%) | 74 (51.8%) | 117 (81.8%) | 90 (62.9%) | 56 (39.2%) | |
| Pediatric Otolaryngology | Available | 126 (88.1%) | 122 (85.3%) | 129 (90.2%) | 104 (72.7%) | 107 (74.8%) |
| Participated | 118 (82.5%) | 86 (60.1%) | 124 (86.7%) | 90 (62.9%) | 68 (47.6%) | |
| Sleep Surgery | Available | 93 (65.0%) | 70 (49.0%) | 100 (69.9%) | 76 (53.2%) | 66 (46.2%) |
| Participated | 67 (46.9%) | 26 (18.2%) | 77 (53.8%) | 52 (36.4%) | 27 (18.9%) | |
| Allergy and Immunology | Available | 67 (46.9%) | 38 (26.6%) | 44 (30.8%) | 58 (40.6%) | 57 (39.9%) |
| Participated | 45 (31.5%) | 13 (9.1%) | 33 (23.1%) | 32 (22.4%) | 9 (6.3%) | |
| Comprehensive Otolaryngology | Available | 121 (84.6%) | 106 (74.1%) | 120 (83.9%) | 103 (72.0%) | 83 (58.0%) |
| Participated | 113 (79.0%) | 71 (49.7%) | 109 (76.2%) | 82 (57.3%) | 40 (28.0%) | |
Represents data only from the 2025 cohort (N = 81).
Figure 2.
Likert‐scale rating of interest in subspecialties of otolaryngology. Note: Participants responded on a scale from 1 to 5 where 1 = “Strongly Disinterested” and 5 = “Strongly Interested.”
Participation in any exposure domain (clinical, mentorship, research, operative, and didactic) was generally associated with increased subspecialty interest, although the differences were not statistically significant (Supplement S2, available online). When stratified by domain, participation in clinical experiences in Comprehensive Otolaryngology, Facial Plastic, and Pediatric Otolaryngology was associated with significantly higher interest in the corresponding career/subspecialty (Table 4). Mentorship participation in Facial Plastic, Head and Neck Surgery, and Pediatric Otolaryngology was associated with higher interest in the corresponding subspecialty (Table 5). Research participation in Head and Neck Surgery, Sleep Surgery and Pediatric Otolaryngology was associated with higher interest in the corresponding subspecialty (Table 6). Operative and didactic participation in Pediatric Otolaryngology was associated with greater interest in Pediatric Otolaryngology (Tables 7 and 8).
Table 4.
Association of Clinical Participation in Subspecialty Interest Rating
| Subspecialty | Overall mean (SD) interest | Clinical participation (n) | Interest (mean ± SD) ‐ clinical participation | No clinical participation (n) | Interest (mean ± SD) ‐ no clinical participation | P‐value |
|---|---|---|---|---|---|---|
| Head and Neck Surgery | 3.57 (1.19) | 127 | 3.60 (1.19) | 11 | 3.18 (1.17) | .27 |
| Otology, Neurotology, and Lateral Skull Base Surgery | 3.40 (1.13) | 117 | 3.47 (1.13) | 30 | 3.00 (1.12) | .09 |
| Rhinology and Anterior Skull Base Surgerya | 3.68 (0.99) | 74 | 3.68 (0.99) | 6 | 4.00 (0.89) | .44 |
| Facial Plastic and Reconstructive Surgery | 4.07 (0.97) | 105 | 4.17 (0.97) | 34 | 3.76 (0.96) | .03 |
| Laryngology | 3.33 (1.00) | 118 | 3.38 (1.00) | 20 | 3.05 (0.89) | .17 |
| Pediatric Otolaryngology | 3.58 (1.21) | 118 | 3.69 (1.17) | 20 | 2.90 (1.29) | .006 |
| Sleep Surgery | 3.19 (0.94) | 67 | 3.24 (0.97) | 71 | 3.14 (0.91) | .54 |
| Allergy and Immunology | 2.76 (0.99) | 45 | 2.76 (1.07) | 96 | 2.75 (0.95) | .97 |
| Comprehensive Otolaryngology | 3.99 (0.90) | 113 | 4.06 (0.90) | 25 | 3.64 (0.81) | .03 |
Represents data only from the 2025 cohort.
Table 5.
Association of Mentorship Participation in Subspecialty Interest Rating
| Subspecialty | Overall mean (SD) interest | Mentorship participation (n) | Interest (mean ± SD) ‐ mentorship participation | No mentorship participation (n) | Interest (Mean ± SD) ‐ no mentorship participation | P‐value |
|---|---|---|---|---|---|---|
| Head and Neck Surgery | 3.57 (1.19) | 96 | 3.82 (1.05) | 42 | 2.98 (1.30) | <.001 |
| Otology, Neurotology, and Lateral Skull Base Surgery | 3.40 (1.13) | 73 | 3.58 (1.13) | 64 | 3.20 (1.12) | .06 |
| Rhinology and Anterior Skull Base Surgerya | 3.68 (0.99) | 46 | 3.87 (0.93) | 34 | 3.47 (1.02) | .07 |
| Facial Plastic and Reconstructive Surgery | 4.07 (0.97) | 62 | 4.35 (0.96) | 77 | 3.84 (0.93) | .002 |
| Laryngology | 3.33 (1.00) | 74 | 3.42 (1.03) | 64 | 3.23 (0.94) | .28 |
| Pediatric Otolaryngology | 3.58 (1.21) | 86 | 3.90 (1.02) | 52 | 3.06 (1.33) | <.001 |
| Sleep Surgery | 3.19 (0.94) | 26 | 3.46 (0.99) | 112 | 3.13 (0.92) | .10 |
| Allergy and Immunology | 2.76 (0.99) | 13 | 3.15 (1.07) | 127 | 2.72 (0.97) | .13 |
| Comprehensive Otolaryngology | 3.99 (0.90) | 71 | 4.07 (0.96) | 67 | 3.90 (0.82) | .25 |
Represents data only from the 2025 cohort.
Table 6.
Association of Research Participation in Subspecialty Interest Rating
| Subspecialty | Overall mean (SD) interest | Research participation (n) | Interest (mean ± SD) ‐ research participation | No research participation (n) | Interest (mean ± SD) ‐ No research participation | P‐value |
|---|---|---|---|---|---|---|
| Head and Neck Surgery | 3.57 (1.19) | 85 | 3.76 (1.15) | 53 | 3.25 (1.19) | .01 |
| Otology, Neurotology, and Lateral Skull Base Surgery | 3.40 (1.13) | 49 | 3.65 (1.15) | 88 | 3.26 (1.11) | .05 |
| Rhinology and Anterior Skull Base Surgerya | 3.68 (0.99) | 40 | 3.90 (0.96) | 40 | 3.50 (0.99) | .07 |
| Facial Plastic and Reconstructive Surgery | 4.07 (0.97) | 43 | 4.26 (0.95) | 96 | 3.99 (0.98) | .14 |
| Laryngology | 3.33 (1.00) | 56 | 3.45 (1.13) | 82 | 3.26 (0.88) | .27 |
| Pediatric Otolaryngology | 3.58 (1.21) | 68 | 3.93 (1.15) | 70 | 3.24 (1.18) | <.001 |
| Sleep Surgery | 3.19 (0.94) | 27 | 3.56 (1.01) | 111 | 3.10 (0.90) | .02 |
| Allergy and Immunology | 2.76 (0.99) | 9 | 2.56 (0.73) | 131 | 2.78 (0.99) | .51 |
| Comprehensive Otolaryngology | 3.99 (0.90) | 40 | 4.18 (0.87) | 98 | 3.91 (0.90) | .11 |
Represents data only from the 2025 cohort.
Table 7.
Association of Operative Participation in Subspecialty Interest Rating
| Subspecialty | Overall mean (SD) interest | Operative participation (n) | Interest (mean ± SD) ‐ operative participation | No operative participation (n) | Interest (mean ± SD) ‐ No operative participation | P‐value |
|---|---|---|---|---|---|---|
| Head and Neck Surgery | 3.57 (1.19) | 128 | 3.59 (1.19) | 10 | 3.30 (1.16) | .47 |
| Otology, Neurotology, and Lateral Skull Base Surgery | 3.40 (1.13) | 114 | 3.48 (1.13) | 23 | 3.00 (1.09) | .06 |
| Rhinology and Anterior Skull Base Surgerya | 3.68 (0.99) | 76 | 3.67 (0.99) | 4 | 4.25 (0.96) | .25 |
| Facial Plastic and Reconstructive Surgery | 4.07 (0.97) | 113 | 4.13 (1.00) | 26 | 3.81 (0.80) | .13 |
| Laryngology | 3.33 (1.00) | 117 | 3.35 (0.97) | 21 | 3.24 (1.14) | .63 |
| Pediatric Otolaryngology | 3.58 (1.21) | 124 | 3.65 (1.18) | 14 | 2.93 (1.33) | .03 |
| Sleep Surgery | 3.19 (0.94) | 77 | 3.31 (0.94) | 62 | 3.06 (0.96) | .13 |
| Allergy and Immunology | 2.76 (0.99) | 33 | 2.97 (1.05) | 107 | 2.70 (0.95) | .17 |
| Comprehensive Otolaryngology | 3.99 (0.90) | 109 | 4.03 (0.91) | 29 | 3.83 (0.85) | .29 |
Represents data only from the 2025 cohort.
Table 8.
Association of Didactics Participation in Subspecialty Interest Rating
| Subspecialty | Overall mean (SD) interest | Didactics participation (n) | Interest (mean ± SD) ‐ didactics participation | No didactics participation (n) | Interest (mean ± SD) ‐ No didactics participation | P‐value |
|---|---|---|---|---|---|---|
| Head and Neck Surgery | 3.57 (1.19) | 105 | 3.55 (1.18) | 33 | 3.61 (1.25) | .82 |
| Otology, Neurotology, and Lateral Skull Base Surgery | 3.40 (1.13) | 85 | 3.51 (1.05) | 52 | 3.23 (1.25) | .17 |
| Rhinology and Anterior Skull Base Surgerya | 3.68 (0.99) | 67 | 3.67 (1.02) | 13 | 3.85 (0.80) | .56 |
| Facial Plastic and Reconstructive Surgery | 4.07 (0.97) | 83 | 4.11 (0.94) | 56 | 4.02 (1.04) | .59 |
| Laryngology | 3.33 (1.00) | 90 | 3.32 (0.98) | 48 | 3.35 (1.02) | .86 |
| Pediatric Otolaryngology | 3.58 (1.21) | 90 | 3.74 (1.16) | 48 | 3.27 (1.27) | .03 |
| Sleep Surgery | 3.19 (0.94) | 52 | 3.29 (0.96) | 86 | 3.13 (0.93) | .33 |
| Allergy and Immunology | 2.76 (0.99) | 32 | 2.66 (1.00) | 107 | 2.79 (0.98) | .49 |
| Comprehensive Otolaryngology | 3.99 (0.90) | 82 | 3.99 (0.94) | 56 | 3.98 (0.84) | .97 |
Represents data only from the 2025 cohort.
Discussion
This study explored the associations between OHNS subspecialty exposures and medical students' career interests among OHNS residency applicants in 2024 and 2025. Career and subspecialty preferences among students largely reflected patterns observed among residents and were associated with experiences in targeted domains. Specifically, mentorship, research involvement, and clinical engagement generally correlated with greater interest in corresponding subspecialties, underscoring the potential value of early, structured opportunities. Targeted interventions during medical school to promote diverse exposures in OHNS workforce may have a meaningful influence on future career paths.
Our study found that approximately 58% of responding residency applicants expressed interest in pursuing fellowship training. This rate is relatively lower than studies of OHNS residents, which have reported fellowship interest ranging from 64% to 79%, while 51% to 58% of residents ultimately pursue fellowship training. 1 , 2 , 3 Notably, the studies reporting 70% to 79% interest in fellowship drew data from the American Academy of Otolaryngology–Head and Neck Surgery (AAO‐HNS) Section for Residents and Fellows Annual Survey. 1 , 2 This sample may reflect residents who are more engaged in academic medicine and predisposed toward subspecialization.
In this cohort, the most preferred subspecialties were Facial Plastic, Pediatric Otolaryngology, and Head and Neck Surgery. Likert‐scale ratings of interest showed that the highest‐rated subspecialties were Facial Plastic followed by Head and Neck Surgery, and Pediatric Otolaryngology, while Comprehensive Otolaryngology also shared a large focus for respondents. The overall distribution generally aligned with prior studies among OHNS residents, where Facial Plastic, Pediatric Otolaryngology, and Head and Neck Surgery were among the most popular subspecialties. 3 This interest also generally aligns with the number of fellowship positions available with 67 positions for Facial Plastic, 38 for Rhinology, 35 for Pediatric Otolaryngology, 33 for Head and Neck Surgery, 26 for Otology/Neurotology, and 10 for Sleep Surgery as of 2025. 16 , 17 , 18 , 19 , 20 , 21 , 22
While these early preferences may mirror patterns seen among residents, it is important to acknowledge how these interests can change with experience during residency. Prior studies report a decline in fellowship interest as OHNS residents advance in training, with one study noting that while 79% of postgraduate year (PGY)−1 residents expressed interest in fellowship, this decreased to 64% by PGY‐5 year. 2 , 4 This decline has been attributed to factors such as increasing age, rising educational debt, and evolving intended practice settings. 1 , 2 In addition to changes in overall interest, the specific subspecialty of interest has been shown to shift during training, with declining interest in Otology/Neurotology and Facial Plastic and increasing interest in Head and Neck Surgery and Rhinology as residents approach PGY‐5. 4 These patterns may reflect increasing clarity about clinical interests and professional goals. They may also be a result of growing confidence in clinical and surgical skills as residents gain experience throughout their training. These changes in preferences over time raise important questions about when and how these career and subspecialty interests were initially formed.
Marital status and educational debt emerged as factors associated with fellowship interest. Higher fellowship interest in those who were never married compared to those who are married may reflect competing personal or family considerations, 23 while greater fellowship interest amongst those with higher educational debt may reflect a perception of fellowship specialization as a pathway to higher long‐term earning potential. However, research amongst residents has reported the opposite association between debt and fellowship pursuit. 2 This discrepancy may reflect differences in career stages and exposure to subspecialties during residency. The observed association between educational debt and fellowship interest should be interpreted cautiously, as the wide confidence intervals indicate limited precision, likely reflecting small subgroup counts. Notably, there was no association between other demographic variables, including having a home OHNS program, and increased interest in fellowship for medical students. However, a high percentage of respondents had a home OHNS program, which may skew results. Future research could explore fellowship interest in larger, more diverse cohorts to better understand the influence of these factors.
Our study found that not all forms of exposure were associated with career/subspecialty interest. In this cohort, participation in mentorship, research, or clinical experiences was associated with increased interest in several subspecialties. Prior studies have outlined the critical role that mentorship has on a medical student's decisions to pursue OHNS, especially when the mentor shares the student's racial identity or gender and when the relationship begins early in medical school. 13 , 24 , 25 , 26 While these studies investigated general interest in OHNS, the underlying principle is likely applicable to subspecialties. These connections can foster a sense of belonging and give students confidence to envision themselves within the field. It is also plausible that students with preexisting interest in each subspecialty are more likely to seek out mentorship within that domain. Thus, mentorship may both shape and reflect evolving career interests. This is especially important for students underrepresented in medicine, for whom mentorship and visible role models may be less readily available. 12 , 13 , 27 , 28 In this study, female respondents demonstrated significantly greater interest in Pediatric Otolaryngology compared to males. This is consistent with studies reporting a greater proportion of females in Pediatric Otolaryngology compared to other OHNS subspecialties. 29 , 30 One possible explanation is the greater availability of female role models and mentors within Pediatric Otolaryngology, which has been shown to be associated with student interest in a field. Additionally, females tend to express higher interest in general Pediatrics overall, suggesting that this preference may extend beyond Otolaryngology. 31
Research and clinical exposure were also associated with greater interest in select subspecialties. Research provides students with longitudinal exposure, mentorship, and the opportunity to grow depth of knowledge and commitment to the field. In doing so, students may strengthen connection to a given subspecialty and improve confidence when applying to the field. 15 Clinical exposure facilitates clearer understanding of the scope and daily practice of each subspecialty and prior research has demonstrated that clinical experiences are major determining factors when deciding on a specialty. 1 , 2 , 12 , 27 The relationship between exposure and interest is likely reciprocal, and students may seek out experiences aligned with early interest, while those experiences further shape interests.
While mentorship, research, and clinical exposure were found to be associated with interest in several subspecialties, this was less observed with operative and didactic exposures. These patterns suggest that not all forms of exposure may be equally influential, and targeted experiences should be prioritized in the medical school OHNS curriculum as they may have long‐term impacts on career choice and fellowship. Structured exposure to all OHNS domains and subspecialties may help to promote interest that is driven by informed experience. This could have additional implications for OHNS workforce distribution, as early exposure may influence the pipeline into less saturated or under‐represented areas of the field. A 2023 survey of the OHNS workforce found that 74.7% of practicing Otolaryngologists were male and 70.4% were White. 32 Although subspecialty‐level data was not available, these disparities underscore the potential impact of early and intentional exposure to the diversity of the field.
There are several limitations. This was a cross‐sectional survey, which prevents determination of temporal sequence and limits our ability to assess causality between exposure and interest. It is unclear whether exposure preceded the development of subspecialty interest or whether preexisting interest prompted students to seek out specific opportunities. A survey distribution error in the first year of the study resulted in no data collection on Rhinology exposure and interest. This data limitation decreased our response size, thereby reducing our statistical power to detect associations between Rhinology exposure and subspecialty interest, and introduces response bias in over‐ or under‐detection. In several exposure domains, participation rates were high, resulting in relatively small non‐exposed comparison groups that may limit estimate stability. Smaller denominators in some subspecialties reflect differences in exposure availability (eg, Allergy and Immunology) as well as study design factors, including Rhinology data being collected only in the 2025 cohort, which may further reduce estimate precision. Data were self‐reported and subject to recall bias. The low response rate limits generalizability to the broader OHNS applicant population. Students with greater interest in fellowship training or more subspecialty exposure may have been more likely to complete the survey, potentially introducing significant response bias. Additionally, because 90.9% of respondents reported having a home OHNS department, the findings may overrepresent structurally advantaged applicants with established institutional access and may not be fully generalizable to students without a home program. Participant emails that were not active and spam filters may have limited responses to the survey. Furthermore, factors such as faculty number and representation at each institution were not accounted. Exposure was measured dichotomously (present vs absent) and did not account for intensity, duration, or timing of experiences. Therefore, shadowing experiences and longitudinal mentorship or research relationships were analytically equivalent, which may limit interpretability of the strength of associations observed. Given the number of bivariate comparisons performed, there is an increased risk of type I error. These analyses should be considered exploratory. Future studies may benefit from multivariable or ordinal modeling approaches to provide a more integrated analytic framework. Future research could also assess how curriculum modifications influence subspecialty interest by incorporating qualitative methods, such as in‐depth structured interviews. Longitudinal tracking of student interest from medical school through residency may provide insights into how career preferences evolve.
Despite these limitations, our study contributes to a growing body of evidence emphasizing the importance of structured exposure and mentorship in career decision‐making. Targeted interventions should be evaluated prospectively. Future work may explore whether national or digital subspecialty‐specific mentorship platforms or standardized educational modules implemented early in medical school influence subspecialty interest or workforce distribution. Rigorous evaluation of such initiatives would be necessary to determine their effectiveness, particularly for students without a home OHNS program or from underrepresented backgrounds. Future interventions aimed at enhancing early, diverse, and meaningful comprehensive and subspecialty OHNS exposure may help trainees make informed career choices and support a more balanced workforce across OHNS.
Conclusion
This study found that participation in specific domains within each OHNS subspecialty during medical school—particularly mentorship, research, and clinical experiences—generally correlated with interest in corresponding subspecialties. These findings have implications for refining the OHNS curriculum to promote early and balanced representation. Structured and equitable exposure may better inform career interests and support a more diverse and balanced OHNS workforce.
Author Contributions
Kaitlin Hori, conception and design of work, data acquisition and analysis, interpretation of data, drafting of manuscript, critical revision; Ramon Bustos, conception and design of work, data acquisition and analysis, interpretation of data, drafting of manuscript, critical revision; Tingyu Yang, data analysis, interpretation of data, critical revision; Tamara Chambers, conception and design of work, interpretation of data, critical revision; Janet S. Choi, conception and design of work, data acquisition and analysis, interpretation of data, critical revision.
Disclosures
Competing interests
None.
Funding source
CTSI: This work was supported by grants UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. CIR: This study was supported by an educational grant from the Los Angeles County Medical Center Committee for Interns and Residents (CIR).
Supporting information
Supplement 1. OHNS Residency Applicant Comprehensive and Subspecialty OHNS Exposure Survey. 29‐question survey including items on demographics, exposure to comprehensive and subspecialty OHNS experiences, and career intentions.
Supplement 2. Association of Participation in Any Aspect of Subspecialty on Interest Rating.
This article was presented at the AAO‐HNSF 2025 Annual Meeting & OTO EXPO, October 11‐14, Indianapolis, Indiana.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplement 1. OHNS Residency Applicant Comprehensive and Subspecialty OHNS Exposure Survey. 29‐question survey including items on demographics, exposure to comprehensive and subspecialty OHNS experiences, and career intentions.
Supplement 2. Association of Participation in Any Aspect of Subspecialty on Interest Rating.