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Original Investigation |

Education on, Exposure to, and Management of Vascular Anomalies During Otolaryngology Residency and Pediatric Otolaryngology Fellowship

Robert Chun, MD1; Noel Jabbour, MD2; Karthik Balakrishnan, MD, MPH3; Nancy Bauman, MD4; David H. Darrow, MD5; Ravindhra Elluru, MD6; J. Fredrik Grimmer, MD7; Jonathan Perkins, DO8; Gresham Richter, MD9; Jennifer Shin, MD10
[+] Author Affiliations
1Medical College of Wisconsin, Department of Otolaryngology, Children’s Hospital of Wisconsin, Milwaukee
2Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
3Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
4Department of Otolaryngology, George Washington University, Washington, DC
5Department of Otolaryngology, Eastern Virginia Medical School, Norfolk
6Department of Otolaryngology, Dayton Children’s Hospital, Dayton, Ohio
7Division of Otolaryngology–Head and Neck Surgery, Primary Children’s Hospital, University of Utah Health Sciences, Salt Lake City
8Department of Otolaryngology, Washington University, St Louis, Missouri
9Department of Otolaryngology, University of Arkansas, Fayetteville
10Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2016;142(7):648-651. doi:10.1001/jamaoto.2016.0605.
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Importance  The field of vascular anomalies presents diverse challenges in diagnosis and management. Although many lesions involve the head and neck, training in vascular anomalies is not universally included in otolaryngology residencies and pediatric otolaryngology (POTO) fellowships.

Objective  To explore the education in, exposure to, and comfort level of otolaryngology trainees with vascular anomalies.

Design, Setting, and Participants  A survey was distributed to 39 POTO fellows and 44 residents in postgraduate year 5 who matched into POTO fellowships from April 22 through June 16, 2014.

Main Outcomes and Measures  Survey responses from trainees on exposure to, education on, and comfort with vascular anomalies.

Results  Forty-four residents in postgraduate year 5 who applied to POTO fellowships and 39 POTO fellows were emailed the survey. Fourteen respondents were unable to be contacted owing to lack of a current email address. Thirty-six of 69 residents and fellows (18 fellows and 18 residents [52%]) responded to the survey. Twenty-seven trainees (75%) reported no participation in a vascular anomalies clinic during residency; 6 of these 27 individuals (22%) trained at institutions with a vascular anomalies clinic but did not participate in the clinic, and 28 of the 36 respondents (78%) reported that they had less than adequate or no exposure to vascular anomalies in residency. Among POTO fellows, 11 of 17 (65%) did not participate in a vascular anomalies clinic during fellowship, even though 8 of the 11 had a vascular anomalies clinic at their fellowship program. During fellowship training, 12 of 18 fellows (67%) reported that they had adequate exposure to vascular anomalies. Only 20 respondents (56%) felt comfortable distinguishing among diagnoses of vascular anomalies, and only 4 residents (22%) and 9 fellows (50%) felt comfortable treating patients with vascular anomalies. All fellows believed that training in vascular anomalies was important in fellowship, and 100% of respondents indicated that increased exposure to diagnosis and management of vascular anomalies would have been beneficial to their ability to care for patients.

Conclusions and Relevance  These data indicate that most otolaryngology trainees do not receive formal training in vascular anomalies in residency and that such training is valued among graduating trainees. Conversely, most POTO fellows felt their exposure was adequate and 50% of fellows felt comfortable treating vascular anomalies. However, 65% of POTO fellows had no participation in a vascular anomalies clinic, where many patients are managed by a multidisciplinary team. This finding may indicate that POTO fellows may have a false sense of confidence in managing patients with vascular anomalies and that residency and fellowship programs may consider changes in didactic and clinical programs.

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