Residency Factors Influencing Likelihood of Pursuing Pediatric Otolaryngology Fellowship

CLINICAL QUESTION

Which residency program characteristics are associated with an increased likelihood of trainees pursuing pediatric otolaryngology fellowship training?

BOTTOM LINE

Residents training at children’s hospitals with affiliated pediatric otolaryngology fellowships were significantly more likely to pursue pediatric otolaryngology fellowship training. Programs in the Midwest were also independently associated with higher pediatric fellowship matriculation rates.

BACKGROUND: Interest in pediatric otolaryngology fellowship training has declined in recent years despite increasing fellowship capacity and concern regarding future workforce needs. Although all otolaryngology residency programs include pediatric exposure, not all trainees gain experience managing complex pediatric otolaryngology cases or working within pediatric fellowship environments.

STUDY DESIGN: Retrospective cohort study analyzing publicly available data from all 128 Accreditation Council for Graduate Medical Education (ACGME)-accredited U.S. otolaryngology residency programs from 2017 to 2022. Program characteristics, pediatric rotation structure, fellowship affiliations, and graduate fellowship outcomes were analyzed using univariate and multivariate logistic regression models.

SETTING: ACGME-accredited otolaryngology residency programs across the U.S.

SYNOPSIS: Investigators evaluated 103 residency programs with complete publicly available data, representing 1,029 otolaryngology residency graduates between 2017 and 2022. Overall, 62% of graduates pursued fellowship training, with facial plastics, head and neck surgery, and pediatric otolaryngology representing the most common fellowship choices. Pediatric otolaryngology accounted for 17.9% of fellowship-trained graduates.

Residency programs affiliated with children’s hospitals that also offered pediatric fellowships were significantly more likely to produce graduates who pursued pediatric otolaryngology fellowships (63.6% versus 25.6%, p = 0.001). This association remained significant on multivariate analysis, with such programs showing a fivefold higher likelihood of graduates entering pediatric fellowship training (OR 5.0, p = 0.010).

Geographic variation was also observed. Residency programs located in the Midwest were 4.4 times more likely to produce graduates pursuing pediatric otolaryngology fellowships compared with programs in other regions (p=0.038). In contrast, overall program size, free-standing children’s hospitals alone, and the presence of fellowship-trained pediatric faculty did not independently predict fellowship pursuit.

The authors suggest that exposure to complex pediatric otolaryngology care and participation within fellowship-based clinical teams may increase resident interest in subspecialty training. The findings come amid declining pediatric otolaryngology fellowship fill rates, with only 65% of positions filled in the 2024 match cycle. Limitations include reliance on publicly available data, exclusion of programs with incomplete online information, and inability to directly assess resident motivations or mentorship experiences.

CITATION: Espinel AG, et al. Residency factors influencing likelihood of pursuing pediatric otolaryngology fellowship. Laryngoscope. 2026;136:1946-1951. doi:10.1002/lary.70265.

COMMENT: This study looks at factors influencing residents to pursue pediatric otolaryngology fellowships and finds that trainees having exposure to hospitals with pediatric otolaryngology fellowships increased the likelihood of trainees pursuing pediatric otolaryngology fellowships. There is an increase in the need for pediatric otolaryngologists, with rapid growth in the last five to 10 years, though there is a shortage of these specialists. As we look at a specialty to fill these specialty gaps, this is important information for otolaryngology programs to consider when providing experiences and building programs within their groups for their trainees.–Ryan Belcher, MD, MPH