Why I Chose Otolaryngology in the Era of COVID-19

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I woke one morning with a fullness in my ear and half my face no longer responding to command. I tried to get out of bed but collapsed, unable to orient, the world spinning around me.

Well into my third year in medical school, I had yet to secure an otolaryngology elective due to scheduling logistics caused by COVID-19. Though I hoped to explore the specialty before making a career decision, I gained interest in other surgical areas due to increased clinical exposure in those fields and was near set on pursuing a different specialty. It was a complete surprise, then, to have my first clinical otolaryngology experience as a third year be that of a hospitalized patient with Ramsay Hunt syndrome.

COVID-19 and Specialty Selection

While many students enter medical school with ideas about their future career decision, most won’t make a selection until finishing the didactic curriculum and entering the clinical years. Students must gauge how well they fit a specialty by balancing numerous factors, including personality, specialty content, skills, mentorship, income, and geography, among others. Unsurprisingly, this decision is more commonly made after students have the opportunity to assess a day-to-day experience with direct patient and physician contact during clinical rotations.

For those with multiple interests, specialty selection is a consuming and iterative process that can feel near impossible given the variety of career opportunities in medicine and the relative lack of exposure. The stakes are high, given student debt considerations and reports of high burnout in certain fields. For other students, there’s little decision making involved. Some of my classmates decided on a future career after a single rotation. While the class of 2021 has wrapped up its residency application season, students graduating in 2022 are deep in discussions with faculty, advisors, and classmates about future career plans. It isn’t hard to imagine that COVID-19 has influenced this process.

The degree to which the pandemic has altered the medical education landscape is unprecedented. In a survey of 15 medical programs, nearly three-quarters of students reported that clinical rotations were cut short or canceled, with the same number expressing the sentiment that medical education had been significantly disrupted (BMC Med Educ. 2021;21:14). Ninety-three percent of students reported participating in clinical rotations with no in-person patient contact at the time of the study’s publication.

If not for my experience as a patient, I wouldn’t have been in any position at all to select a career in otolaryngology.

It’s unclear how limited clinical opportunities will influence career decision making, especially in regard to smaller, specialized fields like otolaryngology. In a recent report studying prospective urology applicants, 82% of students reported reduced opportunities for clinical exposure (Urology. 2020;146:36-42). With the cancelation of elective procedures and dramatic shifts in patient care, including the adoption of telehealth, many students question whether their clinical experiences are representative of what a future career may entail.