Otolaryngology- Head and Neck Surgery最新文献

{"title":"Time-Driven Activity-Based Costing (TDABC) in Otolaryngology: A Scoping Review.","authors":"Eric K Kim, Alice Q Liu, Hasan Abdulbaki, Peggy Tahir, Nicole T Jiam","doi":"10.1002/ohn.1099","DOIUrl":"10.1002/ohn.1099","url":null,"abstract":"<p><strong>Objective: </strong>Accurately measuring the cost of a clinical process is critical to identifying ways to increase the value of a healthcare process. The objective of this study was to review time-driven activity-based costing (TDABC) in otolaryngology and to illustrate areas where value may be increased.</p><p><strong>Data sources: </strong>PubMed, Web of Science, Embase, CINAHL Complete, and Business Source Complete from database inception to August 2024.</p><p><strong>Review methods: </strong>In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines, peer-reviewed full-length articles analyzing an otolaryngology care process with TDABC were included. Data collected included study characteristics, objectives, method of process mapping and costing, key study findings, subspecialty focus, and limitations.</p><p><strong>Results: </strong>Nine were included in the final review. Subspecialties consisted of pediatric otolaryngology (N = 4), head and neck surgery (N = 3), and rhinology (N = 2). The primary study aims were to reduce waste (N = 4), quantify cost (N = 4), evaluate the impact of a new intervention (N = 3), and identify quality improvement opportunities (N = 3). Most articles used input from involved personnel and/or direct observation to create process maps and reviewed institutional and/or public records to obtain cost information. TDABC was primarily used to study outpatient clinics or surgeries. Common limitations included limited generalizability, susceptibility to biases, and incomplete information.</p><p><strong>Conclusion: </strong>This scoping review demonstrated that TDABC can be a powerful and versatile tool for costing and identifying opportunities to increase the value of a care process in otolaryngology. Future costing studies can use TDABC to analyze care pathways in understudied otolaryngology subspecialties.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1133-1141"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National and Regional Trends in Congenital Cytomegalovirus Infection From 1998 to 2019.","authors":"Raymond J So, Kimberley S Noij, Jiangxia Wang, Jonathan Walsh, Christine G Gourin, Carolyn M Jenks","doi":"10.1002/ohn.1107","DOIUrl":"10.1002/ohn.1107","url":null,"abstract":"<p><strong>Objective: </strong>To analyze temporal changes and to assess the possible effect of newborn hearing screening (NBHS) programs on changes in congenital cytomegalovirus (cCMV) diagnostic rates in the United States.</p><p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>National Inpatient Sample (NIS) database.</p><p><strong>Methods: </strong>Neonates with cCMV infection were identified using discharge data from the NIS database from 1998 to 2019. Neonates with cCMV infection were identified via International Classification of Diseases codes and categorized as asymptomatic versus symptomatic and with or without hearing loss. Linear regression and interrupted time series analyses were conducted to analyze changes in diagnostic rates over time. Interrupted analyses were based on the timing of NBHS implementation in geographic regions.</p><p><strong>Results: </strong>Per 1,000,000 live births, the estimated total number of cCMV diagnoses increased from 109 in 1998 to 250 in 2019 (the estimated annual increase per 1,000,000 live births is 6.89 ([95% confidence interval, 5.43-8.35], P < .001). Diagnosis of cCMV with hearing loss showed a significant annual increase during this time (0.87 [0.51-1.22], P < .001), and within this group, diagnosis of both asymptomatic (0.18 [0.03-0.32], P = .02) and symptomatic (0.68 [0.37-0.99], P < .001) cases increased significantly. Compared to pre-NBHS, the rate of increase in cCMV diagnosis was significantly higher post-NBHS implementation in the Northeast (P < .001) and South (P = .008).</p><p><strong>Conclusion: </strong>Implementation of state NBHS programs correlated with increasing diagnosis rates of cCMV, though cCMV education and awareness may be contributing. cCMV continues to be underdiagnosed in a large national database.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1409-1417"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Impact of Vaccination Status on Meningitis Risk Post Cochlear Implantation.","authors":"Jamil Hayden, Emily R Youner, Ross Rosen, Chelsea N Cleveland, De'Andre A Warren, Sarah Mowry, Todd D Otteson, Maroun Semaan","doi":"10.1002/ohn.1115","DOIUrl":"10.1002/ohn.1115","url":null,"abstract":"<p><strong>Objective: </strong>To better understand the protective benefit of pneumococcal vaccines on rates of meningitis after cochlear implantation.</p><p><strong>Study design: </strong>Retrospective large database review.</p><p><strong>Setting: </strong>Several studies have shown that cochlear implantation increases the incidence of bacterial meningitis, mostly due to pneumococcal meningitis. However, there are no studies that have demonstrated that pneumococcal vaccination is associated with a decreased risk of meningitis among cochlear implant recipients.</p><p><strong>Methods: </strong>TriNetX, an electronic medical record database, was queried for incidence of meningitis after cochlear implantation, with and without pneumococcal vaccination.</p><p><strong>Results: </strong>There are a total of 35,434 patients in the TriNetX database who have received a cochlear implant. Of these patients, 9803 patients (27.7%) had coding sufficient to assess their immunization status and were included in our study. Of the patients in our study, 9264 patients (93.7%) had evidence of receiving a PCV immunization, while 539 (5.5%) were found to be under vaccinated. A total of 258 patients in our study had an episode of meningitis after cochlear implantation, translating to an overall rate of 2.6%. The vaccinated group demonstrated a significantly lower incidence of meningitis (2.5%, n = 236) compared to the under-vaccinated group (4.1%, n = 22) (relative risk: 1.60; confidence interval (1.0441, 2.4586); P < .0310).</p><p><strong>Conclusion: </strong>Our study provides evidence that pneumococcal vaccination is associated with a significantly lower rate of bacterial meningitis after cochlear implantation. Meningitis is a potentially life-threatening complication. Better adherence to pneumococcal vaccination guidelines pre- and post-CI is critical to reducing the feared risk of bacterial meningitis after cochlear implantation.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1374-1378"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma Matrix Metalloproteinase-9 Predicts Intraoperative Experience and Extent of Resection in Vestibular Schwannoma Surgery.","authors":"Han T N Nguyen, Robert J Macielak, Lisa Zhang, Oliver F Adunka, Kyle C Wu, Yin Ren","doi":"10.1002/ohn.1138","DOIUrl":"10.1002/ohn.1138","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the predictive value of plasma matrix metalloproteinase-9 (MMP-9) level in determining the extent of tumor resection (EOR) and tumor adherence in vestibular schwannoma (VS) surgery.</p><p><strong>Study design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Academic referral center.</p><p><strong>Methods: </strong>Plasma and tumor samples were prospectively collected from patients with nonradiated, sporadic VS undergoing microsurgical resection from July 2022 to June 2023. Plasma MMP-9 levels were measured by enzyme-linked immunosorbent assay, and their association with tumor adherence and postoperative outcomes were evaluated.</p><p><strong>Results: </strong>Thirty-three patients undergoing microsurgical resection agreed to participate (15 females, median age 54 years old, median tumor size 26.7 mm). A gross total resection (GTR) was performed in 18 patients (55%), and a near-total (NTR)/subtotal resection (STR) in 15 (45%). Tumor size was not significantly different between the GTR and NTR/STR groups (20.7 vs 24.8 mm, P= .185). Intraoperatively, a larger fraction of NTR/STR tumors were highly adherent to the brainstem and/or cranial nerves (93% vs 56%, P = .015). Preoperative plasma MMP-9 was higher in patients who underwent an NTR/STR compared to a GTR (229.9 vs 131.2ng/mL, P = .007). On multivariable logistic regression, preoperative plasma MMP-9 strongly predicted EOR by receiver operating characteristic analysis (area under the curve [AUC] = 0.77 P = .008). Combining plasma MMP-9 and age was an excellent predictor of EOR (AUC = 0.91, P = .0001).</p><p><strong>Conclusion: </strong>Plasma MMP-9 levels strongly predicted intraoperative tumor adherence and postoperative extent of resection. This could provide crucial preoperative insights into surgical difficulty, potential complications, and the likelihood of gross total tumor removal, enhancing informed decision-making for both physicians/surgeons and patients.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1379-1386"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Perspective on Women in Otolaryngology Through the Legacy of Dr. Margaret F. Butler.","authors":"Jane Y Tong","doi":"10.1002/ohn.1141","DOIUrl":"10.1002/ohn.1141","url":null,"abstract":"<p><p>This article explores the life of Dr. Margaret F. Butler and her many contributions to the field of otolaryngology. Dr. Butler not only served as the first female chair of an otolaryngology department at the Woman's Medical College of Pennsylvania but her mentorship of other physicians also helped support early efforts to promote gender diversity in the specialty of otolaryngology. Using autobiographical material including Dr. Butler's writings and speeches, many housed in The Legacy Center Archives and Special Collections at Drexel University College of Medicine, we explore the legacy of Margaret F. Butler to provide a perspective on women in otolaryngology.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1484-1486"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Private Equity in Otolaryngology: What Is the Impact on Medicare Payments?","authors":"Roshan Dongre, Najm S Khan, Faizaan Khan, Keyvon Rashidi, Heli Majeethia, Isuru Somawardana, Jeffrey T Vrabec, Masayoshi Takashima, Omar G Ahmed","doi":"10.1002/ohn.1154","DOIUrl":"10.1002/ohn.1154","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess whether private equity (PE) acquisitions of otolaryngology-head and neck surgery (OHNS) practices are associated with changes in Medicare payments and procedure volume.</p><p><strong>Study design: </strong>A cross-sectional study.</p><p><strong>Setting: </strong>PitchBook and the Medicare Provider Utilization and Payment Data File.</p><p><strong>Methods: </strong>PE acquisitions of OHNS practices were determined using the PitchBook database and linked to the 2016-2022 Medicare Provider Utilization and Payment Data File based on practice address. Non-PE practices were included as control if located in a state where an acquisition occurred, with the index point corresponding to the year of acquisition. Medicare payments for all procedures were totaled and averaged. PE-affiliated and non-PE-affiliated practices were compared before and after the acquisition.</p><p><strong>Results: </strong>A total of 9 acquisitions of OHNS practices across 7 states were identified. Pre-acquisition, PE-affiliated otolaryngologists performed more procedures per year (1289 vs 1006, P < .001) compared to their non-PE counterparts, with average payments per procedure of $92.8 versus $91.36 (P = .398), respectively. Post-acquisition, PE-affiliated otolaryngologists performed more procedures per year (1166 procedures vs 950, P = .015) compared to their non-PE counterparts, with average payments of $105.2 versus $91.3 (P < .001), respectively.</p><p><strong>Conclusion: </strong>PE-acquired OHNS practices had increases in average Medicare payments per procedure after acquisition with minimal changes in procedure volumes. In addition, PE firms had a greater number of procedures in both periods. This finding suggests that PE may emphasize both performing high-payout procedures and investing in high-volume practices, although this can be firm-dependent.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1272-1280"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic and Clinical Determinants of 12-Month Decision Regret for Head and Neck Cancer Patients.","authors":"Naomi C Wang, Uma R Ramesh, Maria Feucht, Rahul Alapati, Sarah F Wagoner, Rohit Nallani, Kiran Kakarala, Yelizaveta Shnayder, Chelsea S Hamill, Kevin J Sykes, Andrés M Bur","doi":"10.1002/ohn.1151","DOIUrl":"10.1002/ohn.1151","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to identify factors associated with increased decision regret (DR) 12 months following treatment among head and neck cancer (HNC) patients.</p><p><strong>Study design: </strong>A retrospective observational cohort study.</p><p><strong>Setting: </strong>Patients with newly diagnosed HNC at an academic tertiary care center from 2018 to 2023.</p><p><strong>Methods: </strong>Data from a patient registry assessing quality of life (QOL), DR, social support, and anxiety at initial diagnosis and 12 months post-treatment were analyzed. Only patients who completed the decision regret questionnaire at 12 months were included.</p><p><strong>Results: </strong>Among 225 participants, 60% experienced mild DR and 28% reported moderate to severe regret. Stronger regret was associated with advanced disease presentation, free flap reconstructive surgery, chemoradiation, and disease recurrence. Patients with more severe regret had lower QOL at baseline and 12 months, higher anxiety at 12 months, and lower social support at 12 months. Multivariable analysis identified multimodal treatment including radiation (adjusted odds ratio [aOR] 3.67, 95% confidence interval [CI] [1.25-10.78], P = .018), lower 12-month social support (aOR 1.03, 95% CI [1.00-1.05], P = .039), and decreases in QOL (aOR 1.03, 95% CI [1.00-1.06], P = .024) as independent predictors of increased DR.</p><p><strong>Conclusion: </strong>Treatment involving radiation, lower concurrent social support, and diminished QOL are associated with DR 12 months after treatment. This highlights the potential of interventions aimed at enhancing social support, addressing treatment-related sequelae, and strengthening shared decision-making to prevent regret. Further studies are needed to elucidate factors driving regret in HNC patient subgroups and assess the efficacy of proposed mitigative interventions.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1318-1327"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjuvant Proton Radiation Following Transoral Robotic Surgery for HPV-Positive Oropharyngeal Squamous Cell Carcinoma.","authors":"Jane Y Tong, Vera Bzhilyanskaya, Matthew J Ferris, Jason K Molitoris, Kyle M Hatten","doi":"10.1002/ohn.1150","DOIUrl":"10.1002/ohn.1150","url":null,"abstract":"<p><strong>Objective: </strong>Advances in the treatment of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) include transoral robotic surgery (TORS) and proton beam therapy (PBT). This study aims to improve understanding of the treatment toxicities associated with adjuvant PBT following TORS for OPSCC.</p><p><strong>Study design: </strong>A retrospective review.</p><p><strong>Setting: </strong>An academic tertiary care center in Baltimore, Maryland.</p><p><strong>Methods: </strong>Patients undergoing TORS followed by adjuvant PBT from 2017 to 2023 were reviewed.</p><p><strong>Results: </strong>Forty-seven patients with HPV-associated OPSCC underwent TORS followed by adjuvant PBT. Forty-one (87.2%) patients were male. The median age at first radiation fraction was 61.7 years. Forty-one (87.2%) identified as white and 6 (12.8%) as African American. Most patients had T1 (23 [48.9%]) or T2 (22 [46.8%]), N1 (41 [87.2%]) disease. The majority (98.3%) of acute toxicities were grade 1 or 2, with only 1 (2.1%) patient developing grade 3 toxicities. Three (6.4%) patients required a feeding tube for nutrition during adjuvant proton radiation treatment. The 3 patients who required feeding tubes during radiation also required postoperative nasogastric tubes for a median of 16 days, compared with 3 days for all other patients (Mann-Whitney U, P = .02). The most common chronic toxicities included xerostomia, dysphagia, dysgeusia, and lymphedema, which decreased over time.</p><p><strong>Conclusion: </strong>HPV-associated OPSCC treated with TORS followed by adjuvant PBT demonstrated a favorable toxicity profile with mostly grade 1 or 2 acute toxicities. Feeding tube requirement during adjuvant PBT was low at 6.4%. Many chronic toxicities appeared to decrease in frequency with time from radiation, although further study is required.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1309-1317"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143067134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Suicidal Ideation and Attempt in Patients With Skull Base Tumors.","authors":"Tony Chung, Shaun Edalati, Vikram Vasan, Alfred Marc Iloreta, Satish Govindaraj","doi":"10.1002/ohn.1124","DOIUrl":"https://doi.org/10.1002/ohn.1124","url":null,"abstract":"<p><strong>Objective: </strong>Patients with head and neck cancer experience suicide rates significantly higher than the general population. However, the relationship between skull base tumors (SBTs) and suicidal ideation and attempt (SIA) remains underexplored. This study aims to identify sociodemographic and clinical risk factors for SIA among patients with SBTs.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the National Inpatient Sample (2016-2019) to analyze 275,195 hospitalizations involving SBTs. Survey-weighted methods were used to assess univariable and multivariable risk factors for SIA.</p><p><strong>Results: </strong>Among SBT patients, 2160 (0.78%) were diagnosed with SIA. Younger age (adjusted odds ratio [aOR]: 0.98; P < .001) and emergent admissions (aOR: 2.25; P < .001) were strongly associated with SIA. Socioeconomic difficulties were one of the most significant predictors (aOR: 7.57; P < .001). Depressive, bipolar, and adjustment disorders were the strongest mental health comorbidity predictors (aOR: 8.18, 7.24, 5.19, respectively; P < .001). Alcohol and cannabis use disorders also elevated SIA risk (aOR: 2.79, 2.29, respectively; P < .001). Protective factors included treatment in Western hospitals (aOR: 0.52; P < .001) and undergoing surgery (aOR: 0.29-0.36; P < .001). Meningiomas were associated with lower SIA odds (aOR: 0.68; P = .013), while pituitary adenomas showed a significant association in univariable analysis.</p><p><strong>Conclusion: </strong>Younger age, socioeconomic difficulties, mental health comorbidities, and substance use are key risk factors for SIA in SBT patients, while surgery and treatment in Western hospitals are protective. Regular suicidality screening and proactive mental health interventions are essential for improving outcomes in this vulnerable population.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":"172 4","pages":"1300-1308"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143720856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EMYWAY Workplace-Based Entrustable Professional Activities Assessments in Otolaryngology Residency Training: A Nationwide Experience.","authors":"Fang-Cen Guo, Yu-Ting Chen, Wei-Chung Hsu, Pa-Chun Wang, Mingchih Chen, Jeng-Wen Chen","doi":"10.1002/ohn.1104","DOIUrl":"10.1002/ohn.1104","url":null,"abstract":"<p><strong>Objective: </strong>To present workplace-based entrustable professional activities (EPAs) assessment data from the first 2 years of the EMYWAY platform in otolaryngology residency training in Taiwan.</p><p><strong>Study design: </strong>Two-year cross-sectional study.</p><p><strong>Setting: </strong>Otolaryngology training programs.</p><p><strong>Methods: </strong>In 2020, the Taiwan Society of Otorhinolaryngology-Head and Neck Surgery (TSO-HNS) developed a workplace-based assessment (WBA) framework with 11 EPAs, integrating milestones to evaluate resident competency. In 2021, TSO-HNS piloted the EMYWAY platform for WBAs, which includes an EPA-based assessment workflow, coaching feedback, and a dashboard displaying residents' entrustment-supervision levels. Data are analyzed annually for accreditation and curriculum enhancement. This study reports on the pilot year and the first full-scale year of implementation.</p><p><strong>Results: </strong>Eleven programs participated in the pilot year. Subsequently, 362 faculty members and 274 resident physicians from 34 programs nationwide engaged with EMYWAY. In the full-scale year from August 2022 to July 2023, 9805 responses were recorded, primarily from surgical theaters (45.9%; 4502/9805) and third-year residents (23.8%; 2331/9805). The most frequently evaluated EPAs were \"head and neck\" (17.5%; 1716/9805), \"sinonasal\" (13.5%; 1324/9805), and \"ear\" (12.2%; 1193/9805), with task complexity increasing with resident seniority (P < .0001). A positive correlation was found between residents' self-assessments and faculty members' ratings (r = 0.531; P < .001). Over 98.2% of residents and 88.4% of faculty members provided substantial feedback (>10 words). Analysis of WBAs reported by training programs identified faculty development targets and teaching-intensive tasks.</p><p><strong>Conclusion: </strong>EMYWAY effectively documents workplace learning and tracks resident competency progression. Continuous improvement of WBA quality is essential for advancing the competency-based medical education ecosystem.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":"1242-1253"},"PeriodicalIF":2.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}