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From Expectations to Experience: A Comparison of Program Director Priorities to Resident Case Logs
Taylor S Erickson1, Yoon Soo Park2, Sean Hogan3
1Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, California, USA.
The Laryngoscope
|February 22, 2026
Summary
Surgical resident training in Otolaryngology-Head and Neck Surgery (OHNS) shows significant variation in exposure to essential procedures. Many crucial surgeries are logged infrequently, highlighting a need to refine competency metrics and curricula for better surgical education outcomes.
Area of Science:
- Medical Education
- Surgical Training
- Otolaryngology-Head and Neck Surgery (OHNS)
Background:
- Modern surgical education faces challenges including duty hour limits and specialization.
- Otolaryngology-Head and Neck Surgery (OHNS) training is shifting to a competency-based model.
- Effective training requires defining essential competencies aligned with current practice.
Purpose of the Study:
- To identify essential OHNS procedures as defined by program directors.
- To analyze resident exposure to these essential procedures using national case logs.
- To assess the alignment between training requirements and actual resident experience.
Main Methods:
- An electronic survey was sent to 122 OHNS program directors.
- 111 procedures were evaluated, with 47 classified as essential (≥75% agreement).
- Data from 1480 OHNS residents' Accreditation Council for Graduate Medical Education (ACGME) case logs (2014-2019) were analyzed.
Main Results:
- The survey achieved a 41% response rate from program directors.
- 47 out of 111 procedures were deemed essential by program directors.
- Some ACGME key indicator procedures (e.g., rhinoplasty) were not considered essential.
- Significant variability was found in resident exposure to essential procedures, with nearly half logged <10 times.
Conclusions:
- Resident exposure to essential OHNS surgeries varies widely.
- Many essential procedures are logged infrequently during residency.
- Findings suggest refining ACGME indicators and redesigning curricula to improve exposure to rare procedures and align training with practice.
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