Rhinology Fellowship Training in the United States: Insights From a National Survey

The proportion of otolaryngology trainees pursuing fellowship has increased alongside rapid expansion in rhinology fellowship programs. Contemporary data evaluating trainee motivations, expectations, and outcomes remain limited. This study assesses contemporary data evaluating trainee motivations, expectations, and outcomes among US rhinology fellows over a 7-year period.

A combined prospective and retrospective survey study was conducted using questionnaires administered to incoming and outgoing fellows at US rhinology fellowship programs from 2018 to 2025. Surveys evaluated motivations, procedural comfort, research expectations, career plans, and overall satisfaction. Responses were analyzed descriptively.

A total of 241 responses were analyzed (124 incoming, 117 outgoing). The primary motivation for fellowship was to enhance surgical skills and clinical decision-making, with fewer respondents citing research or mentorship. Fellows reported high comfort with standard endoscopic sinus procedures but lower confidence with advanced skull base and rhinoplasty techniques. Protected research time was inconsistent, with 16%-45% of graduating fellows reporting none, differing from incoming expectations. Interest in a 2-year fellowship was low (29% incoming vs. 18% outgoing). While 71.8% of incoming fellows anticipated academic careers, 64.1% ultimately entered academic practice. Overall satisfaction was high, with 86.3% reporting that fellowship met expectations. Reported shortcomings included limited skull base exposure, reduced surgical autonomy, inadequate billing/coding training, and insufficient research time.

Rhinology fellowship trainees primarily pursue subspecialty training to enhance surgical skills and clinical decision-making. Although training is overwhelmingly perceived as meeting expectations, meaningful gaps persist between anticipated and actual experiences, particularly in protected academic time, exposure to advanced procedures, and non-clinical skill development.