key: cord-1031971-woy4jjw2 authors: Bernstein, Jeffrey D.; Ball, Laurel L.; Nardone, Zachary B.; Watson, Deborah title: A virtual sub‐internship for otolaryngology‐head and neck surgery date: 2021-08-18 journal: Laryngoscope Investig Otolaryngol DOI: 10.1002/lio2.637 sha: 4f77aa682598e140e92ca029877c43d1d7163a04 doc_id: 1031971 cord_uid: woy4jjw2 OBJECTIVE: During the COVID‐19 pandemic, away rotations were suspended for safety purposes. This led to the development of online interactive learning modules for students, now known as virtual sub‐internships (VSIs). To date, VSIs within otolaryngology‐head and neck surgery (OHNS) have been limited in their description and design. STUDY DESIGN: Cross‐sectional survey. SETTING: ACGME‐accredited OHNS residency program. METHODS: Our curriculum for an OHNS VSI is presented. Based on the model used by our OHNS residency program, the VSI consisted of a 2‐week block of activities and interactive small‐group discussions. A post‐VSI feedback survey was distributed to participants; results are reported. RESULTS: Six 2‐week VSI sessions were administered. Twenty‐one individuals participated from all US regions, median 4 individuals per session. Fifteen participants (71.4%) completed the feedback survey. Of survey respondents, 20% lacked a home OHNS residency program, and no respondents' home‐programs featured a VSI. All respondents were satisfied with the schedule and organization of the VSI, and 73.3% (11 of 15) felt it was of appropriate duration. All respondents reported a high degree of familiarity with the program, with a greater (86.7%) or equal (13.3%) level of interest in applying to the residency program as a result of participating in the VSI. CONCLUSION: This VSI curriculum offers a well‐received virtual learning experience for medical students applying to OHNS residency. It provides an opportunity for programs to expand their appeal to potential applicants who may otherwise be restricted in their ability to travel. Visiting sub-internships, also known as externships or away rotations, are an important aspect of the fourth-year curriculum for medical students, particularly those applying into a surgical residency. Within competitive surgical fields such as otolaryngologyhead and neck surgery (OHNS), the away rotation serves as an opportunity for education and audition, allowing programs and applicants to demonstrate their strengths and assess compatibility. For students from institutions without an OHNS residency program, away rotations are a crucial time to gain experience, demonstrate competence, and establish connections in the field. 1 Prior to COVID-19, participation in away rotations was nearly universal for successful applicants to OHNS, with a significant majority completing 2 months of rotations away from their home program. [2] [3] [4] In surgical specialties, completion of an in-person sub-internship has been shown to increase the odds of matching at the host program. [5] [6] [7] In response to COVID-19, away rotations were suspended during the 2020 to 2021 academic year. 8 Recommendations for "novel teleconferencing experiences" consisting of "virtual didactic programs and grand rounds" were suggested in lieu of in-person sub-internship rotations. [8] [9] [10] As program websites and social media accounts have become a key means of connection with prospective applicants, programs across multiple specialties developed various forms of virtual sub-internships (VSIs). [11] [12] [13] [14] [15] [16] Dean et al (2020) first described the implementation of a plastic surgery VSI built around the established Accreditation Council for Graduate Medical Education (ACGME) core competencies for in-person rotations. 13 In other surgical subspecialties, similar curricula have been wellreceived and highly valued by the majority of participating students. [15] [16] [17] In OHNS, only single-day, townhall, or webinar format VSIs have been described in the literature to date. 18, 19 For the 2021 to 2022 application year, the Coalition for Physician Accountability and the Association of American Medical Colleges (AAMC) announced that in-person away rotations are to be limited to one per student, with specific exceptions for students without home-programs. 20 In this new paradigm, OHNS programs will continue to face the problems of accurately assessing candidate appropriateness-of-fit and developing program interest through inherently limited virtual interactions. Therefore, implementing a comprehensive and interactive VSI in OHNS is critical, and may soon become a practice used by residency programs throughout the United States. Our VSI consisted of a 2-week curriculum comprised of scheduled meetings and activities with our institution's OHNS faculty and residents. Core objectives addressed by the curriculum were based upon ACGME objectives and a surgical committee statement, outlined in Issa et al (2015) . 6, 21 (curriculum objectives are reported in Table 1 ). the VSI, participants were assigned to a resident mentor and were encouraged to schedule additional time with individual faculty throughout the course (a complete course schedule is outlined in Table 2 ). A brief feedback survey was generated using Qualtrics software. This study was deemed exempt from review by our institution's Internal Review Board. In the era of COVID-19, many opportunities for travel and inperson education were suspended for safety purposes. 8, 20 In light of these changes, the VSI offers an opportunity for programs to expand their appeal to potential applicants who may otherwise be restricted Limitations of the VSI survey include a low number of participants, which may affect the generalizability of the findings. Furthermore, it was not possible to remove self-selection bias where only the most interested and impressed candidates may have replied to the survey. The timing of the survey shortly after completion of the VSI may also introduce a recency bias, allowing for the conflation of participants' excitement over the prospect of matching to residency. Despite numerous reassurances of anonymity, given the highly competitive residency match environment, participants may have felt compelled to rate aspects of the VSI more highly. In addition, reporting familiarity with certain topics is a relative metric, and may only reflect one's perception of familiarity more than his or her true knowledge. Lastly, lacking a pre-VSI questionnaire limits our ability to determine the true effect of the VSI on building familiarity and positive feelings about the program. These limitations highlight the need for future efforts and a further collaborative, multi-site study on this evolving topic in medical education. A successful and easy-to-implement VSI curriculum for OHNS programs is described. As during the COVID-19 pandemic, VSI opportunities can foster interest in programs for those applicants who are otherwise unable to travel. VSIs are convenient, effective, and may become more prevalent in years to come. 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Otolaryngol-Head Neck Surg Coalition for Physician Accountability Updated recommendations on away rotations for medical education institutions of LCME-accredited, U.S. osteopathic, and non-U.S. medical school applicants Accredation Council for Graduate Medical Education (ACGME) Policies and procedures Virtual rotations during COVID-19: an opportunity for enhancing diversity Matching in orthopaedic surgery The prevalence and cost of medical student visiting rotations Time to reevaluate the away rotation: improving return on investment for students and schools A virtual sub-internship for otolaryngology-head and neck surgery The authors would like to recognize and give thanks to Norissa Gastelum for her many hours of work towards ensuring success in the administration of the virtual sub-internship. The authors declare no conflicts of interest.