Limitations
This study is not without its limitations. Primarily, as this is an
observational study in which the associations and trends presented do
not necessarily imply causality. Further, due to the survey components
of our study, there is risk of recall bias, non-response bias, and
sampling bias. As with all survey-based research, there is potential
self-selection bias among respondents. Likewise, although our sample
size is robust, our data only represent 19% of PGY-1/PGY-2
otolaryngology residents, thus our findings may not be generalizable to
the entire otolaryngology resident population. In addition, only
otolaryngology residents were contacted, thus our survey distribution
method did not directly capture responses from residents who considered
otolaryngology but ultimately pursued another specialty, but instead
used otolaryngology residents’ impressions of what factors impacted
those medical school classmates’ decisions. For these reasons, future
studies that more comprehensively assess the factors and perceptions
impacting applicants’ decisions are needed.