Applicant Perceptions
One-hundred eighteen of 610 (19.3%) otolaryngology residents participated in the survey. Among residents who pursued otolaryngology, 51.3% (n = 58/113) regarded the PSP as a negative influence on the decision to apply to otolaryngology, of which 9.7% (n = 11) qualified the PSP as a major negative influence (Figure 2 ). The ORTA phone interview was regarded as a negative influence in 59.8% (n = 64/107) of otolaryngology residents, of which 19.6% (n = 21) qualified it as a major negative influence (Figure 3 ). For the classmates who considered otolaryngology but applied to a different specialty, otolaryngology residents estimated the PSP and ORTA were negative influences in 51.6% (n = 49/95) and 47.4% (n = 45/95), respectively, of which 8.4% (n = 8/95) qualified both the PSP and the ORTA as major negative influences (Figures 2 and 3 ). Comparing the impact of the PSP and ORTA on otolaryngology residents and the estimated impact on the medical school classmates that considered otolaryngology but did not apply, the PSP impact was similar whereas the ORTA interview was estimated to have a more negative influence on otolaryngology residents than on those who ultimately applied to a different specialty (P= 0.050).
The reputation that it is difficult to match in otolaryngology was viewed as a negative influence among 45.2% (n = 52/115) of otolaryngology residents, of which 12.2% (n = 14) qualified it as a major negative influence (Figure 4 ). Reputation was estimated to be a negative influence in 78.9% (n = 82/104) of medical students who ultimately applied to a different specialty. Reputation had a significantly stronger negative influence on the medical school classmates that considered otolaryngology but did not apply than on otolaryngology residents themselves (P < 0.001).
Advice from PDs was viewed as a negative influence in 6.5% (n = 7/107) of residents who matched into otolaryngology, and 31.4% (n = 27/86) of those who applied to a different specialty (Figure 5 ). Advice from PDs was estimated to have a more negative influence on applicants who applied to other specialties than for the matched otolaryngology residents (P < 0.001). Finally, when otolaryngology residents were asked about the influence of number of classmates applying to otolaryngology from one institution, 69.5% (n = 82/118) of residents reported this did not influence their decision to pursue an otolaryngology residency at all, and 18.6% (n = 22) regarded this as only a slight negative influence.