Students Perception and Awareness of the Term Otolaryngology-Head and Neck Surgery in a Saudi Medical School

Hani Z Marzouki^1*, Noor J Baamir², Talal Al-Khatib¹, Khalid A AlShehri¹ and Mazin A Merdad¹

^*Correspondence: Hani Z Marzouki, Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, Email:

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Introduction

Otolaryngology, or otorhinolaryngology (ORL), is a Modern Greek term derived from ancient Greek words: Ous (ear), rhis (nose), larynx (larynx), and logia [1]. It refers to the specialty of physicians who practice and treat diseases of the ear, nose, throat, face, head, and neck. In the past, the phrase ear, nose, and throat (ENT) were used to describe this specialty. However, over the years, this term has proved its limitations in describing the wide variety of the scope of its practice [2]. Thus, the American Academy of Otolaryngology– Head and Neck Surgery and the American Board of Otolaryngology agreed to change the official name in 1980 to otolaryngology-head and neck surgery (ORLHN) to better describe the scope of this practice [3,4].

The use of informal abbreviations has become quite common because of the difficulty in pronouncing this term. Abbreviations such as ENT, ORL, and ORL-HN are predominantly used by physicians and patients. Moreover, the use of the term otolaryngology predominates in North America, whereas otorhinolaryngology is more popular in Europe [5]. In the literature, a study by Laskin et al. [6] evaluated the public recognition of specialty designations. Their results showed that the least recognized name of a medical specialty was otolaryngology and only 53.5% of the participants were able to correctly match “otolaryngologist” with “ear, nose, and throat” when given a list containing 12 different speciality names to match with what these specialties treat. These results were expected, as otolaryngology is a long and difficult-to-pronounce term with ambiguous meaning. Although this term has been used in the medical field for many years, the scope of this field is still not well-recognized by other physicians. Al-Khatib et al. [7] evaluated the perception of otolaryngologyhead and neck surgery among physicians from other specialties and found that the awareness of the scope of this specialty was not fully satisfactory.

Many studies have been conducted to evaluate the public awareness of terms used to describe different medical specialties. However, no study has evaluated medical students’ perceptions of the same topic. Therefore, we sought to assess medical students’ perceptions and awareness of the term otolaryngology-head and neck surgery.

Methods

Study design and setting

This cross-sectional study was conducted in the year 2019. The authors created a 2-question questionnaire that was added to the ORL-HN final exam of fourth-year female medical students at King Abdulaziz University (KAU), Jeddah, Saudi Arabia. The questionnaire was formulated based on the objectives of the study.

Participants

A total of 86 fourth-year female medical students were included in the study. In King Abdulaziz University, the Bachelor of Medicine, Bachelor of Surgery (MBBS) program consists of one preparatory year, five years of study, and a mandatory internship year. ORL-HN is incorporated into the curriculum in a three-week course during the fourth year.

Data collection and statistical analysis

The data were collected during the final otolaryngology exam of the 2019 female class, and participants were asked to answer a 2-question questionnaire attached to the exam paper. The collected data were managed and encrypted using Microsoft Excel (Microsoft, Redmond, WA). To ensure the privacy and confidentiality of the participants, all identifying variables were removed. Data analysis was performed using SPSS version 24 (IBM, Armonk, NY). Descriptive analyses were performed, and all categorical variables were described as frequencies and percentages.

Results

In this study, we aimed to quantitatively assess students’ perception and awareness of the medical term of otolaryngology-head and neck surgery. A total of 86 female students were included in the study. Table 1 summarizes the responses to the multiple-choice questionnaire. In the first question, when asked about the name of the subject, 67.4% thought that ENT was the official medical term, whereas only 32.6% chose otolaryngologyhead and neck surgery as the correct answer. The second question displayed participants’ justifications if the right term was not chosen. Most participants (97.3%) did not choose the correct answer, as they thought that rhino should be included in the full name of the subject, and 26.66% of the participants believed that ENT is the correct medical term for the specialty. Surprisingly, 17.2% never knew that the name of the subject was otolaryngologyhead and neck surgery.

Table 1: Percentage of responses to the multiple-choice questionnaire (n=86).

Discussion

The field of otolaryngology has evolved markedly over the past few years. In the past, the term ENT was used to sufficiently describe the scope of this field. However, otolaryngology deals not only with diseases of the ears, nose, and throat, but also with other diseases and conditions of the head and neck region. Thus, the American Academy of Otolaryngology–Head and Neck Surgery and the American Board of Otolaryngology changed the official name to otolaryngology-head and neck surgery in 1980 to better fit the expanding scope of this specialty [3]. This study evaluated medical students’ perceptions and awareness of the official medical term of otolaryngology-head and neck surgery.

Our results revealed that most participants were unaware of the correct medical term for this specialty. More than two-thirds (67.4%) believed that ENT was the official name of the specialty. Only 32.6% of participants chose otolaryngology-head and neck surgery as the correct answer.

There were many justifications for choosing ENT as an answer. Most participants thought that ORL-HN was the wrong answer because otolaryngology was missing the term rhino, and therefore did not represent the full scope of the specialty. In addition, 26.66% believed that the official name was ENT.

Moreover, 17.2% of participants did not know that the name of the subject was otolaryngology-head and neck surgery. This is not surprising, as the literature suggests that exposure to otolaryngology is underrepresented in most undergraduate medical schools. A study conducted in the UK found that, on average, otolaryngology training comprised only 8.4 days of UK undergraduate medical curriculum, and 15.8% of students reported no formal clinical experience in a hospital setting [8]. In another study conducted in Saudi Arabia, the mean otolaryngology course length was 2.4 weeks [9]. In our institution, the duration of exposure to otolaryngology is three weeks during medical school. The curriculum is divided into two parts: a theoretical part composed of lectures and tutorials and a clinical part that includes attending clinics and surgeries. Although the exposure and duration are better than those in other medical schools locally and worldwide, they are still considered inadequate compared to other surgical specialties. This could explain the poor perception of official terms.

Interestingly, 7.74% of participants were unaware that the head and neck are part of the specialty, and 4.3% of them thought head and neck surgery was part of general surgery. This result is consistent with another study conducted in Saudi Arabia, which evaluated the perception of otolaryngology-head and neck surgery among physicians from other specialties [7]. The authors found that 77.8% of respondents chose general surgeons over otolaryngology surgeons as experts in performing thyroid surgeries, compared to 47% who chose otolaryngology surgeons. Jackler et al. [5] believed that the ideal medical specialty name must not only convey the type of illnesses it treats, but also have a meaning recognizable to a large portion of the public, that is easy to pronounce, and reasonably short. The term otolaryngology is one of the hardest phrases for non-native English speakers to pronounce compared to other specialty names. The name of the specialty should thoroughly represent the anatomical sites it addresses. Furthermore, otolaryngology has undergone numerous developments over the past few years. The scope of practice that was thought to be limited to the ear, nose, and throat now includes, but is not limited to, various subspecialties such as otology, neurology, facial plastic and reconstructive surgery, laryngology, and pediatric otolaryngology [10]. Therefore, the name of a specialty must anatomically match its scope. Oromaxillofacial surgery and cardiothoracic surgery are two examples of specialty names that describe the anatomical scope of the disease.

Limitations

This study had one main limitation. This was a crosssectional survey conducted in one batch in a single institution. Thus, it is possible that the sample size does not represent the level of awareness among all medical students worldwide.

Conclusions

The medical term otolaryngology-head and neck surgery is a long and difficult-to-pronounce term. However, it describes the scope of the specialty. Medical students need to be aware of official terms and scopes of specialties. One possible way to achieve this is by increasing clinical exposure during medical school training. Another method is to emphasize the wide variety of subspecialties that fall under otolaryngology.

Funding

Self.

Conflicts of Interest

The authors declare no conflict of interest.

Ethical Considerations

This study was approved by the Institutional Review Board and the Research Ethics Committee of King Abdulaziz University in Jeddah (HA-02-J-008).

Authors' Contribution

Hani Z Marzouki: First Author and Supervisor, review of manuscript.

Noor J Baamir: Introduction, methods, discussion and conclusion writing.

Talal Al-Khatib: Review of the manuscript.

Khalid A AlShehri: Introduction, methods, results, and conclusion writing.

Mazin A Merdad: Review of the manuscript.

Disclosures

The authors declare that they have no competing interests to be disclosed.

References

1. Ramoutsaki IA, Bizakis JG, Ramoutsakis JA, et al. Otorhinolaryngology or otolaryngology? An etymological approach. Otolaryngol Head Neck Surg 2004; 131:765–766.

Indexed at, Google Scholar, Cross Ref

2. Al-Khatib T, Al Asmari B, Al Maghrabi F, et al. The perception of otolaryngology: Head and neck surgery speciality among physicians at a tertiary care hospital. J Health Special 2016; 4:190.

Indexed at, Google Scholar

3. Neel III HB, Harner SG, Benninger MS, et al. Evaluation and treatment of the unilateral paralyzed vocal fold. Otolaryngol Head Neck Surg 1994; 111:497-508.

Indexed at, Google Scholar, Cross Ref

4. https://www.entnet.org
5. Jackler RK Mudry A. Otolaryngology: “It’s all greek to me”. Otolaryngol Head and Neck Surg 2014; 150:337–341.

Indexed at, Google Scholar, Cross Ref

6. Laskin DM, Ellis JA, Best AM. Public recognition of specialty designations. J Oral Maxillofac Surg 2002; 60):1182–1185.

Indexed at, Google Scholar, Cross Ref

7. Al-Khatib T, Al Asmari B, Al Maghrabi F, et al. The perception of otolaryngology: Head and neck surgery speciality among physicians at a tertiary care hospital. J Health Spec 2016; 4:190-195.

Indexed at, Google Scholar

8. Powell J, Cooles FAH, Carrie S, et al. Is undergraduate medical education working for ENT surgery? A survey of UK medical school graduates. J Laryngol Otol 2011; 125:896-905.

Indexed at, Google Scholar, Cross Ref

9. Alamri AA, Alshehri KA, Alharbi AA, et al. Factors influencing the choice of otolaryngology (ORL) head and neck surgery as a future specialty for Saudi medical students. J Family Med Prim Care 2019; 8:1941–6.10.

Indexed at, Google Scholar, Cross Ref

10. Kim DW, Toriumi DM. What’s new in otolaryngology--head and neck surgery. J Am College Surg 2003; 197:97–114.

Indexed at, Cross Ref