From Residency to Fellowship: Gender and Race in Neurotology Fellowships Compared With Otolaryngology Residency

Objective: To evaluate temporal trends in gender and racial representation in neurotology fellowships and compare them with concurrent patterns in otolaryngology residencies to assess whether increasing diversity at the residency level has translated into advanced subspecialty training. Study design: Retrospective, cross-sectional analysis. Setting: Accreditation Council for Graduate Medical Education (ACGME)-accredited neurotology fellowship and otolaryngology residency programs in the United States. Patients: All trainees listed in ACGME Data Resource Books from academic years 2007 to 2008 through 2023 to 2024 for gender comparisons and 2011 to 2012 through 2023 to 2024 for race comparisons. Demographic categories analyzed included female versus male and 6 racial groups. Interventions: None. Main outcome measures: Annual proportions of female and racial minority trainees. Trends were evaluated over time, comparing the fellowship and residency cohorts. Differences in proportions between the earliest and most recent years were analyzed. Results: Neurotology fellowship class size increased over time, accompanied by a rise in the proportion of female fellows. Racial diversity also increased, driven primarily by growth in Asian and Hispanic trainees, while proportions of White trainees declined. Black trainee representation remained low, and American Indian/Alaska Native representation decreased. Overall, improvements in neurotology diversity were more gradual than those of otolaryngology residencies, which demonstrated earlier and more pronounced gains. Conclusions: Gender and racial diversity in neurotology fellowships has improved but remains limited compared with residency-level progress. Persistent disparities suggest structural barriers influencing the transition from residency to subspecialty training. Targeted diversity and recruitment initiatives may help align fellowship programs with the evolving demographics of otolaryngology trainees.