From
Dr. Alexander Chiu
Ep. 98 Health Equity Collaborative in ENT with Dr. Alexander Chiu and Dr. Romaine Johnson
With Dr. Alexander Chiu & Dr. Romaine Johnson · hosted by Dr. Gopi Shaw
Chapter 1 of 8 · Fundamentals
Defining equity
Introduction and defining health equity
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Health Equity Collaborative in ENT w/ Dr. Alexander Chiu & Dr. Romaine Johnson | ENT Podcast Ep. 98
Alexander Chiu · 41 min · Published Jun 2026
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Dr Alexander Chiu Welcome-Chair
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Dr. Alexander Chiu, an Elsevier author
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Understanding Health Equity Research w/ Kevin Sykes, PhD, MPH | BackTable ENT Podcast Ep. 152
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Dr Alexander Chiu Welcome-Chief
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Alexander G. Chiu, MD
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What the experts said
Equity requires understanding barriers to medication compliance and surgical consent rather than assuming patients are forgetful or non-compliant.
Equality means giving everyone the same opportunities and access, while equity means providing different resources based on individual circumstances to achieve optimal health.
Current otolaryngology research focuses heavily on describing disparities (e.g., Black children have more severe sleep apnea and higher revision rates) but lacks intervention studies.
At Children's Hospital Dallas, language barriers contributed to increased post-tonsillectomy emergency room visits and phone calls; tracking language preference and improving communication reduced these contacts.
Data from 2012 shows African American Black patients consent less to head and neck cancer surgery and have poorer outcomes when case-controlled for tumor staging.
There is substantial literature describing health disparities on an individual basis but almost no literature on interventions, particularly at the community or society level.
The Health Equity Collaborative was founded in February 2022 and has grown to include approximately 20 academic programs.
Many prolific health disparities researchers work at institutions that do not serve the patient populations they study.
The collaborative's initial focus is on agreeing on data metrics and implementing them at member institutions before moving to intervention studies.
High-impact journals are reluctant to publish qualitative research studies despite their importance in understanding patient and trainee experiences.
Qualitative research using structured interviews and theme extraction is difficult and requires significant discipline and talent.
Mixed methodology papers that combine qualitative interviews with objective metrics were developed partly to satisfy editors who want hard data.
Structured interview questions used in residency applicant selection parallel qualitative research methods and can predict resident performance better than board scores or letters.
Research on families caring for children with disabilities rarely includes qualitative data from caregivers, yet understanding caregiver impact may affect child health outcomes more than prescribed medications.
Community participatory research requires talking to patients to understand what they want from research and how it will impact them locally.
The collaborative initially paid participants for their time and provided elaborate meals but found this approach was not effective for sustained engagement.
The American Academy of Otolaryngology received a grant from GSK to fund a core award for health disparities studies over the next three years.
The collaborative includes representation from various academic levels including department chairs, professors, medical students, and advanced practice providers.
The collaborative plans to hold one large annual meeting at the American Academy meeting and conduct regular Zoom calls between meetings.
Developing good SMART objectives (specific, measurable, in time) for equity work is challenging and progress can be slow, taking nine months to achieve initial concrete outcomes.
The collaborative has two main initial focuses: research and professional identity/recruitment of underrepresented minorities into otolaryngology.
Orthopedic surgery's 'Nth Dimension' program has been more successful than otolaryngology efforts at recruiting people of color over the past five years.
The collaborative is considering developing anti-racism curricula and equity education tailored specifically to otolaryngology for residents and medical students.
Otolaryngology has the least representation of underrepresented minorities among medical specialties.
Faculty demographics and community poverty rates influence how otolaryngologists prioritize equity in patient care; Kansas (low poverty) versus Tucson, Arizona (33% poverty rate) produce different clinical mindsets.
Equity work has changed clinical practice by increasing patience and understanding in consent processes, particularly when exploring reasons for medication non-compliance or surgical hesitation.
Public health departments and population health groups at academic medical centers have more developed expertise in equity research than otolaryngology and can serve as local resources.
HPV vaccine uptake in otolaryngology (relevant to laryngeal papillomas and head/neck cancer prevention) lacks rigorous interventional studies despite frequent discussion.
The American Board of Otolaryngology is interested in questions of professionalism, judgment, and justice as part of continuing certification beyond traditional exam formats.
Research on elite achievers shows they become more interested in maintaining elite status over time rather than maintaining initial idealistic goals.
Law school students who were idealistic and rose to the top of their class became more interested in being elite over time rather than maintaining their original values.