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Enver N, Axiotakis LG, Sulica L, Pitman MJ. Quality of Office-based Procedure Training During Laryngology Fellowship. Laryngoscope 2024; 134:1802-1806. [PMID: 37747121 DOI: 10.1002/lary.31068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 08/17/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The primary objective was to assess the perspectives of recent laryngology fellowship graduates on office-based procedure training, with a secondary objective to compare this with previous research on perspectives of fellowship directors. METHODS Recent laryngology fellowship graduates were surveyed via an online survey platform regarding post-fellowship practice and various aspects of office-based procedure training, including perceived competence, mentorship, and barriers. RESULTS There were 51 respondents. Seventy-six percent of respondents felt they "definitely" received adequate office procedure training. Number of procedures as primary surgeon was significantly associated with perception of adequate training (OR 1.54, 95% CI: 1.08-2.19, p = 0.018) and high post-fellowship office procedure volume (OR 1.56, 95% CI: 1.02-2.39, p = 0.040). Fellows reported a lower percentage of procedures as primary surgeons compared with program directors (46.8% vs. 61.9%, p = 0.028). Fellows and directors agreed that informal debriefs were more commonly employed than more structured training elements such as checklists and simulators. Of nine office procedures, laryngeal electromyography, KTP laser, and transnasal esophagoscopy had the greatest decreases in practice after training. CONCLUSION Although most recent laryngology fellowship graduates endorse adequate office-based procedure training, a range of individual experiences exists, and office procedure volume, both overall and across individual procedures, may decrease after fellowship. Fellows performing office procedures as primary surgeons may be linked to perceived quality of training and post-fellowship volume. LEVEL OF EVIDENCE NA Laryngoscope, 134:1802-1806, 2024.
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Affiliation(s)
- Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Lucas G Axiotakis
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia University Irvine Medical Center, New York City, New York, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York-Presbyterian Hospital, New York City, New York, U.S.A
| | - Lucian Sulica
- Department of Otolaryngology-Head and Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York-Presbyterian Hospital, New York City, New York, U.S.A
| | - Michael J Pitman
- The Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, New York-Presbyterian Hospital, Columbia University Irvine Medical Center, New York City, New York, U.S.A
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Helliwell LA, Hyland CJ, Gonte MR, Malapati SH, Bain PA, Ranganathan K, Pusic AL. Bias in Surgical Residency Evaluations: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:922-947. [PMID: 37142488 DOI: 10.1016/j.jsurg.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Given widespread disparities in the surgical workforce and the advent of competency-based training models that rely on objective evaluations of resident performance, this review aims to describe the landscape of bias in the evaluation methods of residents in surgical training programs in the United States. DESIGN A scoping review was conducted within PubMed, Embase, Web of Science, and ERIC in May 2022, without a date restriction. Studies were screened and reviewed in duplicate by 3 reviewers. Data were described descriptively. SETTING/PARTICIPANTS English-language studies conducted in the United States that assessed bias in the evaluation of surgical residents were included. RESULTS The search yielded 1641 studies, of which 53 met inclusion criteria. Of the included studies, 26 (49.1%) were retrospective cohort studies, 25 (47.2%) were cross-sectional studies, and 2 (3.8%) were prospective cohort studies. The majority included general surgery residents (n = 30, 56.6%) and nonstandardized examination modalities (n = 38, 71.7%), such as video-based skills evaluations (n = 5, 13.2%). The most common performance metric evaluated was operative skill (n = 22, 41.5%). Overall, the majority of studies demonstrated bias (n = 38, 73.6%) and most investigated gender bias (n = 46, 86.8%). Most studies reported disadvantages for female trainees regarding standardized examinations (80.0%), self-evaluations (73.7%), and program-level evaluations (71.4%). Four studies (7.6%) assessed racial bias, of which all reported disadvantages for trainees underrepresented in surgery. CONCLUSIONS Evaluation methods for surgery residents may be prone to bias, particularly with regard to female trainees. Research is warranted regarding other implicit and explicit biases, such as racial bias, as well as for nongeneral surgery subspecialties.
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Affiliation(s)
| | | | - Madeleine R Gonte
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Wayne State University School of Medicine, Detroit, Michigan
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
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Ryan JF, Malpani A, Naz H, Boahene KD, Papel ID, Kontis TC, Maxwell JH, Creighton FX, Byrne PJ, Wanamaker JR, Hager GD, Vedula SS, Malekzadeh S, Ishii LE, Ishii M. Do Attending and Trainee Surgeons Agree on What Happens in the Operating Room During Septoplasty? Facial Plast Surg Aesthet Med 2022; 24:472-477. [PMID: 35255228 PMCID: PMC9700360 DOI: 10.1089/fpsam.2021.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Surgeons must select cases whose complexity aligns with their skill set. Objectives: To determine how accurately trainees report involvement in procedures, judge case complexity, and assess their own skills. Methods: We recruited attendings and trainees from two otolaryngology departments. After performing septoplasty, they completed identical surveys regarding case complexity, achievement of goals, who performed which steps, and trainee skill using the septoplasty global assessment tool (SGAT) and visual analog scale (VAS). Agreement regarding which steps were performed by the trainee was assessed with Cohen's kappa coefficients (κ). Correlations between trainee and attending responses were measured with Spearman's correlation coefficients (rho). Results: Seven attendings and 42 trainees completed 181 paired surveys. Trainees and attendings sometimes disagreed about which steps were performed by trainees (range of κ = 0.743-0.846). Correlation between attending and trainee responses was low for VAS skill ratings (range of rho = 0.12-0.34), SGAT questions (range of rho = 0.03-0.53), and evaluation of case complexity (range of rho = 0.24-0.48). Conclusion: Trainees sometimes disagree with attendings about which septoplasty steps they perform and are limited in their ability to judge complexity, goals, and their skill.
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Affiliation(s)
- John F. Ryan
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anand Malpani
- Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hajira Naz
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kofi D.O. Boahene
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ira D. Papel
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Theda C. Kontis
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica H. Maxwell
- Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- ENT Section, Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Francis X. Creighton
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - John R. Wanamaker
- Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- ENT Section, Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Gregory D. Hager
- Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - S. Swaroop Vedula
- Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
- ENT Section, Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Lisa E. Ishii
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Masaru Ishii
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kim AH, Vaughn CA, King DL, Maizels M, Meade P, Stack BC. Assessment of operative competency for thyroidectomy: Comparison of resident self-assessment vs attending surgeon assessment. Head Neck 2020; 42:3551-3557. [PMID: 32812689 DOI: 10.1002/hed.26420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/26/2020] [Accepted: 07/28/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Self-awareness of skill, essential for progression as a surgeon, has direct bearing on postresidency practice; however, studies have supported that residents achieve self-perceived competence later than believed by program directors. This study compares residents' self-perception of operative competency to attending surgeon's evaluation using Computer Enhanced Visual Learning, a validated online hemithyroidectomy-specific assessment tool. METHODS Eleven otolaryngology-Head and Neck Surgery (HNS) residents completed a preoperative module and postoperative survey, later reviewed by an attending surgeon. Eighty-three performances were assessed for inter-rater reliabilities of key surgical steps. RESULTS Almost perfect agreement (Kappa = 0.81-1.00) was shown in 11 of 18 parameters. Substantial agreement (Kappa = 0.61-0.80) was demonstrated in the remaining seven parameters. CONCLUSIONS Otolaryngology-HNS trainees have high self-awareness of their performance at each step in a hemithyroidectomy. Standardized assessment tools can allow for documentation of procedural performance and serve as guides for improvement. This is the only study to examine otolaryngology-HNS trainees' self-perceived skill compared to an attending surgeon's assessment for hemithyroidectomy.
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Affiliation(s)
- Alexandrea H Kim
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cory A Vaughn
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deanne L King
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Max Maizels
- Department of Urology, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Patrick Meade
- Department of Urology, Lurie Children's Hospital, Chicago, Illinois, USA
| | - Brendan C Stack
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Completion of an Individualized Learning Plan for Otology-Related Milestone Subcompetencies Leads to Improved Otology Section Otolaryngology Training Exam Scores. Otol Neurotol 2019; 40:1392-1398. [PMID: 31688617 DOI: 10.1097/mao.0000000000002392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the relationships among self-assessment of knowledge in otology via an individualized learning plan (ILP), otology milestone achievement rate, and otolaryngology training exam (OTE) otology scores. STUDY DESIGN Prospective study. SETTING One otolaryngology residency covering a tertiary care facility, trauma and hospital center, outpatient ambulatory surgery center, and outpatient clinics. PARTICIPANTS Twenty otolaryngology residents, four from each class. METHODS Residents identified four milestones from otology-related sub-competencies to achieve in a 3-month rotation via an ILP. During the same rotation, the residents sat for the OTE, and their overall and otology scores were analyzed. MAIN OUTCOME MEASURES Completion of an ILP before and at the end of the rotation, self-reported achievement of otology milestones, and OTE score components including total percent correct, scaled score, group stanine, national stanine, and residency group weighted scores. RESULTS Group stanine OTE otology scores were higher for those residents who completed pre- and post-rotation ILPs compared with those who did not, 4.0 (±0.348) versus 2.75 (±0.453), respectively (p = 0.04). Residents who self-reported achieving all four otology milestones had significantly higher otology group stanine scores than the residents who achieved less, 4.1 (±0.348) versus 2.9 ± 0.433, respectively (p = 0.045). Residents who performed well in their PGY program cohort on the otology OTE 1 year were less inclined to complete an ILP for otology in the subsequent year (Pearson correlation -0.528, p = 0.035). CONCLUSION In the otology subspecialty, residents who completed ILPs scored better on OTE examinations independent of resident class. Consequently, programs may find ILPs useful in other otolaryngology subspecialties and across residencies.
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Vaughn C, Kim AH, Maizels M, Rives G, Meade P, Stack BC. Computer Enhanced Visual Learning: A New Tool for Surgical Education and Assessment of Surgical Competency. VideoEndocrinology 2019. [DOI: 10.1089/ve.2019.0153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cory Vaughn
- Department of Otolaryngology and Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Max Maizels
- Division of Urology, Lurie Children's Hospital, Chicago, Illinois
| | - Gregory Rives
- University of Arkansas for Medical Sciences, Little Rock, Arkansas
- Current Address: Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Brendan C. Stack
- Department of Otolaryngology and Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Chen JX, Kozin E, Bohnen J, George B, Deschler DG, Emerick K, Gray ST. Assessments of Otolaryngology Resident Operative Experiences Using Mobile Technology: A Pilot Study. Otolaryngol Head Neck Surg 2019; 161:939-945. [DOI: 10.1177/0194599819868165] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Surgical education has shifted from the Halstedian model of “see one, do one, teach one” to a competency-based model of training. Otolaryngology residency programs can benefit from a fast and simple system to assess residents’ surgical skills. In this quality initiative, we hypothesize that a novel smartphone application called System for Improving and Measuring Procedural Learning (SIMPL) could be applied in an otolaryngology residency to facilitate the assessment of resident operative experiences. Methods The Plan Do Study Act method of quality improvement was used. After researching tools of surgical assessment and trialing SIMPL in a resident-attending pair, we piloted SIMPL across an otolaryngology residency program. Faculty and residents were trained to use SIMPL to rate resident operative performance and autonomy with a previously validated Zwisch Scale. Results Residents (n = 23) and faculty (n = 17) were trained to use SIMPL using a standardized curriculum. A total of 833 assessments were completed from December 1, 2017, to June 30, 2018. Attendings completed a median 20 assessments, and residents completed a median 14 self-assessments. All evaluations were resident initiated, and attendings had a 78% median response rate. Evaluations took residents a median 22 seconds to complete; 126 unique procedures were logged, representing all 14 key indicator cases for otolaryngology. Discussion This is the first residency-wide application of a mobile platform to track the operative experiences of otolaryngology residents. Implications for Practice We adapted and implemented a novel assessment tool in a large otolaryngology program. Future multicenter studies will benchmark resident operative experiences nationwide.
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Affiliation(s)
- Jenny X. Chen
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Elliott Kozin
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jordan Bohnen
- Department of General Surgery Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian George
- Center for Surgical Training and Research, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel G. Deschler
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Emerick
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Stacey T. Gray
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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Harrill WC, Setzen G, Farquhar D, Pillsbury HC. Contemporary analysis of otolaryngic allergy. Laryngoscope 2019; 130:283-289. [PMID: 30982993 DOI: 10.1002/lary.28002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Investigate the current trends in otolaryngic allergy (OA). STUDY DESIGN Cross-sectional survey. METHODS Survey of active AAOA membership. RESULTS Response rate was 27.3%. Regional response distribution rates were proportional to the AAOA membership distribution within the United States (R2 = 0.95; P < 0.001), with no significant regional response bias demonstrated (P = 0.428). Self-reported duration to OA competency was 5.8 years. Physicians reporting OA competency were more likely to be board-certified (P < 0.001) and have AAOA fellowship status (P < 0.001). The AAOA was reported to be the most valuable educational resource toward achieving OA competency, with residency training being least valuable (P < 0.001). 91.5% of respondents' practices offered OA services. Subcutaneous injections predominated at twice the utilization of sublingual immunotherapy. Allergy immunotherapy tablets were rarely utilized. Home allergy shots were offered by 45.2% of respondents. In-office immunotherapy vial compounding was preferred (95.8%) to third-party vendors. 94% of AAOA respondents identified patient compliance to be an issue within OA. Non-inhalant allergy service integration included food allergy (63.5%), asthma (44.9%), allergic fungal sinusitis (43.8%), penicillin allergy (18%), stinging insect allergy (12.6%), and aspirin desensitization (3.9%). CONCLUSION Reported duration to OA competency after residency was surprisingly long. Further investigation of current and future educational/clinical training is warranted given clinical integration reported for OA. Otolaryngology is in the unique position to develop a comprehensive sino-allergy evidence-based strategy integrating the extensive diagnostic and medical treatment arms alongside the surgical expertise of the specialty within a clinical sino-allergy home concept. LEVEL OF EVIDENCE 5 Laryngoscope, 130:283-289, 2020.
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Affiliation(s)
- Willard C Harrill
- Carolina Ear, Nose & Throat/Sinus and Allergy Center, PA, Hickory, North Carolina, U.S.A.,Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Gavin Setzen
- Albany ENT & Allergy Services, PC, Albany, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Albany Medical Center, Albany, New York, U.S.A
| | - Douglas Farquhar
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
| | - Harold C Pillsbury
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, UNC Neuroscience Hospital, Chapel Hill, North Carolina, U.S.A
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Individualized Learning Plan (ILP) Is an Effective Tool in Assessing Achievement of Otology-related Subcompetency Milestones. Otol Neurotol 2018; 39:816-822. [PMID: 29912823 DOI: 10.1097/mao.0000000000001855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the individualized learning plan (ILP) as a tool in assessment of residents' milestone achievements as they pertain to Otology subcompetencies: Chronic Ear Disease, Pediatric Otitis Media, and Hearing Loss. STUDY DESIGN Prospective study. METHODS Twenty otolaryngology residents were instructed to use an ILP and identify six milestones from three otology-related subcompetencies to focus on during the course of a 3-month rotation. They were also asked to plan out specific activities which would help them achieve these milestones, to specify whether or not they successfully achieved them, by what instructional or learning methods and to identify any barriers. The completed ILPs were reviewed by a faculty member. MAIN OUTCOME MEASURES The effectiveness of the ILP was assessed by response compliance rate, corroboration of self-reported milestone achievement with faculty evaluations and the ability to set attainable milestones. RESULTS There was 95% compliance in using an ILP to achieve milestones. Self-reported milestone scores corresponded to the faculty evaluations in a large majority (89.6%) of patients, and tended to be underestimated by the residents. Out of 114 total milestones identified, 44 (38.6%) were not achieved, with particular overestimation in the use of independent study as a learning method. CONCLUSION The ILP is an effective tool in measuring residents' achievement of otology-related milestones, and could possibly be used to supplement or replace faculty assessment. The ILP provides valuable information on barriers to achieving milestones and informs trainees on how to set attainable goals as they pertain to patient care and medical knowledge in otology.
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Harrill WC, Melon DE, Seshul MJ, Katz MS, Zanation AM. Contemporary analysis of practicing otolaryngologists. Laryngoscope 2018; 128:2490-2499. [DOI: 10.1002/lary.27196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Willard C. Harrill
- Carolina Ear, Nose & Throat/Head and Neck Surgery Center, PA; Hickory North Carolina
- Department of Otolaryngology Wake Forest Baptist Medical Center; Winston-Salem North Carolina
| | - David E. Melon
- Department of Otolaryngology Wake Forest Baptist Medical Center; Winston-Salem North Carolina
| | - Merritt J. Seshul
- Department of Otolaryngology Wake Forest Baptist Medical Center; Winston-Salem North Carolina
| | - Marc S. Katz
- Carolina Ear, Nose & Throat/Head and Neck Surgery Center, PA; Hickory North Carolina
| | - Adam M. Zanation
- Department of Otolaryngology/Head and Neck Surgery and Neurosurgery; University of North Carolina at Chapel Hill; Chapel Hill North Carolina U.S.A
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Open tracheostomy training: a nationwide survey among Otolaryngology-Head and Neck Surgery residents. Eur Arch Otorhinolaryngol 2017; 274:4035-4042. [PMID: 28936545 DOI: 10.1007/s00405-017-4751-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/19/2017] [Indexed: 12/30/2022]
Abstract
The aim of this study was to examine the training methods and needs of Otolaryngology-Head and Neck Surgery (OTO-HNS) residents to independently perform open tracheostomy (OT). An anonymous 26-items questionnaire pertaining to OT teaching aspects was distributed to all 93 Israeli OTO-HNS residents during March-June 2016. Residents were categorized as 'juniors,' if they were in their post-graduate year (PGY)-1 and PGY-2; 'mid-residency' (PGY-3 and PGY-4); or 'seniors' (PGY-5 and PGY-6). Response rate was 74% (n = 69). There were 25 'juniors' (36%), 24 'mid-residency' (35%) and 20 'seniors' (29%). Overall, the responses of the 3 groups were similar. Forty-seven (68%) residents estimated that there are ≥ 50 tracheostomies/year in their hospital, which roughly corresponds to an exposure of ~ 8 tracheostomies/year/resident. There was an inconsistency between the number of teaching hours given and the number of hours requested for OT training (23% received ≥ 5 h, but 82% declared they needed ≥ 5 h). Eighty-two percentage reported that their main training was conducted during surgery with peer residents or senior physicians. Forty-five (65%) feel competent to perform OT, including juniors. Due to the need to perform OT in urgent scenarios, the competency of OTO-HNS resident is crucial. Training for OT in Israeli OTO-HNS residency programs is not well structured. Yet, residents reported they feel confident to perform OT, already in the beginning of their residency. Planned educational programs to improve OT training should be done in the beginning of the residency and may include designated 'hands-on' platforms; objective periodic surgical competence assessments; and specialist's feedback, using structured assessment forms.
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Competency‐based assessment in surgeon‐performed head and neck ultrasonography: A validity study. Laryngoscope 2017; 128:1346-1352. [DOI: 10.1002/lary.26841] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/10/2017] [Accepted: 07/12/2017] [Indexed: 12/15/2022]
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Lesko D, Showmaker J, Ukatu C, Wu Q, Chang CWD. Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015. Otolaryngol Head Neck Surg 2017; 156:1067-1071. [DOI: 10.1177/0194599817706327] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.
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Affiliation(s)
- David Lesko
- University of Missouri, Columbia, Missouri, USA
| | - Jason Showmaker
- Capital Region Medical Center, Jefferson City, Missouri, USA
| | | | - Qiwei Wu
- University of Missouri, Columbia, Missouri, USA
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Schoeff S, Hernandez B, Robinson DJ, Jameson MJ, Shonka DC. Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training. Laryngoscope 2017; 127:2490-2494. [DOI: 10.1002/lary.26586] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/03/2017] [Accepted: 02/21/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Stephen Schoeff
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia Health System; Charlottesville Virginia U.S.A
| | - Brian Hernandez
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia Health System; Charlottesville Virginia U.S.A
| | - Derek J. Robinson
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia Health System; Charlottesville Virginia U.S.A
| | - Mark J. Jameson
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia Health System; Charlottesville Virginia U.S.A
| | - David C. Shonka
- Department of Otolaryngology-Head and Neck Surgery; University of Virginia Health System; Charlottesville Virginia U.S.A
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Kshirsagar RS, Chandy Z, Mahboubi H, Verma SP. Does resident involvement in thyroid surgery lead to increased postoperative complications? Laryngoscope 2016; 127:1242-1246. [PMID: 27753090 DOI: 10.1002/lary.26176] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/23/2016] [Accepted: 06/09/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the impact of resident involvement during thyroid surgery on 30-day postoperative complications. STUDY DESIGN Retrospective cohort study. METHODS All patients who underwent thyroid surgery in 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patient demographics, perioperative details, resident involvement in surgery, and 30-day postoperative complications were extracted. Propensity score analysis was used to match resident and nonresident cases. Univariate and multivariate analysis were performed to determine the relationship between resident involvement in thyroid surgery and postoperative outcomes. RESULTS One thousand seven hundred forty-seven patients with and 1,747 patients without resident involvement were case-matched for patient demographics, perioperative variables, and surgical case type. There was no significant difference (P = .19) in 30-day postoperative complication rates of surgeries with and without resident involvement, which were 1.4% and 2%, respectively. Operative time was longer in surgeries with residents than those without residents (119 ± 67 minutes vs. 102 ± 55 minutes, P < .001). Cases with resident involvement had an unplanned reoperation rate of 0.9%, which was significantly lower than the 2.3% rate of surgeries without residents (P = .001). Multivariate analysis revealed no significant association between resident involvement and overall complications (odds ratio = 0.70; P = .18). CONCLUSIONS Resident participation in thyroid surgery was not associated with an increased 30-day postoperative complication rate. These findings demonstrate that patient safety is not adversely affected by resident participation in thyroid surgery. LEVEL OF EVIDENCE 2C Laryngoscope, 127:1242-1246, 2017.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Zachariah Chandy
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Hossein Mahboubi
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
| | - Sunil P Verma
- University Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Irvine, California, U.S.A
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