Does current provision of undergraduate education prepare UK medical students in ENT? A systematic literature review

Oral and maxillofacial surgery and dental health education in undergraduate medicine: a systematic review

Undergraduates in medicine should receive a basic education to ensure understanding of dental concepts, including oral cancer, basic dental health advice, and oral and maxillofacial surgery (OMFS). This review aims to explore the exposure of OMFS and dental education in the UK medical undergraduate curriculum and follows PRISMA protocols. Four databases were used to search for literature: MEDLINE, EMBASE, SCOPUS, and Google Scholar. A three-tier reviewer panel was used to appropriately evaluate data. The Medical Education Research Quality Instrument (MERSQI) was used to assess research quality amongst the included literature. A total of 14 papers were included for review. Surveys assessing medical students' perceptions of OMFS education indicate a need for improvement of the speciality in undergraduate medicine. Mean exposure of graduating medical students to OMFS was 22% (95%CI 11 to 29%). Knowledge of relevant anatomy, physiology, and OMFS-related data was very poor across all surveys. Likewise, oral cancer teaching appears to have room for improvement, only 7% (95%CI 4.1 to 10.3%) of final year medical students can identify oral cancer and less than 20% felt confident in oral assessment and diagnosis. This appears to transfer over into postgraduate medicine where only a mean of 22% of general practitioners can correctly diagnose oral cancer. The results of this review indicate that OMFS and oral cancer are not well covered in the medical curriculum. Doctors require a basic understanding of the OMFS speciality for appropriate referrals and clinical management. Furthermore, the ability of doctors to correctly deal with oral medical problems should be improved to optimise patient outcomes.

Evaluation of the BOPPPS model on otolaryngologic education for five-year undergraduates

BACKGROUND

This study aimed to assess the effectiveness of the BOPPPS model (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) in otolaryngology education for five-year undergraduate students.

METHODS

A non-randomized controlled trial was conducted with 167 five-year undergraduate students from Anhui Medical University, who were allocated to an experimental group and a control group. The experimental group received instruction using the BOPPPS model, while the control group underwent traditional teaching methods. The evaluation of the teaching effectiveness was performed through an anonymous questionnaire based on the course evaluation questionnaire. Students' perspectives and self-evaluations were quantified using a five-point Likert scale. Furthermore, students' comprehension of the course content was measured through a comprehensive final examination at the end of the semester.

RESULTS

Students in the experimental group reported significantly higher scores in various competencies compared to the control group: planning work (4.27 ± 0.676 vs. 4.03 ± 0.581, P < 0.05), problem-solving skills (4.31 ± 0.624 vs. 4.03 ± 0.559, P < 0.01), teamwork abilities (4.19 ± 0.704 vs. 3.87 ± 0.758, P < 0.05), and analytical skills (4.31 ± 0.719 vs. 4.05 ± 0.622, P < 0.05). They also reported higher motivation for learning (4.48 ± 0.618 vs. 4.09 ± 0.582, P < 0.01). Additionally, students in the experimental group felt more confident tackling unfamiliar problems (4.21 ± 0.743 vs. 3.95 ± 0.636, P < 0.05), had a clearer understanding of teachers' expectations (4.31 ± 0.552 vs. 4.08 ± 0.555, P < 0.05), and perceived more effort from teachers to understand their difficulties (4.42 ± 0.577 vs. 4.13 ± 0.59, P < 0.01). They emphasized comprehension over memorization (3.65 ± 1.176 vs. 3.18 ± 1.065, P < 0.05) and received more helpful feedback (4.40 ± 0.574 vs. 4.08 ± 0.585, P < 0.01). Lecturers were rated better at explaining concepts (4.42 ± 0.539 vs. 4.08 ± 0.619, P < 0.01) and making subjects interesting (4.50 ± 0.546 vs. 4.08 ± 0.632, P < 0.01). Overall, the experimental group expressed higher course satisfaction (4.56 ± 0.542 vs. 4.34 ± 0.641, P < 0.05). In terms of examination performance, the experimental group scored higher on the final examination (87.7 ± 6.7 vs. 84.0 ± 7.7, P < 0.01) and in noun-interpretation (27.0 ± 1.6 vs. 26.1 ± 2.4, P < 0.01).

CONCLUSION

The BOPPPS model emerged as an effective and innovative teaching method, particularly in enhancing students' competencies in otolaryngology education. Based on the findings of this study, educators and institutions were encouraged to consider incorporating the BOPPPS model into their curricula to enhance the learning experiences and outcomes of students.

A junior doctor led near-peer acute ENT/head and neck surgery workshop for medical students

Background

Near-peer teaching (NPT) involves teaching by peers who are at a close, but not the same, level of training. This study investigated whether a novel surgical NPT workshop, designed and delivered by junior doctors using simulation models for acute otolaryngology conditions, improved the knowledge and confidence level of senior medical students.

Methods

A one-day NPT workshop was held for medical students in their third year of a four-year postgraduate medical degree at the University of Notre Dame, Sydney, Australia. Four acute otolaryngology/head and neck surgery problems that might be encountered by junior doctors and require prompt management were chosen. These were post-operative neck swelling, epistaxis, and tracheostomy management (obstruction and bleeding). Six junior doctors facilitated didactic tutorials and practical skills training using models. Multiple choice question mini-tests and questionnaires were administered before and after the workshop to assess changes in students' knowledge and confidence in assessment, management, and practical skills.

Results

The most common reason for participation was to acquire knowledge and practical skills (93.2 %). Mean correct MCQ mini-test knowledge scores increased significantly from 60 % pre-workshop to 83.9 % post-workshop (p < 0.05). Students reported significantly increased confidence in recognition and management of all four conditions. All students favoured including the course in their curriculum and would recommend the course to others. The tutors subjectively reported valuable teaching experience.

Conclusion

NPT is an effective method for teaching medical students how to assess and manage acute otolaryngology/ENT surgery conditions that may present as emergencies for junior medical officers on the ward.

Developing and validating a knowledge-based AI assessment system for learning clinical core medical knowledge in otolaryngology

BACKGROUND

Clinical core medical knowledge (CCMK) learning is essential for medical trainees. Adaptive assessment systems can facilitate self-learning, but extracting experts' CCMK is challenging, especially using modern data-driven artificial intelligence (AI) approaches (e.g., deep learning).

OBJECTIVES

This study aims to develop a multi-expert knowledge-aggregated adaptive assessment scheme (MEKAS) using knowledge-based AI approaches to facilitate the learning of CCMK in otolaryngology (CCMK-OTO) and validate its effectiveness through a one-month training program for CCMK-OTO education at a tertiary referral hospital.

METHODS

The MEKAS utilized the repertory grid technique and case-based reasoning to aggregate experts' knowledge to construct a representative CCMK base, thereby enabling adaptive assessment for CCMK-OTO training. The effects of longitudinal training were compared between the experimental group (EG) and the control group (CG). Both groups received a normal training program (routine meeting, outpatient/operation room teaching, and classroom teaching), while EG received MEKAS for self-learning. The EG comprised 22 UPGY trainees (6 postgraduate [PGY] and 16 undergraduate [UGY] trainees) and 8 otolaryngology residents (ENT-R); the CG comprised 24 UPGY trainees (8 PGY and 16 UGY trainees). The training effectiveness was compared through pre- and post-test CCMK-OTO scores, and user experiences were evaluated using a technology acceptance model-based questionnaire.

RESULTS

Both UPGY (z = -3.976, P < 0.001) and ENT-R (z = -2.038, P = 0.042) groups in EG exhibited significant improvements in their CCMK-OTO scores, while UPGY in CG did not (z = -1.204, P = 0.228). The UPGY group in EG also demonstrated a substantial improvement compared to the UPGY group in CG (z = -4.943, P < 0.001). The EG participants were highly satisfied with the MEKAS system concerning self-learning assistance, adaptive testing, perceived satisfaction, intention to use, perceived usefulness, perceived ease of use, and perceived enjoyment, rating it between an overall average of 3.8 and 4.1 out of 5.0 on all scales.

CONCLUSIONS

The MEKAS system facilitates CCMK-OTO learning and provides an efficient knowledge aggregation scheme that can be applied to other medical subjects to efficiently build adaptive assessment systems for CCMK learning. Larger-scale validation across diverse institutions and settings is warranted further to assess MEKAS's scalability, generalizability, and long-term impact.

Teaching Pterygopalatine Fossa Anatomy Using 3D Images and Physical Model: A Novel Teaching Strategy

Medical students often struggle to appreciate the anatomy of the pterygopalatine fossa. This is due to the difficulty in understanding the spatial orientation through textbook diagrams, as well as its deeper location and smaller size in cadaveric specimens. Research has proven that three-dimensional visualization enhances the spatial understanding of anatomy. However, studies have not compared the effectiveness of two different instructional designs that cater to 3D visualization. We conducted a mixed methodology (quasi-experimental pre-test/post-test control design with additional qualitative components) study to compare the effectiveness of a physical model and a 3D image in small-group teaching. The students were divided into control and intervention groups based on their roll numbers. The control group utilized a series of 3D images delivered through Microsoft PowerPoint software on computers. The students in the intervention group used a physical model made of cardboard, with colored wires representing the neurovascular structures. We used 20 spatial anatomy-based multiple-choice questions (MCQs) to assess knowledge acquisition before and after the small group discussion. Additionally, we utilized a validated 10-item feedback questionnaire to evaluate participants' perception of the teaching sessions. There was no significant difference in the knowledge gain and perception scores between the control and intervention groups. These findings suggest that a well-designed 3D image can provide an equivalent learning outcome and level of satisfaction compared to a physical model.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02063-3.

Learning needs of junior doctors in otolaryngology: a qualitative study

OBJECTIVES

There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs.

METHOD

Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians.

RESULTS

The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts.

CONCLUSION

All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.

Using simulation as a platform to prepare for ear, nose and throat emergencies in the coronavirus disease 2019 era and beyond

BACKGROUND

Following limited clinical exposure during the coronavirus disease 2019 pandemic, a simulation-based platform aimed at providing a unique and safe learning tool was established. The aim was to improve the skills, knowledge and confidence of new ENT doctors.

METHOD

The course was developed through 5 iterations over 28 months, moving from a half-day session to 2 full-day courses with more scenarios. Participant, faculty and local simulation team feedback drove course development. High-fidelity scenarios were provided, ranging from epistaxis to stridor, using technology including SimMan3 G mannequin, mask-Ed™ and nasendoscopy simulators.

RESULTS

Participant feedback consistently demonstrated that the knowledge and skills acquired enhanced preparedness for working in ENT, with impact being sustained in clinical practice.

CONCLUSION

Preparing healthcare professionals adequately is essential to enhancing patient safety. This simulation course has been effective in supporting new doctors in ENT and has subsequently been rolled out at a national level.

Medical student otolaryngology research: Involvement, perceptions, motivations

OBJECTIVE

Otolaryngology is a competitive specialty that emphasizes research. This study explored medical student involvement in otolaryngology research including training, productivity, perceptions and career goals.

STUDY DESIGN

Cross-sectional survey.

METHODS

A 27 question multiple choice survey was generated using Qualtrics and posted on an otolaryngology forum (Otomatch) from 10/09/2022 to 12/11/2022.

RESULTS

Thirty fourth year medical students (MS4) applying to U.S. otolaryngology residency programs responded. Nearly all (26/30 = 86.7 %) believe there should be dedicated time to research in medical school. MS4 produced an average of 3.23 otolaryngology papers (± 3.13), 5.23 poster presentations (± 9.22) and 2.50 oral presentations (± 5.06). MS4 feel it is more important for physicians to read (mean 4.47 on a 5-point scale; ± 0.76) than to conduct research (3.03 ± 0.87) or to emphasize it in evaluating residency applicants (2.79 ± 0.96). Seventeen respondents (17/30 = 56.7 %) lack interest in continuing research after medical school. Twenty-eight MS4 were evenly split (14/30 = 46.7 %) between a research-heavy or traditional residency. Students felt pressure to publish in low-impact journals (3.93 ± 0.94) for career advancement.

CONCLUSION

All respondents were involved in research yet the majority (16/30 = 53.3 %) eschew a research-heavy residency. Using research to evaluate success entices involvement for some who may not be interested. Pressure to publish may exacerbate ethical issues like inaccurately assigned authorship and deceptive reporting of publications. A decreased emphasis on research will enable students truly interested to continue without pressure to publish, leading to a potential increase in generalizable studies.

Surgeon educator perspectives of implementing a national undergraduate curriculum in otolaryngology

OBJECTIVE

The General Medical Council will be implementing a national medical licensing assessment for all UK medical students by 2024-25. Surgeon educator perceptions on a national undergraduate curriculum in otolaryngology were reviewed accordingly.

METHOD

A mixed methods study was undertaken within a UK school of surgery assessing ENT surgeon educators. Perspectives on teaching content, quality and student experience were assessed with degree of agreement assessed (Likert scoring). Associated qualitative focus group sessions underwent detailed thematic analysis according to grounded theory.

RESULTS

A response rate of 50 per cent was achieved involving 21 participants working across 14 hospitals. These showed strong agreement that implementation of a national curriculum would improve the standard of teaching delivered at a personal, institutional and national level. Further themes were identified relating to the personal, institutional and specialty related factors influencing practical delivery.

CONCLUSION

A series of practical recommendations are made to potentially assist the implementation of a national ENT curriculum.

Undergraduate perceptions on the educational value of a novel ENT e-Learning platform

ENT is a consistently under-represented specialty in medical school curricula. With social distancing measures limiting face-to-face (FtF) teaching and clinical opportunities, we created an e-Learning platform to consolidate and improve knowledge on common ENT emergencies. Following invitation to medical students undergoing their rotation in ENT at University Hospital Wales (UHW) Cardiff, five focus groups were shown an e-Learning module and interviewed between June and July 2021. 13 medical students participated in total (9 female, 4 male, median age 22 years). These structured interviews were recorded and transcribed. Transcripts were analysed using the qualitative data analysis software NVivo (QSR International, UK). The modules were found to be concise, clinically relevant and beneficial to student confidence in recognising and managing ENT emergencies. While e-Learning will likely never replace face-to-face learning, it was perceived to be a beneficial resource both academically and practically- especially in the context of limited clinical opportunities.

Problem of headache: A cross-sectional study

Objectives

To assess the medical students, interns, general practitioners, and family physicians' perception of neurological and otolaryngeal causes of headaches.

Materials and Methods

A prospective, qualitative, questionnaire-based cross-sectional study took place. Five hundred and seventy-one senior medical students, interns, general practitioners (GPs), and family physicians from different geographical regions in Saudi Arabia were involved in the study. An online questionnaire is used to estimate the respondents' knowledge regarding neurological and otolaryngeal causes of headaches. The obtained data were statistically analyzed using SPSS version 21.

Results

Five hundred and seventy-one participants were involved in the study. They were 377 females and 194 males with a female-to-male ratio of 1.9:1. Most of them were medical students (69.9%). However, medical interns, general practitioners, and family physicians' respondents were (17.3%), (7.5%), and (5.3%), respectively. They constituted different geographical regions of Saudi Arabia. An average level of knowledge about headaches was recorded in (55%) of the participants, while (42.7%) had a good level of knowledge about its etiologies.

Conclusions

A considerable percentage of the current study population has average knowledge about neurological and otolaryngeal factors of headache. It is advocated that the current national medical curriculum be thoroughly reviewed and clear referral pathways must be established to have better management of these cases.

Increased use of cadaver specimens as a method for improving medical student satisfaction with clinical ear anatomy teaching at St George's, University of London: a pilot study

BACKGROUND

Delivering sufficient otology education for undergraduates is known to be difficult, with limited teaching time being a contributing factor. Increasing student access to dissections of the ear could serve to increase satisfaction with teaching at St George's, University of London, UK.

OBJECTIVE

To evaluate student satisfaction with clinical ear anatomy teaching and investigate whether it can be improved using dissected specimens.

METHOD

Participants completed an online survey and knowledge examinations, both before and after attending a new tutorial, with answers from before and after the session being compared.

RESULTS

Pre-teaching satisfaction scores concerning teaching were low, at an average of 2.45 (out of 7), with a mean examination result of 6.53 (out of 10). Post-teaching average satisfaction increased by 3.20 points to 5.65 (out of 7) (p < 0.01) and examination scores increased by 1.53 points to 8.07 (out of 10) (p < 0.01).

CONCLUSION

Students are supportive of increased access to cadaver dissections of the ear, and facilitating this can improve satisfaction with otology teaching.

Seven cardinal questions for the patient with ear, nose or throat complaints: Review

The incidence of otolaryngological problems in general medicine practice is highly seasonal and approaches 25% in some months of the year. Accurate diagnosis in the otolaryngology office often requires the use of binocular microscopy, nasal endoscopy, and flexible laryngoscopy, none of which are available in a general medicine office. Therefore, history taking and physical examination techniques available in the non-otolaryngology office are of utmost importance. Using evidence-based history taking for ear, nose, and throat (ENT) problems facilitates dealing with patients who present with otolaryngologic complaints. In this paper, I present 7 cardinal questions to be asked when taking the history of a patient with ENT complaints.

Litigation in pediatric otorhinolaryngology: Lessons in improving patient care

OBJECTIVE(S)

Medico-legal claims involving children place a substantial financial burden on health services and have a profound emotional and psychological impact on clinicians. Our objective was to analyze both the common causes and cost of litigation in pediatric otorhinolaryngology.

METHODS

A retrospective review of all clinical negligence claims within pediatric otolaryngology (0-17 years inclusive) in NHS (National Health Service) England held by the clinical negligence service 'NHS Resolution between' 4/2013 and 4/2020.

RESULTS

There were 100 claims in pediatric otorhinolaryngology accounting for an estimated potential total cost of just under £49 million with an average of 14 claims per year. Over half (52%) of claims were related to an operation with cause codes "Operator Error/Intra-Op Problem", "Diathermy Injury" and "Failure to Warn - Consent" most cited. The most common operation cited in a claim was tonsillectomy with an average cost per claim of £47,084. There were 21 claims coded as either "failure to diagnose" or "failure to treat" in relation to cholesteatoma, with an average cost per claim of £61,086.

CONCLUSION

This is the largest study to date analyzing the reasons and potential cost of clinical negligence claims within pediatric otolaryngology. Many learning opportunities exist to reduce patient morbidity, mortality and improve the patient experience through litigation data analysis.

Online learning: an effective option for teaching ENT to medical students?

OBJECTIVE

ENT is underrepresented in the curriculum, and this has been compounded by coronavirus disease 2019. Recent restructures have removed ENT placements from the curriculum. This lack of exposure needs to be addressed, and increased use of online learning represents an opportunity to facilitate this. This study aimed to evaluate whether online learning can effectively deliver undergraduate ENT teaching.

METHODS

An online ENT module was created; content was structured on the Sheffield Medical School curriculum. Pre- and post-module tests and 5-point Likert scales were used to assess student knowledge and confidence, respectively.

RESULTS

A total of 115 participants were recruited. Test scores improved by 29 per cent (p < 0.001) and confidence by 66 per cent. Anatomy and ENT conditions demonstrated significant improvement in confidence, with a lower confidence score for examination.

CONCLUSION

This study showed improved knowledge and confidence, whilst highlighting greater efficacy in content over practical skills teaching. Online learning is a validated educational tool; however, it should not be used as a replacement but as an adjunct to supplement learning.

Effectiveness of Virtual Reality-Based Training on Oral Healthcare for Disabled Elderly Persons: A Randomized Controlled Trial

(1) Background: Virtual reality (VR) technology is a widely used training tool in medical education. The present study aimed to evaluate the effectiveness of VR training of oral hygiene students on providing oral healthcare to disabled elderly persons. (2) Methods: A randomized controlled trial was conducted. In 2021, oral hygiene students were randomly assigned to a VR experimental group (EG; n = 11) and a control group (CG; n = 12). The EG received two-hour, thrice-repeated VR-based training interventions at 2-week, 4-week, and 6-week follow-ups. The CG received no VR-based interventions. Data were collected using a self-administered questionnaire before and immediately after each intervention. We performed generalized estimating equations to compare the responses. (3) Results: The EG exhibited a more significant improvement in oral care-related knowledge, attitude, self-efficacy, and intention at the 6-week follow-up than the CG. The students’ intention to assist the elderly in using interdental brushes (β = 0.91), with soft tissue cleaning (β = 0.53), and with oral desensitization (β = 0.53), and to have regular dental visits (β = 0.61) improved significantly at the 6-week follow-up. (4) Conclusions: VR training positively affected students’ knowledge, attitude, self-efficacy, and intentions on providing oral healthcare to disabled elderly persons.

Anatomical Models versus Nontactile Distanced Learning in Otolaryngology Teaching

Introduction  Medical schools in the United Kingdom are under increasing pressure to provide more streamlined, applicable teaching due to rising numbers of trainee doctors but are failing to meet their educational need for otolaryngology. The recent novel coronavirus disease 2019 (COVID-19) pandemic has placed additional pressures on medical schools to adapt the medium over which the curriculum is delivered. The use of tactile learning with three-dimensional models and distanced learning via videoconferencing may provide alternative teaching methods to meet otolaryngology undergraduate learning requirements. This pilot study aimed to assess the differences in undergraduate student attitudes toward tactile learning via nontactile distanced learning and review their acceptability among this cohort.

Methods  Two groups of medical students observed a single educational event on the larynx and management of the airway. The learning opportunity was delivered in a lecture format with the lecturer demonstrating on an anatomical model of the larynx. Group one (tactile group) had an identical model to interact with during the lecture and were present within the lecture theater; group two (nontactile group) did not and observed the lecture via video link. Students were asked to rank their opinion to several statements about the session based on an 11-point Likert's scale and give qualitative feedback.

Results  All ranked feedback was mainly positive. Tactile learning was statistically equivalent to nontactile learning based on the ranked feedback from the students, except for “improvement in anatomical knowledge,” for which the students believed tactile learning was superior ( p  = 0.017). A variety of qualitative feedback was received by both groups.

Conclusion  This pilot study provides evidence for the acceptability among students of the use of nontactile distanced learning to deliver the otolaryngology undergraduate curriculum compared with tactile learning. This can provide the basis for larger studies to assess the educational impact of these different teaching methods.

Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study

INTRODUCTION

Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition.

METHODS

We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally.

RESULTS

We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3).

DISCUSSION

This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.

The provision of undergraduate clinical placements in ENT during the coronavirus disease 2019 pandemic - exploring patient perspectives on a variety of approaches

Background

The coronavirus disease 2019 pandemic has greatly disrupted routine ENT services. Subsequently, universities have chosen to either augment or suspend clinical placements.

Objective

This study aimed to elicit patients’ perspectives toward various approaches to clinical placements in ENT during the coronavirus disease 2019 pandemic.

Methods

Cross-sectional questionnaires were given to patients attending the ENT department for routine out-patient care. Responses were measured using a five-point Likert scale. Seventy-nine patients completed the survey.

Results

Ninety-five per cent of respondents felt the coronavirus disease 2019 pandemic had not reduced their comfort in interacting with medical students. Most participants reported being comfortable with students participating directly or remotely in their care, and with students having access to their anonymised data. Twenty-five per cent of participants stated that they are uncomfortable with consultations being recorded and shared for medical education purposes.

Conclusion

A number of approaches to clinical placements remain acceptable to patients. Educational leads should continue to offer placements in ENT that can incorporate direct or remote observation of consultations.

What can be learned from litigation in otology? A review of clinical negligence claims in England 2013-2018

BACKGROUND

Litigation in the National Health Service continues to rise with a 9.4 per cent increase in clinical negligence claims from the period 2018 and 2019 to the period 2019 and 2020. The cost of these claims now accounts for 1.8 per cent of the National Health Service 2019 to 2020 budget. This study aimed to identify the characteristics of clinical negligence claims in the subspecialty of otology.

METHODS

This study was a retrospective review of all clinical negligence claims in otology in England held by National Health Service Resolution between April 2013 and April 2018.

RESULTS

There were 171 claims in otology, 24 per cent of all otolaryngology claims, with a potential cost of £24.5 million. Over half of these were associated with hearing loss. Stapedectomy was the highest mean cost per claim operation at £769 438. The most common reasons for litigation were failure or delay in treatment (23 per cent), failure or delay in diagnosis (20 per cent), intra-operative complications (15 per cent) and inadequate consent (13 per cent).

CONCLUSION

There is a risk of high-cost claims in otology, especially with objective injuries such as hearing loss and facial nerve injury.

Introduction of an ENT emergency-safe boot camp into postgraduate surgical training in the Republic of Ireland

Background

Otolaryngology (ENT) is a craft surgical specialty, which presents significant challenges for the novice surgical trainee (NST), when managing patients with potentially life-threatening conditions. We assess current evidence behind intensive, simulation-rich training programmes or “boot camps”. We outline an ENT emergency-safe boot camp for NSTs and the impact this can have on trainees’ competence when dealing with ENT emergencies.

Methods

We designed a standardized “ENT emergency-safe boot camp”, aimed at NSTs with a view to up-skilling them in the management of 3 critical clinical scenarios namely post-thyroidectomy haematoma, post-tonsillectomy haemorrhage and epistaxis. All core surgical trainees (CSTs) (n = 54) on the National Surgical Training programme at the Royal College of Surgeons (RCSI) were enrolled on the boot camp. A pre- and post-boot camp anonymised self-assessment was completed by all participants.

Results

Trainees’ self-assessment demonstrated an increase in median competence scores from 3/5 to 4/5 for management of post-thyroidectomy haematoma and epistaxis. There was a greater increase in self-assessed competence scores from 2/5 to 4/5 for the management of post-tonsillectomy haemorrhage. Ninety-two percent of respondents said the course added to their previous knowledge, 70% of respondents said it improved their technical skills and 85% of participants said the course gave them more confidence with handling ENT related on-call problems.

Conclusion

Study participants expressed an increase in confidence when dealing with specific ENT emergencies, following boot camp training. This correlates with published data. Patient safety should be enhanced, as a result of participation in this dedicated ENT emergency-safe boot camp.

Using medical reality television as a technology-enhanced learning strategy to provide authentic patient care experiences during clinical placements: a case study research investigation

BACKGROUND

Over the last decade, the use of technology-enhanced learning (TEL) has rapidly expanded and diversified. Since the COVID-19 pandemic, there is a growing demand for distance and online learning strategies to support and even replace learning experiences previously afforded by clinical placements and clerkships. An intriguing but under-researched modality is the use of medical reality television to provide authentic experiences of patient care. This strategy does not feature in published medical educational literature, though promising research is emerging from other disciplines.

METHODOLOGY

A programme of learning using medical reality television clips to facilitate case-based learning was developed according to the principles of 'anchored instruction', a technology-based educational theory. Clips were taken from the UK television show '24 hours in A&E'. Medical students' learning experiences were investigated using a qualitative approach addressing the following research questions: - What is the perceived emotional experience of medical students when watching reality television in an educational context? - How do medical students relate their experience of watching reality television in a formal educational setting to their perceived learning needs in the clinical environment? A case study research methodology was adopted within the interpretivist paradigm. Data were triangulated from semi-structured interviews with students and non-participant observation of the teaching session. Field notes and transcripts were analysed through an inductive thematic analysis.

RESULTS

In response to the medical reality television, a diverse range of emotions were expressed including: excitement, amusement, concern, nervousness, sadness and joy. Students identified gaps in their clinical knowledge such as interpreting results, practical aspects of prescribing and end of life care. Key themes were increased student engagement and a promotion of holistic care practices.

DISCUSSION

Students perceived reality television as a highly realistic and relatable medium and an enjoyable, memorable way to contextualise learning from the classroom to real life, a finding mirrored in previous studies in other fields. The high degree of emotion expressed may explain the improved subjective memorability of the cases.

CONCLUSION

Medical reality television offers a unique means of engaging students by providing authentic experiences of patient care and should be valued alongside other technology-enhanced learning strategies.

How does participation in a voluntary prize exam affect medical students' knowledge and interest in ENT, plastic surgery, ophthalmology and dermatology?

BACKGROUND

Otolaryngology (ENT), plastic surgery, ophthalmology and dermatology are medical specialties which tend to receive less coverage in UK medical school curricula compared to larger, generalist specialties. As a result, there are fewer opportunities for medical students to learn and to cultivate an interest. There are numerous papers that report concerns about junior doctors' ability to manage conditions within these specialties, which may jeopardise patient safety. The aim of our pilot project was to increase medical students' interest and knowledge of ENT, plastic surgery, ophthalmology and dermatology. In addition to describing our project, we present and discuss literature on UK undergraduate education in these specialties and its impact on preparedness of junior doctors and future career choices.

METHODS

One hundred twelve final year medical students at Newcastle University were invited to take part in a voluntary two-part (written and clinical) exam, in which prizes could be won and all participants would receive a certificate of participation. We distributed two online surveys to the students, one administered before the exam and one afterwards. Data was collected regarding the students' motivation for entering the prize exam and the students' baseline interest and knowledge in these specialties before and after the prize exam. Free-text responses were collected about the students' opinion of the project and whether participation was beneficial.

RESULTS

Sixteen students participated in the exam. There was a statistically significant increase in the students' knowledge in ENT (p < 0.000), plastic surgery (p < 0.000), ophthalmology (p < 0.028) and dermatology (p < 0.012) after participation in the exam, but not in their interest levels. ENT was the preferred specialty of our cohort. The students reported that they found participation beneficial to their learning, particularly receiving exam feedback and explanations to exam questions.

CONCLUSIONS

This pilot project was a useful intervention in increasing medical students' knowledge in these specialties, but not in their levels of interest. It also demonstrates that medical students are willing to participate in voluntary initiatives (in their spare time) to gain more learning opportunities and that medical students value timely exam feedback to guide their revision.

A randomised trial to assess the educational benefit of a smartphone otoscope in undergraduate medical training

PURPOSE

Competent otoscopy is a key otolaryngology skill for a broad range of medical careers, yet undergraduate's confidence to perform otoscopy is reported as low. Smartphone otoscopes have been suggested to improve undergraduates learning of normal eardrum anatomy because unlike the traditional otoscope, the learner and educator share the same image. This study aimed to evaluate whether a smartphone otoscope could enhance medical undergraduates recognition of common ear pathology.

METHODS

52 medical students were randomised into a standard group that used a traditional otoscope and an intervention group that used a smartphone otoscope. Both groups received a short didactic presentation on the recognition of common ear pathologies and were asked to diagnose four simulated pathologies. Both groups received feedback and guidance on how to better visualise the tympanic membrane. Force response items and 5-point Likert scales loaded on an electronic platform recorded their diagnosis and their perceptions towards the otoscope.

RESULTS

The smartphone-group (n = 20) had higher overall rates of correct diagnosis compared to control (n = 22) (84% vs. 39%, p = < 0.001). Only the grommet station did not show a significant improvement between the two groups (100% vs. 91%, p = 0.49). 90% (n = 20) of participants felt the smartphone otoscope was preferential for their learning. The same number expressed that they want to use it in future learning. The remainder were indifferent.

CONCLUSIONS

The smartphone otoscope enabled learners to better observe and recognise middle ear pathology. This popular learning tool has the potential to accelerate the learning curve of otoscopy and therefore improve the proficiency of future doctors at recognising middle ear diseases.

A survey of ENT undergraduate teaching in the UK

Background

ENT presentations are prevalent in clinical practice but feature little in undergraduate curricula. Consequently, most medical graduates are not confident managing common ENT conditions. In 2014, the first evidence-based ENT undergraduate curriculum was published to guide medical schools.

Objective

To assess the extent that current UK medical school learning outcomes correlate with the syllabus of the ENT undergraduate curriculum.

Method

Two students from each participating medical school independently reviewed all ENT-related curriculum documents to determine whether learning outcomes from the suggested curriculum were met.

Results

Sixteen of 34 curricula were reviewed. Only a minority of medical schools delivered teaching on laryngectomy or tracheostomy, nasal packing or cautery, and ENT medications or surgical procedures.

Conclusion

There is wide variability in ENT undergraduate education in UK medical schools. Careful consideration of which topics are prioritised, and the teaching modalities utilised, is essential. In addition, ENT learning opportunities for undergraduates outside of the medical school curriculum should be augmented.

Do Medical Students Receive Adequate Otolaryngology Training? A Canadian Perspective

Objectives:

Otolaryngology—head and neck surgery (OHNS) training has been found to be underrepresented in medical school curricula. The study aimed to assess (i) students’ clinical OHNS exposure, (ii) their confidence managing OHNS conditions, and (iii) the correlation between OHNS exposure and confidence managing OHNS conditions.

Methods:

Fourth-year medical students at two Canadian Universities completed a survey assessing baseline characteristics, OHNS training, and confidence managing OHNS conditions.

Results:

Of 87 returned surveys, 46 students had no clinical OHNS exposure, while 29 felt there was adequate OHNS exposure. The majority of students lacked confidence recognizing conditions requiring emergent referral. Students with greater OHNS training had greater confidence managing OHNS conditions ( r = 0.267, P = .012).

Conclusion:

The majority of medical students have minimal OHNS exposure. Students with greater OHNS exposure have greater confidence managing OHNS conditions. A review of Canadian medical school curricula is warranted to ensure adequate OHNS exposure.

A Near-Peer Teaching Module to Supplement Current Undergraduate Teaching in ENT Surgery

BACKGROUND

Near-peer teaching (NPT) has been successfully used in other medical specialties but not in ear, nose and throat surgery (ENT). Historically, undergraduates receive limited ENT exposure and subsequently report low confidence in ENT competencies. This has been a posited cause of high referral rates to the specialty. This study aimed to see if NPT could be implemented as an adjunct to traditional ENT teaching.

ACTIVITY

Learners received a short NPT module that was focused on clinical ENT. Pre- and post-module questionnaires collected data on students' confidence and knowledge.

RESULTS AND DISCUSSION

One hundred twenty-five undergraduate learners received the intervention. There was a significant percentage increase in both confidence (24.2%, p = < 0.001) and knowledge (35.9%, p = < 0.001) of learners. In a supervised setting, NPT could be a valuable adjunct to traditional undergraduate ENT education.

Current innovations in otolaryngology medical education in the UK: a systematic literature review

OBJECTIVE

Recent studies have indicated a lack of ENT training at the undergraduate and post-graduate levels. This study aimed to review the impact of recent educational innovations in improving ENT training for medical students and junior doctors in the UK.

METHODS

Three independent investigators conducted a literature search of published articles on ENT education. Included studies were analysed using qualitative synthesis methods.

RESULTS

An initial search yielded 2008 articles; 44 underwent full-text evaluation and 5 were included for final analysis. Most included studies demonstrated benefits for students when compared to existing teaching standards in terms of objective assessment (knowledge and skills gained) or subjective assessment (confidence and preference) following implemented educational innovations.

CONCLUSION

This study identified educational innovations developed in the past 15 years to enhance the teaching of core ENT competencies. More research is needed to establish their impact on the state of ENT medical education in the UK.

ENT training amongst general practitioners: results from a questionnaire

OBJECTIVES

To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum.

METHOD

An online questionnaire-based survey was sent to general practices in England.

RESULTS

A total of 417 general practitioners completed the questionnaire. Sixty-seven per cent had completed an ENT rotation at medical school whereas 27 per cent had undertaken a postgraduate placement in ENT. Fifty-one per cent had received post-graduate teaching in ENT, mainly in the form of lectures. The majority of general practitioners were not satisfied with their training in ENT at undergraduate and post-graduate levels. Eighty-five per cent of general practitioners believed formal hospital-based ENT training should remain in the undergraduate curriculum.

CONCLUSION

General practitioners reported insufficient exposure to ENT during both post-graduate and undergraduate training. Proposals to outsource undergraduate ENT teaching to affiliated departments such as general practice are of concern.

Simulation-based ENT induction: validation of a novel mannequin training model

OBJECTIVE

To ascertain whether simulation-based teaching is superior to lecture-based teaching for an induction programme using a home-made induction model.

METHODS

A simulation-based induction programme was designed and separate lecture-based teaching covering the same content was organised for junior doctors. The junior doctors were asked to complete pre- and post-induction surveys regarding confidence and anxiety levels. The skills taught included microsuction, flexible nasendoscopy, and anterior and posterior nasal packing. Structured interviews were conducted after the programme to gain qualitative data for analysis. The trainees' knowledge retention was compared using a standardised written assessment one month after the session.

RESULTS

Simulation-based teaching using the induction model was associated with a statistically significant increase in confidence levels and reduction in anxiety levels, and was associated with greater knowledge retention.

CONCLUSION

A regular simulation induction programme should be introduced using the induction model, as it leads to better knowledge retention and increased confidence levels.

Improving clinical undergraduate experience in otolaryngology: an audit of practice

BACKGROUND

Otolaryngology is under-represented in UK medical schools. This presents challenges in terms of exposing students to the diversity of otolaryngology, as well as 'showcasing' the specialty as a career option. This study aimed to audit the impact of a change in the delivery of final year tuition on student satisfaction.

METHOD

Participants were final year medical students completing a 2-day otolaryngology placement. A novel teaching programme was developed in response to feedback from students who completed a baseline teaching programme. The novel programme was evaluated over a 10-week period using questionnaires.

RESULTS

Fifty-eight participants completed the novel programme questionnaire. Overall, there was a positive impact on student satisfaction. Students completing the novel programme expressed a desire for increased otolaryngology placement.

CONCLUSION

This approach is an effective means of teaching otolaryngology to undergraduates. A mutual desire for greater exposure to otolaryngology in the undergraduate curriculum is held by medical students and otolaryngologists.

Specialty Showcase Days: Can Specialist Careers Workshops Improve The Consideration Of ENT For Medical Students?

OBJECTIVE

We hypothesize that poor consideration of specialist surgery is due to a lack of exposure to information about careers and practice itself. Ear, Nose, and Throat (ENT) surgery is given little weight in medical school curricula, despite ENT problems being extremely common. Our objective is to assess whether a specialty showcase day was sufficient to boost informed consideration of this career.

DESIGN

We designed a half-day course involving an interactive careers workshop exploring ENT as a specialty choice, alongside simulation stations of commonly presenting ENT problems led by ENT doctors. We used pre- and post-course evaluation sheets to explore factors that encourage and discourage students from surgical careers and perceptions of ENT.

SETTING

A large proportion of UK medical schools do not offer ENT placements, and of those that do, nearly half are not compulsory. This leaves students unaware of ENT as a career option and unclear about what an ENT career comprises. Our half-day course took place in the simulation suite at St Mary's Hospital, London.

PARTICIPANTS

Medical students were mainly in their third year of study and had aspirations towards a variety of surgical and non-surgical careers, with a minority aspiring towards ENT before the course.

RESULTS

Our results demonstrate that all students found the session useful and had a much better understanding of ENT practice, with almost all students leaving more likely to consider a career in ENT.

CONCLUSION

We would like to repeat this session in different student year groups and compare their perceptions with our results. We find our results a good case for including informative careers workshops as part of medical school teaching. We pose that interactive workshops exploring specialist surgical careers are a valid way to enable students in making informed career decisions - particularly in specialties that are under-represented at medical school.

A systematic review of factors affecting choice of otolaryngology as a career in medical students and junior doctors

Background

There is growing concern over a future shortfall in provision of UK otolaryngology consultants. There is a declining rate of applications to otolaryngology specialty training in the UK.

Objective

This study aimed to systematically review the literature to establish what factors influence medical students’ and junior doctors’ decision to pursue a career in otolaryngology.

Method

Medline, Embase and PubMed databases were searched in January 2019. Additional manual reference checks of identified literature were performed.

Results

Eleven articles were included in the review. Common factors that positively influenced the decision to pursue a career in otolaryngology were exposure to the specialty, positive role models and a good work-life balance. Lack of exposure was a consistent deterrent from pursuing a career in otolaryngology.

Conclusion

This review reiterates the need for greater exposure to otolaryngology in the undergraduate curriculum. In addition, mentorship for students with an interest in otolaryngology should be a priority.

Head and Neck Anatomy: Effect of Focussed Near-Peer Teaching on Anatomical Confidence in Undergraduate Medical Students

OBJECTIVES

To assess the effect of near-peer head and neck anatomy teaching on undergraduates and to quantify the benefit from a focussed teaching course. Near-peer teaching involves colleagues within close seniority and age proximity teaching one another on a specified topic.

DESIGN

Small group teaching sessions were delivered to medical students on 3 key areas of ENT anatomy. Participants were given a precourse and postcourse questionnaire to determine the benefit attained from the course.

SETTING

An undergraduate anatomy course taking place at the University of Birmingham Medical School.

PARTICIPANTS

A total of 30 medical students: 15 preclinical (years 1-2) and 15 clinical (years 3-5) medical students participated from a single institution.

RESULTS

A total of 71% of students expressed inadequate teaching of head and neck anatomy in undergraduate curriculum. All students (n = 30) expressed benefit from the course, however the patterns of learning differed: preclinical students showed a significant improvement in both their ability to name anatomical structures and their application (p < 0.05).

CONCLUSIONS

Near-peer learning provides benefit to all medical undergraduates in the context of teaching anatomy which may make it a valuable teaching tool for the future of medical education.

Otolaryngology exposure in a longitudinal integrated clerkship setting

BACKGROUND

Although 20-40% of primary care complaints are Otolaryngology-Head and Neck Surgery (OtoHNS) related, little emphasis is placed on OtoHNS instruction at the undergraduate medical education level. An OtoHNS clerkship rotation is not required at most Canadian medical schools. Furthermore, at institutions offering an OtoHNS rotation, less than 20% of students are able to complete a placement. Given that a large percentage of medical students in Canada will pursue primary care as a career, there remains a gap in providing OtoHNS clinical training. During the longitudinal integrated clerkship at the Northern Ontario School of Medicine (NOSM), students are assigned to one of 14 sites, and not all have access to an otolaryngologist. This study looks to quantify the level of exposure students are receiving in OtoHNS at NOSM and to assess their comfort level with diagnosing and treating common otolaryngologic conditions.

METHODS

A structured 13-item survey was administered to second, third and fourth year medical students at NOSM.

RESULTS

A majority (67.9%) of medical students surveyed had not observed an otolaryngologist. Furthermore, most students (90.6%) reported receiving very little OtoHNS classroom based and clinical instruction during medical school.

CONCLUSIONS

A discrepancy exists between the quantity and breadth of OtoHNS training received in undergraduate medical education and the volume of OtoHNS encounters in primary care practice. Although geographic dissemination of students in the distributed learning model may be a challenge, strategies such as standardized objectives and supplemental electronic resources may serve to solidify clinical knowledge.

How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014

OBJECTIVE

To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions.

DESIGN

A rapid review of the literature (registration #CRD42013005305).

DATA SOURCES

Nine major databases (and key websites) were searched in two timeframes (July-September 2013; updated May-June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures.

DATA EXTRACTION

At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013-2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes.

RESULTS

Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy.

CONCLUSIONS

Educational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team-working, prescribing and clinical reasoning). Future research in areas we are unsure about should adopt a programmatic and rigorous approach, with clear definitions of preparedness, multiple stakeholder perspectives along with multisite and longitudinal research designs to achieve a joined-up, systematic, approach to understanding future educational requirements for junior doctors.