Otolaryngology Residency Training Program Research Articles

A Reproducible Peritonsillar Abscess Incision and Drainage Model for Junior Trainees.

To describe the design and construction of a reproducible, low-cost, peritonsillar abscess (PTA) incision and drainage simulator and assess its impact on trainees' confidence. The 2-part simulator we developed consisted of a manikin head with a fixed, partially open mouth and a modular PTA mold. The mold is created by injecting a lotion and water mixture into plastic bubbles, followed by silicone solidification. Neodymium magnets secure the silicone-abscess packet to the manikin's palate. The simulator was utilized during an academic otolaryngology residency training program Annual Otolaryngology Boot Camp. A self-assessment Likert scale questionnaire was used to evaluate participants' confidence before and after simulator training. Fourth-year medical students and junior (first and second year) residents who participated in the boot camp and agreed to complete the evaluation were included. Three medical students, 17 PGY-1, and 10 PGY-2 residents agreed to complete the evaluation. All trainees agreed the model was useful for learning skills. The overall post-training confidence Likert scores of participants, and PGY-1 residents in particular, significantly improved compared to their pre-training scores (P < .001). Our model offers an affordable and efficient training opportunity for residents to enhance their competence in managing PTAs. This approach, with its simple yet effective design and low production cost, shows potential for scalability on a broader scale.

Impact of the COVID-19 pandemic on the otolaryngology residency training program in a university-based hospital in Bangkok, Thailand.

This study aimed to evaluate the impact of the COVID-19 pandemic on the otolaryngology residency training program in Vajira Hospital, Navamindradhiraj University. Conducted from October 2021 to January 2022, this cross-sectional survey included all residents, residents who graduated in 2021, and the attending staff. One form was sent to both resident groups for self-assessment and another form to the attending staff for resident assessment. The survey questions were about attitude toward COVID-19 service, knowledge, outpatient department service, surgical skills, and burnout assessment using the Maslach Burnout Inventory. This study included 17 residents and 9 attending staff members. COVID-19 indeed had affected the clinical and surgical training. Regarding the attitude toward COVID-19 services, the residents were moderately satisfied. They were concerned about work suspension resulting from infection and also death from COVID-19. N95 masks and other protective gears were scarce. Compared with those during the prepandemic era, residents had fewer academic activities, and they preferred hybrid teaching. The inpatient department, outpatient department, and surgical training opportunities, as well as elective and urgent surgeries, were also reduced. The attending staff considered 1-year extension of the training program, but the residents disapproved. The residents became less confident both in outpatient department service and surgical skill, and they felt emotional exhaustion, depersonalization, and decreased sense of personal accomplishment. COVID-19 pandemic had significant impact on otolaryngology residency training programs. It did not only affect burnout among residents but also caused a perception of skill and knowledge reduction.

How the COVID-19 pandemic affects specialty training: An analysis of a nationwide survey among otolaryngology residents in Chile.

Coronavirus disease 2019, or COVID-19, has become a global pandemic. Given that the highest viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is found in the airway, otolaryngologists are at high risk of infection. As a result, multiple recommendations have emerged regarding protective measures for surgical teams, including suspending non-urgent procedures and surgeries. To evaluate the impact of the COVID-19 pandemic on otolaryngology residency training programs nationwide. A cross-sectional survey-based study was completed in April 2020. The participants were recruited through an online survey, sent by email to all Chilean otolaryngology residents. Demographics, clinical activities, on-call shifts, COVID-19 infection status, exposure to COVID-19 patients, deployment to other specialties, diagnostic/therapeutic procedures, and surgeries performed were analyzed. Self-reported surgical data logs from previous years were used to compare results. Forty-seven residents completed the survey (84% response rate); 64% of residents refer seeing patients ten days or less during April 2020. Commonly performed procedures such as flexible nasolaryngoscopy, rigid nasal endoscopy, and peritonsillar abscess drainage were not performed by over 40% of the residents in that month. Only 38% participated in surgeries, with an average of 0.6 surgeries as a first surgeon, a dramatic decrease in surgical exposure when comparing the data logs from previous years. Most residents refer the following measures taken by their residency program to improve residency training: bibliographic videoconferences (87%), online clinical case seminars (60%), weekly journal clubs (38%), among others. Clinical and surgical opportunities decreased dramatically during April 2020. Adjustments to the regular academic curricula should be considered to decrease the negative impact of this pandemic on residency training.

Insights on Otolaryngology Residency Training during the COVID-19 Pandemic.

Otolaryngology residency training programs are facing a novel challenge due to severe acute respiratory syndrome coronavirus 2. The widespread impact and chronicity of this pandemic makes it unique from any crisis faced by our training programs to date. This international medical crisis has the potential to significantly alter the course of training for our current resident cohort. The decrease in clinical opportunities due to the limitations on elective surgical cases and office visits as well as potential resident redeployment could lead to a decline in overall experience as well as key indicator cases. It is important that we closely monitor the impact of this pandemic on resident education and ensure the implementation of alternative learning strategies while maintaining an emphasis on safety and well-being.

A time-sensitive rubric for assessing mastoidectomy proficiency.

To develop a time-sensitive, standardized rubric for cadaveric temporal bone dissection for otolaryngology resident education. This is a five-year prospective cohort study that evaluated otolaryngology resident performance during sequential cadaveric temporal bone dissection courses at a single otolaryngology residency training program. A canal-wall-up mastoidectomy with a facial recess approach was performed adhering to a 30-minute time limit and graded according to a standardized rubric. Main outcome measures included: (1) correct structure identification and (2) injuries sustained to structures as compared by resident post-graduate year (PGY) level. Thirteen residents were evaluated from October 2012 to March 2017. This included 57 individual graded exercises performed over ten dissection courses. The average score for PGY-2 residents was lowest (68.9), and PGY-5 residents achieved the highest average score (87.7). Junior residents correctly identified fewer structures (77.5%) when compared to senior residents (91.3%), p<0.0001. Correct performance of a facial recess approach was achieved by 100% of senior residents, but only 59.3% of junior residents (p=0.0003). The percentage of major injuries, which included the facial nerve, tegmen, labyrinth, and ossicular chain, decreased each PGY-level from a maximum of 17% by PGY-2 residents to a minimum of 5% by PGY-5 residents. Senior residents correctly identify more structures and are able to complete a facial recess approach with higher fidelity when subjected to a time-sensitive graded mastoidectomy rubric.

Assessment of Otolaryngology Residency Training Program in Iran: Perspectives of Faculty Members and Recently Graduated Medical Students.

There is limited evidence regarding the quality of otolaryngology residency programs in Iran. Regarding this, the present study aimed to assess some aspects of otolaryngology residency program in the field of otology in Iran based on the perspectives of faculty members and graduates. This study was conducted on 105 recent graduates and 30 faculty members and/or program directors in otolaryngology using two self-administered questionnaires. While the faculty members believed that a resident should work on at least 5.4 temporal bone surgeries on average, the actual number was 2.49. Tympanoplasty was assigned the highest rate of satisfaction by the recent graduates, whereas the lowest score belonged to middle ear exploration, ossiculoplasty, and stapes surgery. Only 53.6% of the graduates stated that there was an organized training curriculum in temporal laboratory. The recent graduates reported to have more frequent experiences of performing usual otology operations. However, they had fewer experiences of performing more advanced surgeries. The recently graduated subjects had a significantly low level of satisfaction with their competencies in carrying out more complex types of otology surgeries. High prevalence of otology surgeries in Iran provides valuable opportunities for training otolaryngology residents to achieve an acceptable level of competency. However, the results of this study strongly suggest the necessity of quality improvement both in teaching-learning and assessment processes in otolaryngology training programs.

What do otolaryngologists want to learn? An educational targeted needs assessment study

IntroductionTargeted needs assessment which includes identifying the needs of learners is a key step of program development. However, this step is commonly underestimated in postgraduate medical education programs, including otolaryngology residency training. Determining the needs of otolaryngologists may help educators to design more purposeful continuing medical education training programs. Furthermore, needs of specialists may provide a clearer insight about effectiveness of the residency programs in that specialty. ObjectiveTo determine training needs of otolaryngology specialists and to identify deficiencies in otolaryngology residency training programs. MethodsSeventy-eight otolaryngology specialists, who completed all data gathering forms properly, were included in this descriptive, cross-sectional study. Demographic data of the participants were collected. Training needs of the participants were determined in seven basic areas of otolaryngology via two-round Delphi method. The basic areas were otology–neurotology, rhinology, laryngology, head and neck surgery, pediatric otolaryngology, sleep disorders and facial plastic surgery. Additionally, we asked an open-ended question to investigate the reasons why the participants perceived themselves incompetent and undereducated, or why they needed further training in some of the basic otolaryngology areas. ResultsFacial plastic surgery, otology-neurotology and head and neck surgery were the most cited training areas in the needs assessment. Training needs differed according to experience and place of work. Financial expectations, deficiencies in residency training, regression in knowledge and skills, and special interest were effective determinants on decisions of the participants while determining their training needs. ConclusionOtolaryngologists need further training in some areas of their field due to different reasons. Determining these areas and reasons will help in designing more effective continuous medical education activities and residency training programs in otolaryngology.

Initial and Long-term Retention of Robotic Technical Skills in an Otolaryngology Residency Program.

To objectively assess the initial and long-term retention of robotic surgical skills of otolaryngology residents. This study was performed in an academic otolaryngology residency training program. Between October 2015 and November 2016, residents were invited to complete a prospective, multiphase robotic surgical skills training course: 1) online da Vinci Surgical System Assessment and didactic, 2) faculty-supervised robotic simulator training, 3) robotic docking and draping training, 4) robotic dry-lab exercises. To optimize surgical skill retention, the training laboratory was repeated 2 weeks after the initial training session. Twenty otolaryngology residents were included. Primary outcome was measured as robotic skill assessment scores on three tasks: camera targeting, peg board, and needle targeting. Skill assessments were completed prior to training, between the two training sessions, and at 1 month and 6 months after training. Residents were also asked to complete a self-assessment questionnaire. Camera targeting scores were improved at midtraining (P < .001) and 1-month posttraining (P = .010). Peg board scores were improved at 1 month training (P = .043). Needle targeting scores were improved at midtraining (P = .002), 1 month (P = .002), and 6 months posttraining (P < .001). Resident self-assessment scores demonstrating comfort with using the robotic console (P < .01) and docking/draping (P < .01) improved significantly following the training. Following a multiphase robotic training program, otolaryngology residents demonstrated significant, objective skill acquisition and retention at 1 month and 6 months follow-up. Although the proposed training strategy may be considered an important step in otolaryngology residency training, additional innovations are being designed toward a formal robotic training curriculum. NA Laryngoscope, 129:1380-1385, 2019.

The Impact of the Veteran's Affairs Medical System on an Otolaryngology Residency Training Program.

The field of otolaryngology has become the leading specialty in the management of head and neck pathology and trauma. Graduate medical education programs tasked to train military head and neck surgeons within the Department of Defense (DoD) maintain certification by ensuring adequate surgical case volume and training. In recent years, surgical case numbers have declined due to an overall healthy active duty patient population and deployments of residency faculty. As such, a novel initiative between the San Antonio Military Medical Center and the South Texas Veteran's Healthcare system was developed to provide seamless care among active duty service members, dependents, retirees, and veterans. The goal of this study is to review the impact on Otolaryngology Key Indicator Procedures (KIP), as defined by the Accreditation Council for Graduate Medical Education (ACGME), following integration of a Veterans Affairs health care population into a military otolaryngology residency program. Further, we aim to assess the potential secondary benefits of an integrated health care initiative between the DoD and the Veteran's Affairs (VA) systems. Otolaryngology key indicator procedures, as defined by the ACGME, were reviewed at an academic military medical center before and after implementation of an ENT Federal Healthcare Consortium integrating care of VA patients at a military hospital. The surgical scheduling system at our institution was queried for cases within the KIP categories of "Head & Neck" and "Otology" from 2011 to 2015. Case data was reviewed from the San Antonio Military Medical Center before (2011-2012) and following integration of VA patient care (2013-2015). A total of 520 "Head & Neck" and 532 "Otology" KIP were performed following development of an ENT Federal Consortium. One hundred and sixty-five KIPs were performed on patients referred from the VA. The range of VA-generated cases contributing to total KIPs for "Head & Neck" and "Otology" ranged from 6.8% to 59.5% and 0% to 18.9% per year. The establishment of a Federal Healthcare Consortium and integration of VA patient population provided a tangible and quantifiable increase in otolaryngology KIPs. Development of a training relationship with VA patients is beneficial in reaching outcome-oriented goals for otolaryngology residents.

Current Status of Radiology Training in Otolaryngology Residency Programs

Otolaryngologists use head and neck imaging on a daily basis. However, little is known about the training residents receive on the subject. Understanding the current training environment is important to identify areas of improvement for resident education. To assess the current state of radiology training in otolaryngology residency programs. This was a cross-sectional survey of 106 otolaryngology residency program directors involving multiple academic institutions. The main outcome of this study is the number of US otolaryngology residency programs that have a radiology curriculum. Measured outcomes were obtained from an anonymous online survey and reported as a percent of total respondents. Program directors from 39 of 106 (37%) US otolaryngology residency training programs responded to the survey. Twenty-eight of 39 (71%) have a focused radiology curriculum; 18 of 28 (64%) conduct sessions on a monthly basis, 8 of 28 (29%) on a quarterly basis, and 2 of 28 (7%) on a weekly basis. The predominant format (20 of 27 programs [74%]) is a mix of case-based review of inpatient studies and standard lectures. The largest proportion of sessions were run by radiologists (13 of 28 [46%]), with a mix of radiology and otolaryngologists close behind (11 of 28 [39%]). Twenty-two of 39 residency programs (56%) have a dedicated radiology rotation within their educational curriculum, of which 17 of 22 (77%) occur in postgraduate year 1 (PGY-1) of training, 3 of 22 (14%) in PGY-3, and 2 of 22 (9%) in PGY-4. Rotation lengths range from 1 week to 3 months, with most running 1 to 4 weeks. Thirty-two of 38 of US program directors (84%) believe that a formal radiology curriculum would benefit their residents. Thirty-five of 39 believe that this should be a case-based review of images. Twenty-four of 38 believe this should be done on a monthly basis. Fifteen of 39 responding program directors (39%) believe the optimal time is during the PGY-3 of training, 36% (14 of 38) favor the PGY-2, and 23% (9 of 38) in PGY-1. Despite no standardized requirements from the Accreditation Council for Graduate Medical Education (ACGME), 71% of US otolaryngology residency program directors who responded to our survey have a radiology curriculum. Most run didactics sessions at the desired frequency, setting, and format preferred by responding program directors. More than half of programs provide a dedicated radiology rotation, mostly during PGY-1, while identifying PGY-2 and PGY-3 as the optimal time for such an experience. These results highlight the need for a more thorough review of radiology education requirements from the ACGME to improve the training of otolaryngology residents across the country.

Practice Patterns of Sleep Otolaryngologists at Training Institutions in the United States.

Objective To assess the practice characteristics of adult sleep otolaryngologists within US otolaryngology residency training programs. Study Design Cross-sectional online survey. Setting Otolaryngology residency training programs. Subjects and Methods Program directors from 106 otolaryngology training programs in the United States were contacted. Program directors were instructed to forward a survey to otolaryngologists within the institution who provided Accreditation Council for Graduate Medical Education (ACGME) Otolaryngology Milestone Project feedback in "sleep-disordered breathing." The survey assessed demographics, nonsurgical practices, and surgical/procedural practices of adult sleep otolaryngologists. Data were collected and analyzed. Results Forty-six surveys met inclusion criteria, representing 40 of 106 (38%) programs. Ninety-three percent of respondents reported that residents gained a significant portion of their sleep medicine training from themselves (ie, the respondents), yet only 36% of respondents spent ≥50% of their time on sleep medicine/surgery. Forty-one percent reported being board certified in sleep, with 18% having completed an ACGME fellowship in sleep medicine. Respondents with board certification were more likely to spend greater portions of their practice on sleep medicine/surgery, χ2(3, n = 44) = 23.161 ( P < .001), treat non-obstructive sleep apnea sleep disorders (13 of 18 vs 1 of 26, P < .001), interpret polysomnograms (13 of 17 vs 1 of 15, P < .001), and perform drug-induced sleep endoscopy, χ2(1, n = 43) = 5.43, ( P = .02). A similar pattern was seen with stratification by ACGME sleep medicine fellowship. Conclusion This study highlights the variance in practice patterns among sleep otolaryngologists who instruct residents. Board certification and fellowship training in sleep medicine significantly influence breadth of trainee exposure to this field. The highly disparate trainee experiences to sleep otolaryngology across US programs require attention.

Measuring Nontechnical Aspects of Surgical Clinician Development in an Otolaryngology Residency Training Program.

Surgical competency requires sound clinical judgment, a systematic diagnostic approach, and integration of a wide variety of nontechnical skills. This more complex aspect of clinician development has traditionally been difficult to measure through standard assessment methods. This study was conducted to use the Clinical Practice Instrument (CPI) to measure nontechnical diagnostic and management skills during otolaryngology residency training; to determine whether there is demonstrable change in these skills between residents who are in postgraduate years (PGYs) 2, 4, and 5; and to evaluate whether results vary according to subspecialty topic or method of administration. Prospective study using the CPI, an instrument with previously established internal consistency, reproducibility, interrater reliability, discriminant validity, and responsiveness to change, in an otolaryngology residency training program. The CPI was used to evaluate progression in residents' ability to evaluate, diagnose, and manage case-based clinical scenarios. A total of 248 evaluations were performed in 45 otolaryngology resident trainees at regular intervals. Analysis of variance with nesting and postestimation pairwise comparisons were used to evaluate total and domain scores according to training level, subspecialty topic, and method of administration. Longitudinal residency educational initiative. Assessment with the CPI during PGYs 2, 4, and 5 of residency. Among the 45 otolaryngology residents (248 CPI administrations), there were a mean (SD) of 5 (3) administrations (range, 1-4) during their training. Total scores were significantly different among PGY levels of training, with lower scores seen in the PGY-2 level (44 [16]) compared with the PGY-4 (64 [13]) or PGY-5 level (69 [13]) (P < .001). Domain scores related to information gathering and organizational skills were acquired earlier in training, while knowledge base and clinical judgment improved later in residency. Trainees scored higher in general otolaryngology (mean [SD], 72 [14]) than in subspecialties (range, 55 [12], P = .003, to 56 [19], P < .001). Neither administering the examination with an electronic scoring system, rather than a paper-based scoring system, nor the calendar year of administration affected these results. Standardized interval evaluation with the CPI demonstrates improvement in qualitative diagnostic and management capabilities as PGY levels advance.

Simulation Activity in Otolaryngology Residencies.

Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty. Web-based survey. US otolaryngology residency training programs. An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported. Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives. Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs.

Early detection of factual knowledge deficiency and remediation in otolaryngology residency education

Within otolaryngology residency training, the annual Otolaryngology Training Examination (OTE) is the primary method used to assess, quantify, and compare the factual knowledge acquired by each resident. The objective of this study was to develop a more frequent method for tracking of factual knowledge to prevent educational delay. Retrospective analysis of educational scores. For each didactic lecture within a single otolaryngology residency training program, multiple choice questions were provided before and after each lecture. Questions were based on lecture objectives that were derived from the American Board of Otolaryngology curriculum. Scores were tracked over the course of 1 academic year and compared to the scores of residents on the OTE administered in that year to determine correlation with a validated measure of factual knowledge. The effect of remedial measures on improvement in OTE scores was determined. Over the course of 1 academic year, there were 328 questions presented to 12 residents before and after 32 lectures in the didactic program. Ten residents completed an average of 244 questions. Overall OTE scores demonstrated a significant and very strong correlation to lecture question scores (Pearson r = 0.86, P = .002). Remedial measures for residents during the previous 5 years who had inadequate OTE scores were successful in improving scores (P = .002). A structured didactic program that uses review questions to assess knowledge can be used to track acquisition of factual knowledge. Early identification of residents with deficiencies facilitates the development of individualized learning plans that result in successful remediation.

Skull Base Operative Experience in U.S. Otolaryngology Residency Training Programs

Objectives: To understand national trends in otolaryngology resident operative exposure to skull base surgery, and to explore differences between our institution's resident case log and overall surgical volume.

Allergy education in otolaryngology residency: a survey of program directors and residents

The purpose of this study was to survey program directors of the accredited otolaryngology residency programs and resident attendees of the 2013 American Academy of Otolaryngic Allergy (AAOA) Basic/MOC Course regarding resident education and participation as well as assessment of competency in otolaryngic allergy and immunotherapy. A multiple-choice questionnaire was sent to all accredited otolaryngology residency training programs in the United States as part of resident attendance at the 2013 AAOA CORE Basic/MOC Course. Following this, a similar multiple-choice survey was sent to all resident attendees from the programs that responded positively. Program directors reported that 73% of their academic institutions offer allergy testing and immunotherapy. More PDs than residents indicated that residents participate in allergy practice and perform/interpret skin testing and in vitro testing, and more residents (85%) than program directors (63%) reported inadequate or no allergy training. Program directors and residents equally indicated that residents do not calculate immunotherapy vial formulations or administer immunotherapy injections. The majority of program directors indicated that resident competency in allergy was assessed through direct observation, whereas residents more commonly perceived that no assessment of competency was being performed for any portion of allergy practice. This survey demonstrates a discrepancy between program directors and residents regarding resident involvement and adequacy of training in the allergy practice. Although the majority of otolaryngology residencies report offering otolaryngic allergy services and education, the vast majority of residents report inadequate allergy training and less participation in an allergy practice compared to the majority of program directors.

A Systematic Review of Simulation in Otolaryngology Residency Training

Objectives: The central premise of our systematic review was to determine: Where does the field of otolaryngology stand in incorporating simulation into residency training? We believe there has been a profound increase in the use of simulation in otolaryngology residency training programs recently, which can be described by a simultaneous increase in the number of otolaryngology simulation-based publications. Study Design: Systematic review. Data Sources: A literature search was performed using the Ovid Medline and PubMed search engines. Methods: Two independent reviewers separately evaluated the 142 articles for relevance using specific inclusion and exclusion criteria. Results: Sixty-nine articles were included and broken down into number of publications produced per year, country of origin, resident training level targeted, the specific area being simulated, and the fidelity of the simulation. The number of simulation-based publications has increased from 1996 through 2012. The United States has produced 61% of the articles, with another 8 countries also contributing. The simulated areas were temporal bone/ear (28), airway/endoscopy (19), sinus (15), head and neck cancer (2), and esophagus (1). The fidelity of these simulations was also described as high (55 articles, 80%), low (6 articles, 9%), or both (8 articles, 11%). Conclusions: Simulation-based medical education in otolaryngology has grown tremendously since the 1990s with a corresponding increase in the number of publications. We anticipate this trend will continue, as simulation takes an increasingly important role in providing the innovative solutions to meet the challenges of training future otolaryngologists.

Complicaciones de la cirugía endoscópica nasosinusal en un programa de entrenamiento de residentes

Introduction Endoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. Methods Descriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. Results Of the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade i, 19 (9.8%) cases; grade ii, 55 (28.6%); and grade iii, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21(10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. Conclusions Endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.

Complications of endoscopic sinus surgery in a residency training program

IntroductionEndoscopic sinus surgery presents a series of complications that can vary depending on the technique used and the surgeon's experience. This technique needs a learning curve, which must be developed during the residence training program. MethodsDescriptive and retrospective study, reviewing the medical records of endoscopic sinus surgery for nasal polyps of 192 patients who had undergone operations performed by residents at our department between January 2002 and January 2008. Patient sex, age, affectation scale and minor and major complications were described. All these procedures were performed by 3rd or 4th-year residents under the supervision of a faculty member. ResultsOf the 192 patients, 127 (66.14%) were male and 65 (33.85%) female, aged between 24 and 78 years old, with a mean age of 49 years old. Nasal endoscopy revealed polyposis of grade I, 19 (9.8%) cases; grade II, 55 (28.6%); and grade III, 118 (61.45%). There were 44 (22.9%) total complications, 40 (20.8%) minor and 4 (2.08%) major complications. The most common minor complication was synechia formation in 21(10.93%) cases, followed by bleeding without need for transfusion in 12 (6.25%). The major complication was a breach of the lamina papyracea in 4 patients (2.08%). There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. ConclusionsEndoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.

Monitoring stress levels in postgraduate medical training

The Accreditation Council for Graduate Medical Education (ACGME) mandates that residency Program Directors (PD) monitor resident well-being, including stress. Burnout, as a measure of work-related stress, is defined by a high degree of emotional exhaustion and depersonalization, and a low degree of personal accomplishment using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). The purpose of this study is to describe the use of the MBI-HSS as a method of monitoring stress levels in an academic otolaryngology residency training program and introduce this survey as a tool for wider use in meeting ACGME requirements. The MBI-HSS was administered to residents in an academic otolaryngology residency training program on three separate occasions: at the beginning, middle, and end of different academic years. In addition, at the time of the third administration, the MBI-HSS was completed by faculty and staff in the same department. Surveys were completed and collected anonymously. Responses were scored against normative data from the MBI-HSS overall sample and the medicine subscale. Low, average, and high levels of burnout were identified for the individual categories of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA); average levels for each category were calculated. Twenty-two residents completed the first survey, taken near the end of an academic year; 19 completed the second administration in the middle of the following academic year; and 24 completed the third survey at the beginning of the subsequent academic year. Thirteen faculty and 23 staff also completed the third survey. We found that three, one, and one residents reported high levels of burnout on the first, second, and third surveys, respectively. These figures compare to one faculty member and no staff members in the same department reporting high levels of burnout. The MBI-HSS is an established and validated tool for identifying burnout in resident physicians. Residency PDs may find the MBI-HSS useful as an aid in monitoring resident well-being and stress. In our own department, we found levels of burnout comparable to those previously reported for residents and faculty in this specialty.