Otolaryngology Residency Training Research Articles

Assessing and Documenting General Competencies in Otolaryngology Resident Training Programs

The objectives of this study were to: 1) implement web-based instruments for assessing and documenting the general competencies of otolaryngology resident education, as outlined by the Accreditation Council of Graduate Medical Education (ACGME); and 2) examine the benefit and validity of this online system for measuring educational outcomes and for identifying insufficiencies in the training program as they occur. We developed an online assessment system for a surgical postgraduate education program and examined its feasibility, usability, and validity. Evaluations of behaviors, skills, and attitudes of 26 residents were completed online by faculty, peers, and nonphysician professionals during a 3-year period. Analyses included calculation and evaluation of total average performance scores of each resident by different evaluators. Evaluations were also compared with American Board of Otolaryngology-administered in-service examination (ISE) scores for each resident. Convergent validity was examined statistically by comparing ratings among the different evaluator types. Questionnaires and software were found to be simple to use and efficient in collecting essential information. From July 2002 to June 2005, 1,336 evaluation forms were available for analysis. The average score assigned by faculty was 4.31, significantly lower than that by nonphysician professionals (4.66) and residents evaluating peers (4.63) (P < .001), whereas scores were similar between nonphysician professionals and resident peers. Average scores between faculty and nonphysician groups showed correlation in constructs of communication and relationship with patients, but not in those of professionalism and documentation. Correlation was observed in respect for patients but not in medical knowledge between faculty and resident peer groups. Resident ISE scores improved in the third year of the study and demonstrated high correlation with faculty perceptions of medical knowledge (r = 0.65, P = .007). Compliance for completion of forms was 97%. The system facilitated the educational management of our training program along multiple dimensions. The small perceptual differences among a highly selected group of residents have made the unambiguous validation of the system challenging. The instruments and approach warrant further study. Improvements are likely best achieved in broad consultation among other otolaryngology programs.

The Effects of Previously Acquired Skills on Sinus Surgery Simulator Performance

The Endoscopic Sinus Surgery Simulator is currently being studied as a tool for otolaryngology resident training. While examining performance patterns on the simulator, we sought to define any relationships that may exist between students' previously acquired skills and their performance on the simulator. Twenty-six medical students were enrolled in our study. After completing their trials, they were asked to complete a 28-item questionnaire. This questionnaire included yes/no questions as well as 10-point Likert scale instruments. Only 4 students did not respond to the questionnaire. Significant contributions to simulator performance were elucidated for a number of previously learned skills, but most were short-lived. For example, experienced video gamers were significantly better at hazard avoidance in the simulator's novice mode (P = .03), but their advantage dissipated as they advanced to intermediate mode trials. In addition, students' handedness contributed to simulator performance for only the first 3 trials (P = .04), but this relationship, too, was no longer statistically significant in later trials. Some study students had skills and characteristics that significantly aided them in their ability to perform surgery on the simulator. However, these benefits were short-lived, and these results suggest that practicing plays a more important and long-standing role than other factors in surgical simulator performance. It follows that surgical simulation should play a more prominent role in surgical education because residents who practice on simulators such as this are, in turn, practicing for the reality of the operating room.

Miniseminar: maximizing OTO training 2004: Insider's perspectives, from match to program accreditation

The training of an otolaryngologist-head and neck surgeon is an increasingly complex educational process that spans at least 5 years, beginning with the early “Match” and ending with successful completion of an accredited otolaryngology residency training program. We will discuss nuances of the selection and match process for incoming residents, current ACGME accreditation guidelines, and regulations for training including the new duty hours requirements and trends from other specialties. Successful novel approaches will also be presented. In addition, we will consider potential future changes, both internal and external to the specialty, that could impact the training of otolaryngologists. This miniseminar will be of interest to current residents and medical students, faculty that participate in a training program, and practicing otolaryngologists. Residency training is not directed using an exact “formula,” and there are many successful models of good training. The Panel represents a spectrum of “insider” personnel from the ACGME, RRC, and the San Francisco Match. The Panel will also provide views from a senior otolaryngology resident and program directors from both a small and large program. Invited speaker presentations will be followed by a dynamic audience-participatory discussion related to these topics. The Panel will discuss: (1) The Otolaryngology Match: trends, misconceptions, and maximizing the resident selection process; (2) Mastering the ACGME accreditation process and Program Requirements; (3) Duty Hour regulations: specifics and solutions; (4) Presenting your Program during the ACGME site visit experience; (5) Future horizons and directions.

The effects of previously acquired skills on sinus surgery simulator performance

Objectives: The endoscopic sinus surgery simulator (ES3) is currently being studied as a tool for otolaryngology resident training. While examining performance patterns on the simulator, we sought to define any relationships that may exist between subjects’ previously acquired skills and their performance on the simulator. Methods: Twenty-six medical students were enrolled in our ES3 study. After completing their trials, they were asked to complete a 28-item questionnaire. This questionnaire included yes/no questions, as well as 10-point Likert scale instruments. Results: Only 4 subjects did not respond to the questionnaire. Significant contributions to simulator performance were elucidated for a number of previously learned skills, but most were short-lived. For example, experienced video gamers were significantly better at hazard avoidance in the simulator’s novice mode ( P = 0.03), but their advantage dissipated as they advanced to intermediate mode trials. Additionally, subjects’ handedness contributed to simulator performance for only the first 3 trials ( P = 0.04), but this relationship, too, was no longer statistically significant in later trials. Conclusions: Some study subjects had skills and characteristics that significantly aided them in their ability to perform surgery on the simulator. However, these benefits were short-lived, and these results suggest that practicing plays a more important and long-standing role than other factors in surgical simulator performance. It follows that surgical simulation should play a more prominent role in surgical education, since residents who practice on simulators such as the ES3 are, in turn, practicing for the reality of the operating room.

Endoscopically Monitored Percutaneous Dilational Tracheotomy in a Residency Program

Endoscopically guided percutaneous dilational tracheotomy (PDT) has become a well-established alternative to the more traditional open tracheotomy, yet its use by otolaryngologists is limited. As airway management specialists, otolaryngologists should be familiar with a wide range of definitive procedures, including PDT. Few otolaryngology programs teach the technique. The objective of the present study was to determine the complication rate and outcome of PDT after its introduction in a residency teaching program. We also wished to evaluate whether the time savings reported by experienced surgeons could be repeated in our setting. Tertiary referral teaching hospital. We prospectively reviewed our first 54 consecutive PDTs and compared them to 29 consecutive standard open tracheotomies, which were reviewed retrospectively. Complications (13% vs. 33%, P = .030), operative time (12 vs. 24 min, P < .0001) and total procedure time (37 vs. 80 min, P < .001) were significantly reduced in the PDT group as compared with standard tracheotomy. Initial outcome data were equal in both groups. We found that PDT can be safely and effectively taught as part of an otolaryngology residency training program.

Safety of Endoscopic Sinus Surgery in a Residency Training Program

Over the past decade, endoscopic sinus surgery has become one of the most frequently performed operations in otolaryngology. Nevertheless, concerns have been raised about the safety of this procedure in a residency training program. To address this issue, we carried out a retrospective review to assess the complications of endoscopic sinus surgery performed by otolaryngology residents under close supervision. We reviewed the medical records of 597 patients who had undergone 719 operations performed by residents in the Department of Otolaryngology-Head and Neck Surgery of the University of Southern California-Los Angeles County Medical Center and at the University Hospital between June 1988 and December 1995. Most of these procedures were performed by junior residents under the supervision of either a senior resident or faculty member. We found that the incidence of minor and major complications was 12.2 and 0.4%, respectively. The most common minor complications were vascular. The only major complication was excessive bleeding that required transfusion. There were no cases of blindness, cerebrospinal fluid rhinorrhea, or death. We conclude that endoscopic sinus surgery in an otolaryngology residency training program is a relatively safe procedure, especially when performed under faculty supervision.

Comparison of internal maxillary artery ligation versus embolization for refractory posterior epistaxis

OBJECTIVE: This study examined the advantages and disadvantages of internal maxillary artery (IMA) ligation versus embolization for the treatment of refractory posterior epistaxis. METHODS: Thirty-nine patients underwent 42 procedures for treatment of posterior epistaxis at the University of Cincinnati Medical Center between 1986 and 1994. Complication rates, failure rates, demographics, and the costs of IMA ligation and embolization were compared. A review of 20 studies published between 1973 and 1995 was done to determine the complication and failure rates of IMA ligation and embolization. Finally, a mail survey was used to determine the availability and use of IMA ligation and embolization by urban and rural otolaryngologists in Ohio. RESULTS: Complication and failure rates of IMA ligation and embolization were similar at our institution. In the literature review, IMA ligation had a higher complication rate, but fewer failures. Although the major complication rates were not significantly different, those associated with embolization were often more serious than those associated with IMA ligation. At our institution, the cost of IMA embolization was significantly lower than the cost of IMA ligation. Only 11% of Ohio otolaryngologists in nonurban areas have embolization available to treat posterior epistaxis. CONCLUSION: IMA ligation is more effective than IMA embolization but may be associated with a higher minor complication rate. The major complications that occur with IMA embolization are often more serious. Although IMA embolization was less expensive at our institution, it is unavailable in most nonurban regions in Ohio. Training in the use of IMA ligation for refractory posterior epistaxis should continue in otolaryngology residency training programs despite the increasing availability of embolization at university training centers. (Otolaryngol Head Neck Surg 1998;118:636-42.)

Teaching paradigm for decision making in facial skin defect reconstructions.

To present a decision paradigm for facial defect reconstruction, and test the ability of this paradigm to improve resident performance. A decision paradigm for reconstruction of facial skin defects is proposed and explained, with patient examples. The paradigm's usefulness is then tested with residents. Otolaryngology residency training program at a tertiary hospital. Otolaryngology residents. Twelve residents took a pretest wherein they were presented with drawings of skin defects and asked to choose the "best" (most aesthetically pleasing) type of reconstruction from a closed set. This paradigm was presented to these residents, and their posttest consisted of choosing again with the same defects and closed set of choices. Cosmetic outcomes of reconstructive decisions on the pretest and posttest were rated on a scale of 0 to 5 (with 0 indicating poor; 5, excellent). There was a significant improvement in reconstructive choices between the pretest and posttest (P<.001, Student t test). This paradigm can be easily modified to accommodate different surgical approaches preferred by individual surgeons and is thus useful in almost any reconstructive teaching situation.

Safety of thyroidectomy in residency: a review of 186 consecutive cases.

A retrospective review was performed to assess the surgical complications of thyroidectomy performed by otolaryngology residents under close supervision by faculty. One hundred eighty-six consecutive cases of thyroidectomy performed by the residents in the Department of Otolaryngology--Head and Neck Surgery at the University of Southern California were reviewed. Sixty-nine percent of thyroidectomies were performed for malignant or possible malignant diseases, and 31% were performed for benign conditions. Transient (less than 2 weeks in duration) hypocalcemia occurred in 26% of the patients; the vast majority of cases resolved within the first week. Five percent of the patients developed persistent hypocalcemia requiring prolonged replacement therapy. The incidence of unexpected postoperative permanent vocal cord paralysis was 0.9%. These complication rates are comparable to those in previously published large series on results of thyroidectomy. Thyroidectomy performed in an otolaryngology residency training program is a safe procedure when closely supervised by experienced faculty.

Otolaryngology residency and fellowship training. The resident's perspective.

Based on the success rate of US otolaryngology graduates on the American Board of Otolaryngology Certification Examination, it would appear that otolaryngology training is quite good. However, it is not clear that all aspects of training are equal in quality, not only between programs but also within a single program. One indication that there may be areas of weakness is the fact that despite the perceived national shortages of primary care physicians in the United States and the overabundance of specialists, 25% of the approximately 260 graduating otolaryngology residents extend their training beyond specialty training to subspecialty levels (Manpower Committee of the American Academy of Otolaryngology-Head and Neck Surgery, unpublished data obtained from chief resident questionnaires, 1990-1992). The most popular area of fellowship training is facial plastic surgery, followed by neurotology and head and neck oncology. Pediatric otolaryngology fellowships make up most of the balance. Most of the fellowships are well structured and are 1 year in duration. Others are more like apprenticeships and may be of shorter duration. A few are 2 years long and include a significant research commitment reserved for individuals entering academic practice.