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Offergeld C, Kuhn S, Kromeier J, Heermann S, Widder A, Flayyih O, Everad F, Knopf A, Albrecht T, Burkhardt V, Hildenbrand T, Ramackers W. [Is the use of virtual reality in otorhinolaryngology teaching automatically positively rated by students? : A questionnaire-based evaluation among students]. HNO 2024; 72:367-374. [PMID: 38578464 PMCID: PMC11045625 DOI: 10.1007/s00106-024-01453-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Analogous to the situation in other disciplines, digital ENT teaching made significant progress during the pandemic. Most ENT clinics nationwide were able to offer a complete virtual teaching program in time. Innovative teaching methods were also used early on. This was recognized in student teaching evaluations. Due to the expansion of virtual reality (VR) in medical teaching, even greater satisfaction should be expected through improved teaching quality. MATERIALS AND METHODS Surveys were performed with students (n = 180) of the ENT block internship in the summer semester of 2023. The aim of the evaluation was to determine the students' satisfaction with and subjective effectiveness of the newly implemented VR digital teaching method for teaching ear anatomy and coniotomy. A survey was also carried out among resident physicians. RESULTS The ENT teaching was perceived favorably by the students, with an average rating of 11.7 out of 15. The learning effectiveness and the value of VR in the ENT learning portfolio was evaluated varyingly by the students. The physicians' assessment was different, with a more positive perception. CONCLUSION Virtual reality represents an innovative component in the teaching portfolio of otolaryngology. This new teaching method is viewed and accepted as a future-oriented tool. Remarkably, the physicians involved voted consistently positively, while the students gave more critical assessments and pointed out limitations in the individual and subjective areas. These findings are in contrast to the further development of innovative teaching methods demanded by student interest groups.
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Affiliation(s)
- C Offergeld
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - S Kuhn
- Institut für Digitalisierung in der Medizin, Universitätsklinikum Gießen-Marburg, Marburg, Deutschland
| | - J Kromeier
- Klinik für Radiologie, St. Josef-Krankenhaus Freiburg, Freiburg, Deutschland
| | - S Heermann
- Institut für Anatomie und Zellbiologie, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Widder
- Studiendekanat der Med. Fak., Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - O Flayyih
- Studiendekanat der Med. Fak., Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - F Everad
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - A Knopf
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Albrecht
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - V Burkhardt
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Hildenbrand
- Univ.-HNO-Klinik, Medizinische Fakultät, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - W Ramackers
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
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Youner ER, Chillakuru YR, Xu H, Dedmon M, Labadie R, Djalilian H, Mahboubi H, Westerberg B, Vaisbuch Y, Blevins N, Chen J, Lin V, Joyce MG, Moncada PX, Dabiri S, Gurgel RK, Kouhi A, Monfared AS. Content Validity of a High-Fidelity Surgical Middle Ear Simulator: A Randomized Prospective International Multicenter Trial. Otol Neurotol 2023; 44:903-911. [PMID: 37590880 DOI: 10.1097/mao.0000000000003998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE After demonstration of face validity of a surgical middle ear simulator (SMS) previously, we assessed the content validity of the simulator with otolaryngology residents. STUDY DESIGN Multicenter randomized prospective international study. SETTING Four academic institutions. METHODS Novice participants were randomized into control, low-fidelity (LF), and high-fidelity (HF) groups. Control and LF produced 2 recordings from 2 attempts, and HF produced 4 recordings from 10 attempts, with trials 1, 4, 7, and 10 used for scoring. Three blinded experts graded videos of the simulated stapedectomy operation using an objective skills assessment test format consisting of global and stapedotomy-specific scales. RESULTS A total of 152 recordings from 61 participants were included. Baseline characteristics did not differ significantly between groups. Depending on the step of the operation, inter-rater reliability ranged from 24 to 90%. For LF and HF, years of training was significantly associated with improved scores in certain objective skills assessment test subparts. HF outperformed the control group on stapes and global scores ( p < 0.05). The HF group demonstrated improvement in global score over trials, but plateaued after four trials. Scores varied greatly for participants from different institutions in certain operative steps, such as transecting incudostapedial joints, likely due to differences in instrumentation and time elapsed since manufacture. CONCLUSION Practice with SMS led to better performance in both global and stapes-specific scores. Further studies are needed to examine construct validity and to create otology-appropriate grading systems. Variables like instrumentation and decline in flexibility of the simulator after 12 months greatly affect performance on the simulator.
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Affiliation(s)
- Emily R Youner
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Yeshwant R Chillakuru
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Helen Xu
- Department of Otolaryngology, Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Matthew Dedmon
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Robert Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hamid Djalilian
- Department of Otolaryngology-Head and Neck Surgery and Biomedical Engineering, University of California, Irvine, California, USA
| | | | - Brian Westerberg
- BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yona Vaisbuch
- Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel
| | - Nikolas Blevins
- Department of Otolaryngology, Stanford University, Stanford, California
| | - Joseph Chen
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto
| | - Vincent Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada
| | - Morgan G Joyce
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Paola X Moncada
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
| | - Sasan Dabiri
- Department of Otolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Richard K Gurgel
- Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ali Kouhi
- Department of Otolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan S Monfared
- Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA
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Sethia R, Alfayez Y, VanKoevering KK, Seim NB. Altered Airway Anatomy Course Using 3D-Printed Models for Medical Students. Otolaryngol Head Neck Surg 2023; 168:714-719. [PMID: 35943806 DOI: 10.1177/01945998221117507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Many non-airway-trained personnel are uncomfortable managing altered airway anatomy (AAA), including tracheostomy and total laryngectomy (TL) patients. Significant morbidity and mortality have resulted from first responders' inability to stabilize the airway until expert airway providers arrive. All medical school graduates should demonstrate competency of this life-saving skill. Our hypothesis was hands-on interactive simulation using 3-dimensional (3D)-printed models would improve AAA knowledge and confidence. STUDY DESIGN Blinded, prospective cohort study. SETTING The Ohio State University College of Medicine. METHODS A novel curriculum was designed to teach all third-year medical students AAA fundamentals via case-based discussions, surgical videos, and hands-on student demonstration of competency by inserting a tracheostomy and endotracheal tube through 3D-printed tracheostoma models. Pre- and postcourse 5-item Likert scale surveys and AAA knowledge assessments were administered. RESULTS Students (n = 258) felt more comfortable with knowledge of AAA equipment (3.99 vs 1.38, P < .0001), ability to stabilize AAA patients until expert airway providers arrive (3.67 vs 1.37, P < .0001), and AAA overall (3.75 vs 1.49, P < .0001) postcourse vs precourse. AAA knowledge assessment scores improved from 34.3% precourse to 75.6% postcourse (P < .0001). Interestingly, 30.7% chose bag-mask ventilation over mouth and nose and/or transoral/transnasal intubation for a total laryngectomy patient precourse vs 5.5% postcourse (P < .0001). In total, 86.7% reported inadequate exposure to AAA in medical school and 98.4% found the course to be a valuable experience. CONCLUSION This hands-on course significantly increases medical student knowledge and comfort managing AAA patients. The course can be expanded to various trainees and providers to further promote AAA education and ultimately improve patient safety.
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Affiliation(s)
- Rishabh Sethia
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center & The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Yazen Alfayez
- The Ohio State University College of Engineering, Columbus, Ohio, USA
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center & The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center & The James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
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Richardson CM, Zopf DA, Ikeda AK, van Horn A, Cohen K, Nourmohammadi Z, Nassar M, Park JS, Johnson KE. A Validated 3D Printed Laryngeal Suturing Simulator for Endoscopic Laryngeal Cleft Repair. Laryngoscope 2023; 133:785-791. [PMID: 35932231 DOI: 10.1002/lary.30320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Endoscopic laryngeal cleft repair (ELCR) with endolaryngeal suturing is an advanced surgical skill. This study objective was to assess the validity of 3-dimensionally (3D) printed laryngeal suturing simulator for ELCR. STUDY DESIGN Development and validation of a simulator for ELCR. METHODS An ELCR model was developed using 3D printed and readily available materials. Participants were surveyed before and after a simulation session using five-point Likert scale questions. Performance data was assessed using blinded expert video review and rated using a novel objective structured assessment of technical skills (OSATS) for endoscopic laryngeal suturing. RESULTS Twenty-one participants ranging from residents to attendings completed the simulation session. Survey respondents reported on a five-point Likert scale that the model was "easy to use" and "quite realistic" (both mean of 4). Confidence improved significantly in 86% of participants (p < 0.01). Overall OSATS scores (out of a total of 55) showed a median improvement in technical skills of 11.7 points (p = 0.004). OSATS demonstrated good intra-rater (κ = 0.689 and 0.677) and moderate inter-rater (κ = 0.573) reliability. Completion times improved from the first to the last suture by a median time of 512 to 350 s (decrease of 202 s, p = 0.002). Participants with no prior ELCR experience improved more than those with in vivo experience. CONCLUSION This study demonstrates the validity of a simulator utilizing 3D printed larynges for ELCR. A novel OSATS for endoscopic laryngeal suturing was successfully implemented. Confidence, technical skills, and completion times improved with the use of the model across a variety of participants. Laryngoscope, 133:785-791, 2023.
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Affiliation(s)
- Clare M Richardson
- Division of Pediatric of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - David A Zopf
- Division of Pediatric of Otolaryngology - Head and Neck Surgery, CS Mott Children's Hospital, Ann Arbor, Michigan, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison K Ikeda
- Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Adam van Horn
- Division of Otolaryngology - Head and Neck Surgery, Marshall University, Huntington, West Virginia, USA
| | - Katheryn Cohen
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Zahra Nourmohammadi
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Michel Nassar
- Department of Otolaryngology - Head and Neck Surgery, Montefiore Medical Center, New York City, New York, USA
| | - Jason S Park
- Department of Otolaryngology - Head and Neck Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kaalan E Johnson
- Division of Pediatric of Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Otolaryngology - Head and Neck Surgery, University of Washington, Seattle, Washington, USA
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McCool KE, Marks SL, Hawkins EC. Endoscopy Training in Small Animal Internal Medicine: A Survey of Residency Training Programs in North America. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:515-523. [PMID: 34115581 DOI: 10.3138/jvme-2020-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Competency in multiple endoscopic techniques is a major goal of small animal internal medicine (SAIM) residency programs. Training relies predominantly on mentored supervision of procedures performed on patients. Supplementation of this apprenticeship model with classroom sessions and hands-on laboratories can be advantageous to trainees and patients. Few veterinary resources describe supplemental training options, and no single source exists for mentors to consult for program development. The purpose of this study was to describe the supplemental training opportunities currently available to SAIM residents at academic hospitals in the US and Canada and to compare their timing during the residency, resident and faculty time commitment, and perceived helpfulness. Data were collected by an electronic survey distributed to one faculty member per institution. The response rate was 80% (24/30). Most programs (22/24; 92%) offered some form of supplemental training, including classroom sessions (9/24) and hands-on laboratories using physical models (7/24), virtual reality simulators (2/24), and cadaver (2/24) and anesthetized (2/24) dogs. Fifteen programs provided residents with the opportunity to attend external endoscopy workshops. Only three programs required any training prior to residents performing procedures on patients. There was considerable variability in training between programs, precluding statistical comparisons. The survey identified topics for classroom sessions and several inexpensive physical models, rated very or extremely helpful, that would be suitable for programs with limited budgets. A human-based virtual reality simulator was also rated highly by two programs. Comprehensive, external workshops evoked numerous positive comments with perceived value ranging from somewhat to extremely helpful.
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6
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Saga-Gutierrez C, Chiesa-Estomba CM, Larruscain E, Calvo-Henriquez C, San Jose C, Altuna X. “Omepralith”: A novel simulation model for training in sialoendoscopy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:137-140. [DOI: 10.1016/j.otoeng.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/13/2020] [Indexed: 12/01/2022]
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Murr AT, Lumley CJ, Feins RH, Hackman TG. Evaluation of a 3D-Printed Transoral Robotic Surgery Simulator Utilizing Artificial Tissue. Laryngoscope 2021; 132:1588-1593. [PMID: 34882806 PMCID: PMC9177903 DOI: 10.1002/lary.29981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transoral robotic surgery (TORS) poses challenges for operators in training, with limited robot access on a platform requiring distinct surgical skills. Few simulators exist, and current virtual reality training modules exclude head and neck simulations. This study evaluates the construct validity for a novel low-cost TORS simulator. STUDY DESIGN Single institution prospective observational study. METHODS Using 3D-printed oral cavity structures and replaceable artificial tissue components, a modular TORS simulator was constructed for short-duration hands-on simulations with the da Vinci SI robot. Sixteen surgeons of differing robotic skill levels, no experience (novice), prior experience, and formal robot training, participated in simulated tonsil and tongue base tumor resections. Video recordings of each participant were graded by a blinded robotically trained surgeon using a 35-point Global Evaluative Assessment of Robotic Surgery (GEARS) criterion adapted for the TORS simulator. RESULTS Operators reporting formal robotic training or prior robot experience achieved significantly higher mean total GEARS scores compared to novice operators (32 vs. 20.5; P < .001). Overall, mean total GEARS scores correlated with reported experience level; novice operators scored 54% of total points at 19 (4.5), operators with prior experience scored 82.3% of total points at 28.8 (2.6), and robotically trained operators scored 97.1% of total points at 34 (1.7). CONCLUSION With a GEARS criterion, our simulator successfully differentiated novice from experienced and robotically trained operators of the da Vinci SI robot during simulated tonsillectomy and base of tongue resections. These findings support the construct validity of this prototype simulator and offer a foundation for further testing of predictive validity. LEVEL OF EVIDENCE 2 Laryngoscope, 2021.
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Affiliation(s)
- Alexander T Murr
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Catherine J Lumley
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Richard H Feins
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Trevor G Hackman
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
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Abstract
Endoscopic ear surgery (EES) has become an integral part of otologic surgery. Training in EES involves learning fundamental techniques for endoscopic visualization, becoming proficient at one-handed dissection, mastering use of instruments designed for endoscopic ear surgery, and learning to optimize the operating room setup specifically for EES. Despite the steep learning curve, EES offers several advantages over the microscope for otologic procedures. With the rise in the demand for minimally invasive approaches, EES has a clear role in the future of otologic surgery. Identifying strategies to improve the training process of EES for the novice and experienced otolaryngologist is paramount.
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Affiliation(s)
- Samuel R Barber
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA
| | - Divya A Chari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA
| | - Alicia M Quesnel
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
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9
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Johnson J, Misch E, Chung MT, Hotaling J, Folbe A, Svider PF, Cabrera-Muffly C, Johnson AP. Flipping the Classroom: An Evaluation of Teaching and Learning Strategies in the Operating Room. Ann Otol Rhinol Laryngol 2021; 131:573-578. [PMID: 34350805 DOI: 10.1177/00034894211036859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES With increasing restraints on resident's experiences in the operating room, with causes ranging from decreased time available to increasing operating room costs, focus has been placed on how to improve resident's education. The objectives of our study are to (1) determine barriers in education in the operating room, (2) identify effective learning and teaching strategies for residents in the operating room with a focus on the tonsillectomy procedure. METHODS An online survey was sent to all otolaryngology residents and residency programs for which contact information was available from January 2016 to March 2016 with 139 respondents. The 12-question survey focused on information regarding limitations to learning how to perform tonsillectomies as well as difficulties with teaching the same procedure. Resident responses were separated based on PGY level, and analysis was performed using t-tests and Chi squared analysis. RESULTS Common themes emerged from responses for both teaching and learning how to perform tonsillectomies. A significant limitation in learning the procedure was lack of visualization during the surgery (57% learning vs 60% teaching). For both learners and teachers, the monopolar cautery instrument was found to be the most preferred instrument to use during tonsillectomy (80% each). The majority of resident respondents (93%) felt that an instructional video would be beneficial for both learning and teaching the procedure. CONCLUSIONS Significant limitations for learning and teaching in the operating room were identified for performing tonsillectomies. Future endeavors will focus on resolving these limitations to improve surgical education. EVIDENCE LEVEL Level IV.
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Affiliation(s)
- Jared Johnson
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Emily Misch
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael T Chung
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Jeffrey Hotaling
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Adam Folbe
- Department of Otolaryngology, William Beaumont Hospital - Royal Oak, Royal Oak, MI, USA
| | - Peter F Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Cristina Cabrera-Muffly
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew P Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Zhu Y, Sivaparthipan CB, Vinothraj V. Analysis of physical health with internet of things-based computational narrowband physical health framework. Technol Health Care 2021; 29:1217-1231. [PMID: 34092672 DOI: 10.3233/thc-213002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Physical health is vital to the improvement of our skills and the enhancement of eye movements. The coordination of good body movement helps to establish a safe position of the body. The challenging characteristics of physical education include insufficient time allocation, inadequately trained teachers, and inadequate provision of the equipment is considered as an important factor. OBJECTIVE In this paper, IoT-based Computational Narrowband Physical Health Framework (IoT-CNPHF) has been proposed to strengthen adequate time allocation, appropriately qualified teachers, and sustainable provision in the physical education system. METHOD Massive extended range analysis is introduced to enhance the duration and time allotted for physical activity that helps in creating awareness about the importance of physical activities and sports in our daily life. The multimodal supervised technique is incorporated with IoT-CNPHF to improve the knowledge of physical education for the teachers and to provide suitable provision for students in the physical education system. RESULTS The simulation analysis is performed based on accuracy, performance, and its efficiency proves the reliability of the proposed framework.
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Affiliation(s)
- Yacheng Zhu
- College of Physical Education and Health, East China Normal University, Shanghai 200241, China
| | - C B Sivaparthipan
- Department of Computer Science and Engineering, Adhiyamaan College of Engineering, India
| | - V Vinothraj
- V.R.S. College of Engineering and Technology, India
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11
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Deutsch ES, Malekzadeh S, Schmalbach CE. Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation. Otolaryngol Head Neck Surg 2021; 166:23-34. [PMID: 34003066 DOI: 10.1177/01945998211013314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Simulation training has taken a prominent role in otolaryngology-head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to resident training, this tool has value in lifelong learning and extends beyond the individual otolaryngologists to include simulation-based learning for teams and health systems processes. Part III of this PS/QI primer provides an overview of simulation in medicine and specific applications within the field of OTO-HNS. The impact of simulation on PS/QI will be presented in an evidence-based fashion to include the use of run and statistical process control charts to assess the impact of simulation-guided initiatives. Last, steps in developing a simulation program focused on PS/QI will be outlined with future opportunities for OTO-HNS simulation.
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Affiliation(s)
- Ellen S Deutsch
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sonya Malekzadeh
- Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Cecelia E Schmalbach
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
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12
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Saga-Gutierrez C, Chiesa-Estomba CM, Larruscain E, Calvo-Henriquez C, San Jose C, Altuna X. "Omepralith": A novel simulation model for training in sialoendoscopy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30200-4. [PMID: 33814119 DOI: 10.1016/j.otorri.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION There are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy. MATERIALS AND METHODS A simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model. RESULTS Twenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey. CONCLUSION We describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.
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Affiliation(s)
- Carlos Saga-Gutierrez
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España
| | - Carlos Miguel Chiesa-Estomba
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España.
| | - Ehkiñe Larruscain
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España
| | - Christian Calvo-Henriquez
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - Carlos San Jose
- Instituto de Investigación Sanitaria Biodonostia, Donostia, Gipuzkoa, España
| | - Xabier Altuna
- Servicio de Otorrinolaringología-Cirugía de Cabeza y Cuello, Hospital Universitario Donostia, Donostia, Gipuzkoa, España
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13
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Yang SF, Powell A, Srinivasan S, Kim JC, Baker SR, Green GE, Zopf DA. Addressing the Pandemic Training Deficiency: Filling the Void with Simulation in Facial Reconstruction. Laryngoscope 2021; 131:E2444-E2448. [PMID: 33656188 PMCID: PMC8013962 DOI: 10.1002/lary.29490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/21/2021] [Accepted: 02/17/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE/HYPOTHESIS To assess the use of a three-dimensional (3D) printed, multilayer facial flap model for use in trainee education as an alternative method of teaching surgical techniques of facial reconstruction. STUDY DESIGN Cohort study. METHODS A 3D printed facial flap simulator was designed from a computed tomography scan and manufactured out of silicone for low-cost, high-fidelity simulation. This simulator was tested by a group of Otolaryngology-Head and Neck Surgery trainees at a single institution. The simulator group was compared to a control group who completed an exercise on a traditional paper facial flap exercise. Both groups underwent didactic lectures prior to completing their respective exercises. Pre- and post-exercise Likert scale surveys measuring experience, understanding, effectiveness, and realism were completed by both groups. Central tendency, variability, and confidence intervals were measured to evaluate the outcomes. RESULTS Trainees completing the facial flap simulator reported a statistically significant (p < 0.05) improvement in overall expertise in facial flap procedures, design of facial flaps, and excision of standing cutaneous deformities. No statistically significant improvement was seen in the control group. CONCLUSIONS Trainees found the facial flap simulator to be an effective and useful training tool with a high level of realism in surgical education of facial reconstruction. Surgical simulators can serve as an adjunct to trainee education, especially during extraordinary times such as the novel coronavirus disease 2019 pandemic, which significantly impacted surgical training. LEVEL OF EVIDENCE NA Laryngoscope, 131:E2444-E2448, 2021.
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Affiliation(s)
- Shiayin F Yang
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Allison Powell
- University of Michigan Medical School, Ann Arbor, Michigan, U.S.A
| | | | - Jennifer C Kim
- Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Shan R Baker
- Department of Otolaryngology-Head and Neck Surgery, University Michigan Health Systems, Ann Arbor, Michigan, U.S.A
| | - Glenn E Green
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, Michigan, U.S.A
| | - David A Zopf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor, Michigan, U.S.A.,Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Michigan, USA
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14
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Tatum SA. The Art of Teaching, Training, and Putting the Scalpel in Residents' Hands. Facial Plast Surg Clin North Am 2020; 28:469-475. [PMID: 33010865 DOI: 10.1016/j.fsc.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surgical education is under tremendous pressure due to ever-increasing medical knowledge and demands on trainees' time. They must continually learn more in less time due to work hour limitations, regulations, and electronic medical record demands. Surgical training must become more efficient. There is an unprecedented array of education and training opportunities for resident preparation. The preparation for each case has to be maximal. Preoperative, intraoperative, and postoperative simulation and discussions improve the educational benefit of the trainee experience. For the teaching surgeon, putting a scalpel in residents' hands requires patience, knowledge, judgment, and a leap of faith in the resident.
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Affiliation(s)
- Sherard Austin Tatum
- Department of Otolaryngology, Cleft and Craniofacial Center, Division of Facial Plastic and Reconstructive Surgery, Upstate Medical University, State University of New York, 750 East Adams Street, CWB, Syracuse, NY 13210, USA.
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15
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Sagayam KM, D S, Dang H, Wahab MHA, Ambar R. IoT Based Virtual Reality Game for Physio-therapeutic Patients. ANNALS OF EMERGING TECHNOLOGIES IN COMPUTING 2020; 4:39-51. [DOI: 10.33166/aetic.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Biofeedback therapy trains the patient to control voluntarily the involuntary process of their body. This non-invasive and non-drug treatment is also used as a means to rehabilitate the physical impairments that may follow a stroke, a traumatic brain injury or even in neurological aspects within occupational therapy. The idea behind this study is based on using immersive gaming as a tool for physical rehabilitation that combines the idea of biofeedback and physical computing to get a patient emotionally involved in a game that requires them to do the exercises in order to interact with the game. This game is aimed towards addressing the basic treatment for ‘Frozen Shoulder’. In this work, the physical motions are captured by the wearable ultrasonic sensor attached temporarily to the various limbs of the patient. The data received from the sensors are then sent to the game via serial wireless communication. There are two main aspects to this study: motion capturing and game design. The current status of the application is a single ultrasonic detector. The experimental result shows that physio-therapeutic patients are benefited through the IoT based virtual reality game.
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16
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Givi B, Moore MG, Bewley AF, Coffey CS, Cohen MA, Hessel AC, Jalisi S, Kang S, Newman JG, Puscas L, Shindo M, Shuman A, Thakkar P, Weed DT, Chalian A. Advanced head and neck surgery training during the
COVID
‐19 pandemic. Head Neck 2020; 42:1411-1417. [DOI: 10.1002/hed.26252] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Babak Givi
- Department of OtolaryngologyNYU Langone Health New York New York USA
| | - Michael G. Moore
- Department of OtolaryngologyIndiana University Indianapolis Indiana USA
| | - Arnaud F. Bewley
- Department of OtolaryngologyUniversity of California Davis California USA
| | - Charles S. Coffey
- Department of Surgery, Division of OtolaryngologyUniversity of California San Diego California USA
| | - Marc A. Cohen
- Head and Neck ServiceMemorial Sloan‐Kettering Cancer Center New York New York USA
| | - Amy C. Hessel
- Department of Head and Neck SurgeryMD Anderson Cancer Center Houston Texas USA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel Deaconess Medical Center Boston Massachusetts USA
| | - Steven Kang
- Department of OtolaryngologyOhio State University Columbus Ohio USA
| | - Jason G. Newman
- Department of OtolaryngologyUniversity of Pennsylvania Philadelphia Pennsylvania USA
| | - Liana Puscas
- Department of Head and Neck SurgeryDuke University Durham North Carolina USA
| | - Maisie Shindo
- Department of OtolaryngologyOregon Health and Science University Portland Oregon USA
| | - Andrew Shuman
- Department of OtolaryngologyUniversity of Michigan Ann Arbor Michigan USA
| | - Punam Thakkar
- Division of OtolaryngologyThe George Washington University Washington DC USA
| | - Donald T. Weed
- Department of OtolaryngologyUniversity of Miami Coral Gables Florida USA
| | - Ara Chalian
- Department of OtolaryngologyUniversity of Pennsylvania Philadelphia Pennsylvania USA
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17
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Barber SR, Jain S, Mooney MA, Almefty KK, Lawton MT, Son YJ, Stevens SM. Combining Stereoscopic Video and Virtual Reality Simulation to Maximize Education in Lateral Skull Base Surgery. Otolaryngol Head Neck Surg 2020; 162:922-925. [DOI: 10.1177/0194599820907866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mastery of lateral skull base (LSB) surgery requires thorough knowledge of complex, 3-dimensional (3D) microanatomy and techniques. While supervised operation under binocular microscopy remains the training gold standard, concerns over operative time and patient safety often limit novice surgeons’ stereoscopic exposure. Furthermore, most alternative educational resources cannot meet this need. Here we present proof of concept for a tool that combines 3D-operative video with an interactive, stereotactic teaching environment. Stereoscopic video was recorded with a microscope during translabyrinthine approaches for vestibular schwannoma. Digital imaging and communications in medicine (DICOM) temporal bone computed tomography images were segmented using 3D-Slicer. Files were rendered using a game engine software built for desktop virtual reality. The resulting simulation was an interactive immersion combining a 3D operative perspective from the lead surgeon’s chair with virtual reality temporal bone models capable of hands-on manipulation, label toggling, and transparency modification. This novel tool may alter LSB training paradigms.
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Affiliation(s)
- Samuel R. Barber
- Department of Otolaryngology–Head and Neck Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Saurabh Jain
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, Arizona, USA
| | - Michael A. Mooney
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kaith K. Almefty
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Young-Jun Son
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, Arizona, USA
| | - Shawn M. Stevens
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
- The Arizona Ear Institute, Phoenix, Arizona, USA
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18
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20 Year Review of Three-dimensional Tools in Otology: Challenges of Translation and Innovation. Otol Neurotol 2020; 41:589-595. [DOI: 10.1097/mao.0000000000002619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Bhalla S, Tolley N, Awad Z. Creating a Validated Simulation Training Curriculum in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of Review
Simulation-based training is an integral component of surgical training. It allows practice of technical skills within a safe environment without compromising patient safety. This article seeks to review current virtual and non-virtual reality simulation models within the literature and review their validation status.
Recent Findings
Many simulation models exist within otolaryngology and are currently being used for education. New models are also continuously being developed; however, validity should be proven for the models before incorporating their use for educational purposes. Validity should be determined by experts and trainees themselves.
Summary
A validated simulation curriculum should be incorporated within the otolaryngology training programme. A curriculum based on the current training programme at our institution serves as an exemplar for local adoption.
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20
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Powell AR, Srinivasan S, Green G, Kim J, Zopf DA. Computer-Aided Design, 3-D-Printed Manufacturing, and Expert Validation of a High-fidelity Facial Flap Surgical Simulator. JAMA FACIAL PLAST SU 2020; 21:327-331. [PMID: 31021369 DOI: 10.1001/jamafacial.2019.0050] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Facial flap procedures may be difficult for surgical trainees to conceptualize and challenging for supervising surgeons to allow entrustment early in training. Simulation outside of the operating room may accelerate and enhance the surgical education experience. Objective To design and manufacture a 3-dimensional (3-D)-printed, multilayer, anatomically accurate facial flap model for use in surgical education. Design, Setting, and Participants In this multicenter validation study, a 3-D-printed facial flap simulator was designed from a computed tomographic (CT) scan and manufactured for low-cost, high-fidelity simulation. Expert otolaryngology-head and neck surgeon feedback was acquired through surgical rehearsal and performance of 8 local facial flap procedures on the facial flap simulator by 7 otolaryngologists fellowship trained in facial plastic surgery. Main Outcomes and Measures Likert scale surveys were made based on evaluation criteria categorized into domains of realism, experience, and applicability of the simulator. Measures of central tendency, variability, and confidence intervals were generated to evaluate the outcomes. Results Seven expert otolaryngology-head and neck surgeons completed a Likert scale evaluation survey containing quantitative analysis of 6 questions on physical attributes, 12 questions on realism, 8 questions on experience, and 4 questions on the applicability of the simulator. All expert surgeons were additionally fellowship trained in facial plastic surgery with their mean years in practice being 11.9. Overall evaluation demonstrated valuable ability of the simulator for medical education with suggestions for future directions. Importantly, the simulator was rated on a scale of 1 (no value) to 4 (great value) as 3.86 as a training tool, 3.57 as a competency evaluation tool, and 3.43 as a rehearsal tool. Conclusions and Revelance Expert experience with the local facial flap simulator was rated highly for realism, experience, performance, and usefulness. With slight refinement, the model has strong potential for broad use in training in otolaryngology-head and neck surgery and facial plastic surgery. Level of Evidence NA.
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Affiliation(s)
| | | | - Glenn Green
- Otolaryngology-Head and Neck Surgery, Pediatric Division, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor
| | - Jennifer Kim
- Otolaryngology-Head and Neck Surgery, Pediatric Division, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor
| | - David A Zopf
- Otolaryngology-Head and Neck Surgery, Pediatric Division, University of Michigan Health Systems, CS Mott Children's Hospital, Ann Arbor.,Department of Biomedical Engineering, University of Michigan, Ann Arbor
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21
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Vaitaitis VJ, Dunham ME, Kwon YC, Mayer WC, Evans AK, Baker AJ, Walker KD, Cespedes GD, Stanley A, Opiri M. A Surgical Simulator for Tympanostomy Tube Insertion Incorporating Capacitive Sensing Technology to Track Instrument Placement. Otolaryngol Head Neck Surg 2020; 162:343-345. [DOI: 10.1177/0194599820901684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a device engineered for realistic simulation of myringotomy and tympanostomy tube insertion that tracks instrument placement and objectively measures operator proficiency. A 3-dimensional computer model of the external ear and cartilaginous external auditory canal was created from a normal maxillofacial computed tomography scan, and models for the bony external auditory canal and tympanic cavity were created with computer-aided design software. Physical models were 3-dimensionally printed from the computer reconstructions. The external auditory canal and tympanic cavity surfaces were coated with conductive material and wired to a capacitive sensor interface. A programmable microcontroller with custom embedded software completed the system. Construct validation was completed by comparing the run times and total sensor contact times of otolaryngology faculty and residents.
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Affiliation(s)
- Vilija J. Vaitaitis
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Michael E. Dunham
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Yong-Chan Kwon
- Department of Biological and Agricultural Engineering, Louisiana State University College of Engineering, Baton Rouge, Louisiana, USA
| | - Wyatt C. Mayer
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Adele K. Evans
- Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center School of Medicine, New Orleans, Louisiana, USA
| | - Amari J. Baker
- Department of Biological and Agricultural Engineering, Louisiana State University College of Engineering, Baton Rouge, Louisiana, USA
| | - Kyla D. Walker
- Department of Biological and Agricultural Engineering, Louisiana State University College of Engineering, Baton Rouge, Louisiana, USA
| | - Gabriel D. Cespedes
- Department of Biological and Agricultural Engineering, Louisiana State University College of Engineering, Baton Rouge, Louisiana, USA
| | - Abishek Stanley
- Department of Biological and Agricultural Engineering, Louisiana State University College of Engineering, Baton Rouge, Louisiana, USA
| | - Michelle Opiri
- Department of Biological and Agricultural Engineering, Louisiana State University College of Engineering, Baton Rouge, Louisiana, USA
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22
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Mussi E, Mussa F, Santarelli C, Scagnet M, Uccheddu F, Furferi R, Volpe Y, Genitori L. Current Practice in Preoperative Virtual and Physical Simulation in Neurosurgery. Bioengineering (Basel) 2020; 7:bioengineering7010007. [PMID: 31947718 PMCID: PMC7175342 DOI: 10.3390/bioengineering7010007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/27/2019] [Accepted: 01/01/2020] [Indexed: 01/17/2023] Open
Abstract
In brain tumor surgery, an appropriate and careful surgical planning process is crucial for surgeons and can determine the success or failure of the surgery. A deep comprehension of spatial relationships between tumor borders and surrounding healthy tissues enables accurate surgical planning that leads to the identification of the optimal and patient-specific surgical strategy. A physical replica of the region of interest is a valuable aid for preoperative planning and simulation, allowing the physician to directly handle the patient’s anatomy and easily study the volumes involved in the surgery. In the literature, different anatomical models, produced with 3D technologies, are reported and several methodologies were proposed. Many of them share the idea that the employment of 3D printing technologies to produce anatomical models can be introduced into standard clinical practice since 3D printing is now considered to be a mature technology. Therefore, the main aim of the paper is to take into account the literature best practices and to describe the current workflow and methodology used to standardize the pre-operative virtual and physical simulation in neurosurgery. The main aim is also to introduce these practices and standards to neurosurgeons and clinical engineers interested in learning and implementing cost-effective in-house preoperative surgical planning processes. To assess the validity of the proposed scheme, four clinical cases of preoperative planning of brain cancer surgery are reported and discussed. Our preliminary results showed that the proposed methodology can be applied effectively in the neurosurgical clinical practice both in terms of affordability and in terms of simulation realism and efficacy.
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Affiliation(s)
- Elisa Mussi
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
- Correspondence: ; Tel.: + 39-055-2758703
| | - Federico Mussa
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50141 Florence, Italy; (F.M.); (L.G.)
| | - Chiara Santarelli
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Mirko Scagnet
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50141 Florence, Italy; (F.M.); (L.G.)
| | - Francesca Uccheddu
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Rocco Furferi
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Yary Volpe
- Department of Industrial Engineering, University of Florence, via di Santa Marta, 3, 50139 Firenze, Italy; (C.S.); (F.U.); (R.F.); (Y.V.)
| | - Lorenzo Genitori
- Department of Pediatric Surgery, Meyer Children’s Hospital, Viale Pieraccini 24, 50141 Florence, Italy; (F.M.); (L.G.)
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Sparks D, Kavanagh KR, Vargas JA, Valdez TA. 3D printed myringotomy and tube simulation as an introduction to otolaryngology for medical students. Int J Pediatr Otorhinolaryngol 2020; 128:109730. [PMID: 31634651 DOI: 10.1016/j.ijporl.2019.109730] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/12/2019] [Accepted: 10/12/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Surgical simulation models have been shown to improve surgical skill and confidence for surgical residents before real life procedures. Surgical simulators can be similarly applied in undergraduate medical education as a tool to introduce students to the field of otolaryngology. METHODS Ear models were created using 3D printing and high-performance silicone. Twenty medical students participated in a slide presentation and a myringotomy tube simulation station, each completing a pre- and post-survey using a 5-point Likert scale. RESULTS A previously validated 3D myringotomy simulator was used. Twenty medical student volunteers participated in the simulation including 14 first-year and 6 s-year medical students. None of the participating students reported observing myringotomy and placement of tympanostomy tubes before the session. Medical student participants rated their knowledge of the steps of the procedure and where to insert the tympanostomy tube at 2 (2 = disagree) or below with a mean of 1.35 SD = 0.47 and 1.2 SD = 0.41 respectively. At the completion of the educational session, the medical students rated their knowledge of the steps of the procedure as significantly improved at 4.45 SD = 0.6 (p = 0.00001). DISCUSSION We found that medical students with no prior exposure to ear anatomy or surgical training were able to use the simulator as an introduction to the specialty. There was a perceived improvement in their medical knowledge and basics of a procedural skill. CONCLUSION Medical schools can provide an inexpensive, safe, procedural practice tool using 3D printing as an introduction for students interested in surgical procedures.
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Affiliation(s)
- Devika Sparks
- University of Connecticut Health Center, Farmington, CT, USA
| | | | | | - Tulio A Valdez
- Stanford University Department of Otolaryngology, Palo Alto, CA, USA.
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24
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Simulation-based ENT induction: validation of a novel mannequin training model. The Journal of Laryngology & Otology 2019; 134:74-80. [PMID: 31865923 DOI: 10.1017/s0022215119002639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Anschuetz L, Huwendiek S, Stricker D, Yacoub A, Wimmer W, Caversaccio M. Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study. ANATOMICAL SCIENCES EDUCATION 2019; 12:507-517. [PMID: 30430760 DOI: 10.1002/ase.1837] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 06/09/2023]
Abstract
Teaching methodologies for the anatomy of the middle ear have not been investigated greatly due to the middle ear's highly complex structure and hidden location inside of the temporal bone. The aim of this randomized study was to quantitatively compare the suitability of using microscope- and endoscope-based methods for teaching the anatomy of the middle ear. We hypothesize that the endoscopic approach will be more efficient compared to the microscopic approach. To answer the study questions, 33 sixth-year medical students, residents and otorhinolaryngology specialists were randomized either into the endoscopy or the microscopy group. Their anatomical knowledge was assessed using a structured anatomical knowledge test before and after each session. Each participant received tutoring on a human cadaveric specimen using one of the two methods. They then performed a hands-on dissection. After 2-4 weeks, the same educational curriculum was repeated using the other technique. The mean gains in anatomical knowledge for the specialists, residents, and medical students were +19.0%, +34.6%, and +23.4%, respectively. Multivariate analyses identified a statistically significant increase in performance for the endoscopic method compared to the microscopic technique (P < 0.001). For the recall of anatomical structures during dissection, the endoscopic method outperformed the microscopic technique independently of the randomization or the prior training level of the attendees (P < 0.001). In conclusion, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge as compared to the microscopic approach. The participants subjectively preferred the endoscope for educational purposes.
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MESH Headings
- Adult
- Anatomy/education
- Cadaver
- Curriculum
- Dissection
- Ear, Middle/anatomy & histology
- Ear, Middle/diagnostic imaging
- Education, Medical, Continuing/methods
- Education, Medical, Continuing/statistics & numerical data
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/statistics & numerical data
- Educational Measurement/statistics & numerical data
- Endoscopy
- Female
- Humans
- Internship and Residency/methods
- Internship and Residency/statistics & numerical data
- Male
- Mental Recall
- Microscopy
- Middle Aged
- Program Evaluation
- Random Allocation
- Students, Medical/statistics & numerical data
- Surgeons/education
- Surgeons/statistics & numerical data
- Teaching
- Young Adult
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Daniel Stricker
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Abraam Yacoub
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
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26
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Abstract
BACKGROUND The field of otology is increasingly at the forefront of innovation in science and medicine. The inner ear, one of the most challenging systems to study, has been rendered much more open to inquiry by recent developments in research methodology. Promising advances of potential clinical impact have occurred in recent years in biological fields such as auditory genetics, ototoxic chemoprevention and organ of Corti regeneration. The interface of the ear with digital technology to remediate hearing loss, or as a consumer device within an intelligent ecosystem of connected devices, is receiving enormous creative energy. Automation and artificial intelligence can enhance otological medical and surgical practice. Otology is poised to enter a new renaissance period, in which many previously untreatable ear diseases will yield to newly introduced therapies. OBJECTIVE This paper speculates on the direction otology will take in the coming decades. CONCLUSION Making predictions about the future of otology is a risky endeavour. If the predictions are found wanting, it will likely be because of unforeseen revolutionary methods.
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27
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Okhovat S, Milner TD, Clement WA, Wynne DM, Kunanandam T. Validation of Animal Models for Simulation Training in Pediatric Laryngotracheal Reconstruction. Ann Otol Rhinol Laryngol 2019; 129:46-54. [PMID: 31466464 DOI: 10.1177/0003489419870820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). METHODS Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. RESULTS All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. CONCLUSION Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Saleh Okhovat
- Department of Otolaryngology, Head and Neck Surgery, Royal Hospital for Children, Glasgow, UK
| | - Thomas D Milner
- Department of Otolaryngology, Head and Neck Surgery, Royal Hospital for Children, Glasgow, UK
| | - William A Clement
- Department of Otolaryngology, Head and Neck Surgery, Royal Hospital for Children, Glasgow, UK
| | - David M Wynne
- Department of Otolaryngology, Head and Neck Surgery, Royal Hospital for Children, Glasgow, UK
| | - Thushitha Kunanandam
- Department of Otolaryngology, Head and Neck Surgery, Royal Hospital for Children, Glasgow, UK
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Kudryashov SE, Kozlov VS. [The rhinological simulator: the upgrade and validation study with the evaluation of the effectiveness of its application]. Vestn Otorinolaringol 2018; 83:50-55. [PMID: 29953056 DOI: 10.17116/otorino201883350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to upgrade the rhinological simulator employed as a tool for the teaching of the basic technical skills in endoscopic sinus surgery (ESS). The new ESS simulator providing a model of the nasal cavity consists of the replaceable cylinders and the adaptable table stand. It includes a set of 3D printed nasal models. Each of them is the elliptical tube of a specific size. The participants of the study performed different tasks depending on the structural properties of the tubes. A wide variety of surgical instruments and esndoscopes could be fitted to the simulator. 16 otorhinolaryngologists having no previous experience with ESS were recruited into the study to evaluate the effectiveness of the training procedures. After a brief tutorial, the participants practiced an one hour-long exercise per day during 5 days. The pre-training and post-training performances were videotaped. The task-performance time and the number of technical errors made by the operators were estimated immediately before and after the training session. To assess the subjective attitudes of the operators toward the new technology, the participants of the study were asked to complete the model questionnaire soon after the termination of the training course. The questionnaire contained 34 items. The correctness of the answers was assessed based on the 5-point Likert scale, with score 1 meaning 'totally disagree' and score 5 - 'totally agree'. The statistically significant reduction of the performance time and the number of technical mistakes was documented within the first 5 hours after the onset of teaching (p<0.05) which suggests the effectiveness of the training procedures. The questionnaire study has demonstrated the positive attitude of the trainees toward the proposed technology. The average score based on the Likert scale was higher than 3 for all kinds of questions. It is concluded that the results of this study give evidence of the positive assessment of the upgraded rhinological simulator as an effective tool for the teaching of the basic skills necessary to operate various surgical instruments and endoscopes by the novice surgeons in the field of endoscopic sinus surgery .
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Affiliation(s)
- S E Kudryashov
- Federal state budgetary institution of additional professional education 'Central State Medical Academy', General Management Department, Administration of the President of the Russian Federation, Moscow, 121359
| | - V S Kozlov
- Federal state budgetary institution of additional professional education 'Central State Medical Academy', General Management Department, Administration of the President of the Russian Federation, Moscow, 121359
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Barber SR, Jain S, Son YJ, Chang EH. Virtual Functional Endoscopic Sinus Surgery Simulation with 3D-Printed Models for Mixed-Reality Nasal Endoscopy. Otolaryngol Head Neck Surg 2018; 159:933-937. [PMID: 30200812 DOI: 10.1177/0194599818797586] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The surgeon's knowledge of a patient's individual anatomy is critical in skull base surgery. Trainees and experienced surgeons can benefit from surgical simulation; however, current models are expensive and impractical for widespread use. In this study, we report a next-generation mixed-reality surgical simulator. We segmented critical anatomic structures for 3-dimensional (3D) models to develop a modular teaching tool. We then developed a navigation tracking system utilizing a 3D-printed endoscope as a trackable virtual-reality (VR) controller and validated the accuracy on VR and 3D-printed skull models within 1 cm. We combined VR and augmented-reality visual cues with our 3D physical model to simulate sinus endoscopy and highlight segmented structures in real time. This report provides evidence that a mixed-reality simulator combining VR and 3D-printed models is feasible and may prove useful as an educational tool that is low cost and customizable.
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Affiliation(s)
- Samuel R Barber
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Saurabh Jain
- 2 Department of Systems and Industrial Engineering, University of Arizona, Tucson, Arizona, USA
| | - Young-Jun Son
- 2 Department of Systems and Industrial Engineering, University of Arizona, Tucson, Arizona, USA
| | - Eugene H Chang
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Arizona, Tucson, Arizona, USA
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Patel VA, Siddique L, Stahl L, Carr MM. Hereditary angioedema education in otolaryngology residencies: survey of program directors. Int Forum Allergy Rhinol 2018. [PMID: 29543388 DOI: 10.1002/alr.22116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this work was to assess resident education regarding contemporary management of hereditary angioedema using a web-based survey. METHODS An 11-item, multiple-choice, electronic questionnaire was sent to all 106 accredited otolaryngology training programs in November 2016. Questions focused on resident education, management principles, and formalized assessment. RESULTS A total of 34 program directors responded, representing 32% of otolaryngology residences. Ninety-seven percent believed otolaryngology residents should be knowledgeable in the management of hereditary angioedema due to C1 inhibitor deficiency (C1-INH-HAE). Specifically, 38% and 26% of program directors felt their residents were comfortable and very comfortable in C1-INH-HAE management, respectively. Of those surveyed, 18% have educational simulation activities and a protocol in place for C1-INH-HAE management. Forty-seven percent of respondents felt their training program provided adequate education and exposure to C1-INH-HAE. Over the last 5 years, 45% felt residents were exposed to 1 to 5 cases of C1-INH-HAE. Sixty-seven percent of residents were trained in the management of C1-INH-HAE through in-person lectures. Seventy-one percent of programs had no formal assessment of resident competency in C1-INH-HAE management. CONCLUSION This study is the first to offer insight into C1-INH-HAE education and management principles in otolaryngology training programs. Surveyed program directors believe residents need a strong knowledge base in the management of C1-INH-HAE but less than half feel their trainees acquire the necessary exposure to this emergent disease process. Future research efforts in this area should aim to determine optimal educational activities as well as how to best incorporate this into otolaryngology residency curricula.
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Affiliation(s)
- Vijay A Patel
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Laila Siddique
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Lauren Stahl
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV
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