1
|
Marouf A, Doty S, Quereshy HA, Johnson BR, Cabrera CI, Mowry S, Tamaki A. A Reproducible Peritonsillar Abscess Incision and Drainage Model for Junior Trainees. Ann Otol Rhinol Laryngol 2024; 133:654-657. [PMID: 38682302 DOI: 10.1177/00034894241249611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVES To describe the design and construction of a reproducible, low-cost, peritonsillar abscess (PTA) incision and drainage simulator and assess its impact on trainees' confidence. METHODS The 2-part simulator we developed consisted of a manikin head with a fixed, partially open mouth and a modular PTA mold. The mold is created by injecting a lotion and water mixture into plastic bubbles, followed by silicone solidification. Neodymium magnets secure the silicone-abscess packet to the manikin's palate. The simulator was utilized during an academic otolaryngology residency training program Annual Otolaryngology Boot Camp. A self-assessment Likert scale questionnaire was used to evaluate participants' confidence before and after simulator training. Fourth-year medical students and junior (first and second year) residents who participated in the boot camp and agreed to complete the evaluation were included. RESULTS Three medical students, 17 PGY-1, and 10 PGY-2 residents agreed to complete the evaluation. All trainees agreed the model was useful for learning skills. The overall post-training confidence Likert scores of participants, and PGY-1 residents in particular, significantly improved compared to their pre-training scores (P < .001). CONCLUSIONS Our model offers an affordable and efficient training opportunity for residents to enhance their competence in managing PTAs. This approach, with its simple yet effective design and low production cost, shows potential for scalability on a broader scale.
Collapse
Affiliation(s)
- Azmi Marouf
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Samuel Doty
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Humzah A Quereshy
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin R Johnson
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sarah Mowry
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
2
|
Rai A, Shukla S, Mehtani N, Acharya V, Tolley N. Does a junior doctor focused 'Bootcamp' improve the confidence and preparedness of newly appointed ENT registrars to perform their job roles? BMC MEDICAL EDUCATION 2024; 24:702. [PMID: 38937721 PMCID: PMC11212423 DOI: 10.1186/s12909-024-05691-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 06/21/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND To assess changes in confidence and preparedness after conducting a 2-day induction bootcamp for novice Ear Nose and Throat (ENT) first year specialty trainee registrars (ST3s) in the United Kingdom (UK). The bootcamp covered common ENT presentations on the ward, and in the elective and emergency settings. METHODS A total of 32 trainees (ST3 or research fellow) voluntarily registered via an online application form to the Southern ST3 accelerated learning course bootcamp through ENT UK. ENT UK is a membership body that supports ENT trainees throughout their careers. They completed a two-day bootcamp that was hosted at St Mary's Hospital, London and 10 skills sessions were delivered by either a senior ENT registrar or an ENT consultant. A pre-session questionnaire was distributed to all participants and a post-session questionnaire was provided that assessed the changes in confidence and preparedness of the participants, if any. The responses were scored by a 10-point Likert scale. Only participants who fully completed the pre and post questionnaire were included, which was 29 in total. RESULTS Participants self-reported a significant increase in confidence (p < 0.001) and preparedness (p < 0.001) following the bootcamp course. The greatest improvements in comparison to all other stations were self-preparedness in the rigid bronchoscopy station and self-confidence in the sphenopalatine artery (SPA) ligation station. CONCLUSION The use of a two-day bootcamp improved confidence and preparedness of managing common ENT presentations in the ward, elective and emergency settings for ENT ST3s. It provides a useful adjunct in the acquisition of technical and non-technical skills alongside the traditional surgical apprenticeship. In the future, more work is required to assess the impact of bootcamps on patient outcomes and long-term benefits on trainees' skill retention and clinical proficiency.
Collapse
Affiliation(s)
- Amar Rai
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK
| | - Shivani Shukla
- The School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nikita Mehtani
- Department of ENT Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Vikas Acharya
- Department of ENT Surgery, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| | - Neil Tolley
- Department of ENT Surgery, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
3
|
Marouf A, Doty S, Quereshy HA, Johnson BR, Cabrera CI, Mowry S, Tamaki A. A Systematic Review of Peritonsillar Abscess Simulators: Enhancing Training and Identifying the Need for Standardization. Laryngoscope 2024; 134:2495-2501. [PMID: 37991176 DOI: 10.1002/lary.31196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/22/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To systematically review the literature regarding previously described peritonsillar abscess (PTA) drainage simulation. DATA SOURCES PubMed, Scopus, Web of Science, Ovid, and Cochrane. REVIEW METHODS A search of the abovementioned databases was performed in August 2022 using the terms "peritonsillar abscess/quinsy," "incision/drainage/aspiration," and "simulation." No time restrictions were applied. We included studies that clearly described how their PTA models were built and underwent validation from experts and/or evaluation from trainees. Articles describing a model only without any evaluation and reports in languages other than English were excluded. RESULTS Our search initially yielded 80 articles after duplicate removal, 10 of which met our criteria and were included. Two studies trained participants on both needle aspiration and incision and drainage (I&D), four studies on I&D only, and four on needle aspiration only. 87.5% to 100% of junior residents reported minimal exposure to PTA prior to simulation. Five studies provided some form of validation to their models. The value of the simulators to train participants on skills received better appreciation than their anatomical fidelity. The perceived confidence level of trainees in managing PTA, which was assessed in 7 studies, substantially improved after training. CONCLUSION PTA simulation improves the confidence of trainees to perform PTA drainage. There is, however, a lack of standardization and evidence regarding transfer validity among PTA simulators. The development of a standardized PTA simulator could allow for more widespread use and increase resident comfort with this procedure in a pre-clinical setting. LEVEL OF EVIDENCE NA Laryngoscope, 134:2495-2501, 2024.
Collapse
Affiliation(s)
- Azmi Marouf
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Samuel Doty
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Humzah A Quereshy
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Benjamin R Johnson
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Sarah Mowry
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| |
Collapse
|
4
|
Brennan LJ, Balakumar R, Waite S, Bennett WO. An update on simulation training in rhinology: a systematic review of evidence. J Laryngol Otol 2024:1-7. [PMID: 38602176 DOI: 10.1017/s0022215124000495] [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: 04/12/2024]
Abstract
BACKGROUND Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training. METHODS Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis ('PRISMA') protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification. RESULTS Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development. CONCLUSION Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training.
Collapse
Affiliation(s)
- Laura J Brennan
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Ramkishan Balakumar
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Seren Waite
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Warren O Bennett
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| |
Collapse
|
5
|
Pasick LJ, Tong JY, Benito DA, Sargi Z, Anis MM. Airway fires in otolaryngologic surgery: A database review. Am J Otolaryngol 2023; 44:104003. [PMID: 37478536 DOI: 10.1016/j.amjoto.2023.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE An estimated 34 % of reported operating room fires involve the airway. Despite the inherent risks in otolaryngologic surgery, education regarding prevention and management of airway fires is limited in graduate medical training. One contributing factor is a lack of reporting of such rare events in our literature. METHODS The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for reports of adverse events related to fires occurring during surgical procedures of the airway from January 1, 2010, to March 31, 2020. RESULTS 3687 reports were identified and 49 unique reports of airway fire were included. Sustained fires were described in 16 (32.7 %) reports and 33 (67.3 %) described transient flares. 2 fires extended beyond the airway and 9 (18.4 %) were noted to have occurred at the start of the case. Fires were reported most commonly during tonsillectomy (n = 22 [44.9 %]), vocal fold excision (n = 5 [10.2 %]), and adenoidectomy (n = 4 [8.2 %]). 46 reports attributed flare initiation to a specific element of the fire triangle. 16 patient and 2 operator injuries were reported. Saline washing was utilized in 7 (14.3 %) cases overall. Patients were extubated immediately in 2 (12.5 %) of the 16 reports of sustained fires. 0 mortalities were reported. CONCLUSION Airway fires were reported in a variety of upper airway procedures performed regularly by otolaryngologists. The triggering factor that led to fire was identified as a spark or char in about half of the reported cases, and only 2 reports described immediate removal of the endotracheal tube.
Collapse
Affiliation(s)
- Luke J Pasick
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Jane Y Tong
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine. Baltimore, MD, USA
| | - Daniel A Benito
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Florida, Stuart, FL, USA
| | - Zoukaa Sargi
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mursalin M Anis
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
6
|
Gervais V, Grabs D, Bougie E, Salib GE, Bortoluzzi P, Tremblay DM. The Montreal Plastic Surgery Residency Bootcamp: Structure and Utility. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5337. [PMID: 37829103 PMCID: PMC10566876 DOI: 10.1097/gox.0000000000005337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/29/2023] [Indexed: 10/14/2023]
Abstract
Transitioning from medical school to surgical residency is a difficult endeavor. To facilitate this period, the University of Montreal's plastic surgery program developed and implemented an intensive 1-month bootcamp rotation. It is the only one of its kind and length amongst plastic surgery residency programs in North America. It includes didactic teachings in anatomy, cadaveric dissections, and surgical approaches for an array of procedures. Clinical and technical skills are reviewed with senior residents and attending surgeons. Research opportunities and case scenarios are also covered. An anonymous online 30-question survey was sent to all residents who participated in the bootcamp rotation between 2013 and 2020. Questions evaluated residents' knowledge of anatomy, basic surgical skills, common approaches, flap knowledge, and on-call case management, before and after the bootcamp. Seventeen plastic surgery residents responded to this questionnaire (81%). The majority confirmed that the bootcamp helped them prepare for residency, research, and on-calls, and also helped them expand their knowledge of anatomy and surgical skills. The residents responded positively to the bootcamp's structure and implementation. This study proposes that surgical programs could benefit from a bootcamp rotation at the beginning of their curriculum. The purpose is to facilitate the transition between medical school and postgraduate training, and to ensure a basic level of competence for all junior residents. Further prospective studies could demonstrate the bootcamp's impact in board certification rates and acceptance into fellowship training programs.
Collapse
Affiliation(s)
- Valerie Gervais
- From the Department of Plastic Surgery, CIUSSS de l’Est-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - Detlev Grabs
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Emilie Bougie
- Department of Plastic Surgery, CHU Ste-Justine, Montréal, QC, Canada
| | - George E. Salib
- Department of Plastic Surgery, Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Dominique M. Tremblay
- From the Department of Plastic Surgery, CIUSSS de l’Est-de-l’Île-de-Montréal, Montréal, QC, Canada
| |
Collapse
|
7
|
Bondzi-Simpson A, Lindo CJ, Hoy M, Lui JT. The Otolaryngology boot camp: a scoping review evaluating commonalities and appraisal for curriculum design and delivery. J Otolaryngol Head Neck Surg 2022; 51:23. [PMID: 35659365 PMCID: PMC9167522 DOI: 10.1186/s40463-022-00583-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Surgical boot camps are becoming increasingly popular in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Despite pioneering virtual reality and simulation-based surgical education, these boot camps have lacked critical appraisal. The objective of this article was to examine the adoption and utility of surgical boot camps in OHNS residency training programs around the world. DATA SOURCES Ovid Medline and PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. Additionally, a grey literature search was performed. REVIEW METHODS Inclusion criteria were peer-reviewed publications and grey literature sources that reported on OHNS boot camps for the novice learner. The search was restricted to human studies published in English. Studies were excluded if they were not examining junior trainees. RESULTS A total of 551 articles were identified. Following removal of duplicates, screening, and full text review, 16 articles were included for analysis. Seven major boot camps were identified across various academic sites in the world. Most boot camps were one-day intensive camps incorporating a mixture of didactic, skill specific, and simulation sessions using an array of task trainers and high-fidelity simulators focusing on OHNS emergencies. Studies measuring trainee outcomes demonstrated improvement in trainee confidence, immediate knowledge, and skill acquisition. CONCLUSION Surgical boot camps appear to be an effective tool for short term knowledge and skill acquisition. Further studies should examine retention of skill and maintenance of confidence over longer intervals, as little is known about these lasting effects.
Collapse
Affiliation(s)
- Adom Bondzi-Simpson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - C J Lindo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Hoy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Justin T Lui
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
8
|
Preparatory surgical bootcamp: an effective form of training with a positive impact on self-confidence and procedural skills of the residents. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
9
|
Tabakin AL, Dave PJ, Srivastava A, Polotti CF, Sterling JA, Elsamra SE. The Feasibility and Efficacy of a Multi-Institutional Urology Boot Camp for Incoming Urology Residents. Urology 2021; 153:69-74. [PMID: 33428979 DOI: 10.1016/j.urology.2020.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/08/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the feasibility and perceived usefulness of a pre-residency urology boot camp for first and second year urology residents. METHODS First and second year urology residents attended a multi-institutional boot camp in July 2019, which consisted of lectures, a hands-on practical, patient simulation session, and networking social event. Attendees completed a pre-course survey where they rated their comfort level in managing interpersonal, post-operative, and urology-specific scenarios on a Likert scale of 0-5. Participants completed follow-up surveys immediately and 6 months after the course regarding confidence in managing the same scenarios and the impact of boot camp on their training. RESULTS 6 urology PGY1s (55%) and 5 PGY2s (45%) from 4 institutions attended the boot camp. On the precourse survey, PGY2s had higher average comfort scores compared to PGY1s for all post-operative scenarios besides hypotension but just 2 urology-specific scenarios, difficult Foley troubleshooting (4 vs 3, P < .01) and obstructing urolithiasis with urosepsis (3.6 vs 2.2, P = .05). Immediately after the course, 10 of 11 (91%) residents reported feeling better prepared to handle all scenarios. All participants reported they would recommend this training to other urology residents. Six months later, the majority of respondents reported using knowledge learned in boot camp on a daily basis. All agreed that it was a useful networking experience, and 63% had since contacted other residents they met at the course. CONCLUSION A pre-residency boot camp is both feasible and valuable for first- and second-year urology residents for gaining practical medical knowledge and professional networking.
Collapse
Affiliation(s)
- Alexandra L Tabakin
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Priya J Dave
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Arnav Srivastava
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Charles F Polotti
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Joshua A Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Sammy E Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| |
Collapse
|