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The introduction of endoscopic ear surgery has implications for the training of otolaryngology residents.
To report on the status of endoscopic ear surgery and assess the effects of this new technology on otolaryngology training in Singapore, from the residents’ perspective.
An anonymous survey was conducted amongst all Singaporean otolaryngology residents. Residents’ exposure to, and perceptions of, endoscopic ear surgery were assessed.
Residents from institutions that practise endoscopic ear surgery were more positive regarding its efficacy in various otological surgical procedures. Of residents in programmes with exposure to endoscopic ear surgery, 82.4 per cent felt that its introduction had adversely affected their training, with 88.3 per cent of residents agreeing that faculty members’ learning of endoscopic ear surgery had decreased their hands-on surgical load. Both groups expressed desire for more experience with endoscopy.
The majority of residents view endoscopic ear surgery as an expanding field with a potentially negative impact on their training. Mitigating measures should be implemented to minimise its negative impact on residents’ training.
This study aimed to examine the impact of trainee involvement in performing tympanoplasty or tympano-ossiculoplasty on outcomes.
A retrospective analysis was performed of a prospective database of all patients undergoing tympanoplasty and tympano-ossiculoplasty in a single centre during a three-year period. Patients were divided into three primary surgeon groups: consultants, fellows and residents. The outcomes of operative time, surgical complications, length of hospital stay, and air–bone gap improvement were compared among the groups.
The study included 398 tympanoplasty and tympano-ossiculoplasty surgical procedures, 71 per cent of which were performed by junior trainees (residents). The junior trainee group was associated with a significantly longer surgical time, without adverse impact on outcomes.
Trainee participation in tympanoplasty and tympano-ossiculoplasty surgery was associated with longer surgical time, but did not negatively affect the peri-operative course or hearing outcome. Therefore, resident involvement in these types of surgery is safe.
Those of Irish domicile or lacking a permanent home in England or Wales were barred from the divorce court, but parliamentary divorce’s noxious reputation encouraged some Irish petitioners to develop means to circumvent its expense and publicity. Various strategies such as renting a house and paying rates in England were deployed to access the divorce court. This chapter samples Irish petitioners who divorced in court both legally and surreptitiously. A covert court divorce could invalidate second marriages, bastardise issue and contest marriage settlements. The late-nineteenth-century court-based divorces of domiciled Irishmen Colonel Sinclair and Colonel Malone were the most widely publicised of these cases. The legitimacy of their divorces was questioned, and problems arose regarding marriage settlements. The court was therefore increasingly rigorous about testing domicile; a rule that all divorce court petitioners would have to swear English domicile and falsification would bar the proceedings was introduced. However, although domicile was more stringently tested, Irish cases were presented to the divorce court with an increased regularity in the early twentieth century.
There is growing concern over a future shortfall in provision of UK otolaryngology consultants. There is a declining rate of applications to otolaryngology specialty training in the UK.
This study aimed to systematically review the literature to establish what factors influence medical students’ and junior doctors’ decision to pursue a career in otolaryngology.
Medline, Embase and PubMed databases were searched in January 2019. Additional manual reference checks of identified literature were performed.
Eleven articles were included in the review. Common factors that positively influenced the decision to pursue a career in otolaryngology were exposure to the specialty, positive role models and a good work-life balance. Lack of exposure was a consistent deterrent from pursuing a career in otolaryngology.
This review reiterates the need for greater exposure to otolaryngology in the undergraduate curriculum. In addition, mentorship for students with an interest in otolaryngology should be a priority.
Earthquakes, landslides, and floods are the most frequent natural disasters in Turkey. The country has also recently experienced an increased number of terrorist attacks. The purpose of this study is to understand the expectations and training of Turkish emergency medicine attending physicians in disaster medicine.
An online questionnaire was administered to the 937 members of the Emergency Medicine Association of Turkey, of which 191 completed the survey (20%).
Most participants (68%) worked at a Training and Research Hospital (TRH) or a University Hospital (UH), and 69% had practiced as an attending for 5 years or less. Mass immigration, refugee problems, and war/terror attacks were considered to be the highest perceived risk topics. Most (95%) agreed that disaster medicine trainings should occur during residency training. Regular disaster drills and exercises and weekly or monthly trainings were the most preferred educational modalities. Most respondents (85%) were interested in advanced training in disaster medicine, and this was highest for those working less than 5 years as an attending. UH and TRH residency training programs were not considered in themselves to be sufficient for learning disaster medicine.
Turkish emergency medicine residency training should include more disaster medicine education and training.
Introduction: Competence committees (CCs) struggle with incorporating professionalism issues into resident progression decisions. This study examined how professionalism concerns influence individual faculty decisions about resident progression using simulated CC reviews. Methods: In 2017, the investigators conducted a survey of 25 program directors of Royal College emergency medicine residency training programs in Canada and those faculty members who are members of the CCs (or equivalent) at their home institution. The survey contained twelve resident portfolios, each containing formative and summative information available to a CC for making progression decisions. Six portfolios outlined residents progressing as expected and six were not progressing as expected. Further, a professionalism variable (PV) was added to six portfolios, evenly split between those residents progressing as expected and not. Participants were asked to make progression decisions based on each portfolio. Results: Raters were able to consistently identify a resident needing an educational intervention versus those who did not. When a PV was added, the consistency among raters decreased by 34.2% in those residents progressing as expected, versus increasing by 3.8% in those not progressing as expected (p = 0.01). Conclusion: When using an unstructured review of a simulated resident portfolio, individual reviewers can better discriminate between trainees progressing as expected when professionalism concerns are added. Considering this, educators using a competence committee in a CBME program must have a system to acquire and document professionalism issues to make appropriate progress decisions.
Introduction: With a shift towards competency-based medical education, it is crucial to not only emphasize learner abilities such as clinical skills but also leadership in the conduct of research. Though the Royal College of Physicians and Surgeons of Canada's (RCPSC) training objectives for Emergency Medicine (EM) residents state that the specialist physician be able to describe the principles of research, the research methodology curriculum across EM training programs in Canada is likely variable. The primary goal of this study was to describe the variability of research methodology teaching among RCPSC-EM residency programs. Methods: An electronic survey was distributed to English-speaking RCPSC-EM program directors (PDs) and EM residents. The survey investigated residents' and PDs’ thoughts on the adequacy of their local curriculum and asked them to quantify their research methodology teaching. The primary outcome was the frequency and content of current research methodology and research ethics teaching as well as a description of scholarly project requirements of EM residency programs across Canada. The data was presented with simple descriptive statistics. Results: 79 EM residents and 7 PDs responded (response rate 22.3% and 58.3%, respectively). All 7 PDs indicate having a research methodology curriculum while 71.6% of residents are aware of this curriculum. Only 57.1% of PDs report having formal assessments. Most programs (71.4%) teach via small groups while 28.6% of programs use large group sessions. Residents identify teaching as led by research staff (68.9%), staff physicians (60%), and EM researchers (57.8%), while only 17.8% use outside educators. Students noted various modalities of curriculum feedback such as online surveys, weekly forms, and verbal feedback. Regarding the strength of the curricula, 85.7% of PDs believed their curriculum prepares residents for board exams, while only 62.2% of residents felt similarly. When asked about using a standard web-based curriculum module if available, 60.5% of residents responded in favour. Conclusion: This study demonstrates that EM residency programs across Canada vary with respect to research methodology curriculum and discrepancies exist between residents’ and program directors’ perceptions of the curriculum. Given the lack of a standardized research methodology curriculum for these residency programs, there is an opportunity for curriculum development to improve training in research methodology.
Introduction: During the one-year CCFP-EM program, residents rotate through different teaching sites. The purpose of this project is to investigate differences in procedural skills acquisition between these sites, which will help identify the effectiveness of each setting for teaching procedural skills amongst EM trainees. Methods: Over a two year period, residents enrolled in a CCFP-EM residency training program were asked to log their procedures and the sites where they were performed. The cumulative data was analyzed to show the number and types of procedures performed at each site. Results: A total of 477 procedures were logged over two years, with 198 procedures performed at urban tertiary emergency departments (EDs), 116 at community EDs, 87 at intensive care units (ICUs), 37 at urgent care centre, 24 in clinics, and 15 at other settings. Overall, 48 point of care ultrasounds, 75 vascular access procedures, 99 reduction/casting, 48 lumbar punctures, 29 procedural sedations, 125 minor surgical procedures, and 32 other procedures were performed. The majority of procedures were performed at the tertiary care urban ED, followed closely by community ED setting. The only exception was vascular access, which was performed most commonly in ICU settings. Conclusion: Our urban tertiary care ED setting provided the most learning opportunity for procedural skill acquisition, suggesting that having maximized time allocated in this setting is essential for EM learners to acquire procedural skills. One exception is that EM learners gain more vascular access training in ICUs.
Innovation Concept: The fairness of the Canadian Residency Matching Service (CaRMS) selection process has been called into question by rising rates of unmatched medical students and reports of bias and subjectivity. We outline how the University of Saskatchewan Royal College emergency medicine program evaluates CaRMS applications in a standardized, rigorous, equitable and defensible manner. Methods: Our CaRMS applicant evaluation methods were first utilized in the 2017 CaRMS cycle, based on published Best Practices, and have been refined yearly to ensure validity, standardization, defensibility, rigour, and to improve the speed and flow of data processing. To determine the reliability of the total application scores for each rater, single measures intraclass correlation coefficients (ICCs) were calculated using a random effects model in 2017 and 2018. Curriculum, Tool or Material: A secure, online spreadsheet was created that includes applicant names, reviewer assignments, data entry boxes, and formulas. Each file reviewer entered data in a dedicated sheet within the document. Each application was reviewed by two staff physicians and two to four residents. File reviewers used a standardized, criterion-based scoring rubric for each application component. The file score for each reviewer-applicant pair was converted into a z-score based on each reviewer's distribution of scores. Z-scores of all reviewers for a single applicant were then combined by weighted average, with the group of staff and group of residents each being weighted to represent half of the final file score. The ICC for the total raw scores improved from 0.38 (poor) in 2017 to 0.52 (moderate) in 2018. The data from each reviewer was amalgamated into a master sheet where applicants were sorted by final file score and heat-mapped to offer a visual aid regarding differences in ratings. Conclusion: Our innovation uses heat-mapped and formula-populated spreadsheets, scoring rubrics, and z-scores to normalize variation in scoring trends between reviewers. We believe this approach provides a rigorous, defensible, and reproducible process by which Canadian residency programs can appraise applicants and create a rank order list.
The Istanbul Strait is an important cetacean habitat that is intensely used by humans. Yet little is known about their spatial-temporal distribution. To understand the encounter rates and residency patterns of bottlenose dolphins, photo-identification data were collected between 2011 and 2016 in the Istanbul Strait. The study showed that bottlenose dolphins are a regular, year-round component of the strait. The encounter rate was estimated to be four groups (22 individuals) per 10 km. The adjacent waters of Marmara Sea and Black Sea, that host relatively less marine traffic, had the highest number of encounters in the area. Conversely, the middle sections had the lowest number of encounters but the highest marine vessel density. Further, the encounter rates dropped to zero in the fishing zones, where the number of purse seines reached up to 100 per day. Additionally, dolphins showed varying degrees of residency patterns, with multi-year re-sightings. Maximum re-sighting distance was up to 35 km, which is more than the total length of the strait. This movement pattern should be investigated as it might reveal possible migration between local populations. This study finds that the Istanbul Strait serves as a critical habitat for the regional bottlenose dolphin populations and they are likely to be a part of a resident local population with a home range extending the length of the strait. Dedicated surveys with inter-regional collaborations are needed to evaluate the home range and population status of this endangered species for their effective conservation in one of the busiest waterways of the world.
At the heart of surgical care needs to be the education and training of staff, particularly in the low-income and/or resource-poor setting. This is the primary means by which self-sufficiency and sustainability will ultimately be achieved. As such, training and education should be integrated into any surgical programme that is undertaken. Numerous resources are available to help provide such a goal, and an open approach to novel, inexpensive training methods is likely to be helpful in this type of setting.
The need for appropriately trained audiologists in low-income countries is well recognised and clearly goes beyond providing support for ear surgery. However, where ear surgery is being undertaken, it is vital to have audiology services established in order to correctly assess patients requiring surgery, and to be able to assess and manage outcomes of surgery. The training requirements of the two specialties are therefore intimately linked.
This article highlights various methods, resources and considerations, for both otolaryngology and audiology training, which should prove a useful resource to those undertaking and organising such education, and to those staff members receiving it.
The application of evidence-informed practice in emergency medicine (EM) is critical to improve the quality of patient care. EM is a specialty with a broad knowledge base making it daunting for a junior resident to know where to begin the acquisition of evidence-based knowledge. Our study’s objective was to formulate a list of “top papers” in the field of EM using a Delphi approach to achieve an expert consensus.
Participants were recruited from all 14 specialty EM programs across Canada by a nomination process by the program directors. The modified Delphi survey consisted of three study rounds, each round sent out via email. The study tool was piloted first with McMaster University’s specialty EM residents. During the first round, participants individually listed top papers relevant to EM. During the two subsequent rounds, participants ranked the papers listed in the first round, with a chance to adjust ranking based on group responses.
A total of eight EM specialty programs responded with 30 responses across the three rounds. There were 119 studies suggested in the first round, and, by the third round, a consensus of>70% agreement was reached to generate the final list of 29 studies.
We produced, via an expert consensus, a list of top studies relevant for Canadian EM physicians in training. It can be used as an educational resource for junior residents as they transition into practice.
Introduction: Direct observation is essential to assess medical trainees and provide them with feedback to support their progression from novice to competent physicians. However, learners consistently report infrequent observations, and calls to increase direct observation in medical training abound. In this study, a theory-driven approach using the Theoretical Domains Framework (TDF) was applied to systematically investigate factors that serve as barriers and enablers to direct observation in residency training. Methods: Semi-structured interviews of faculty and residents from various specialties at two large tertiary-care teaching hospitals were conducted. An interview guide based on the TDF was used to capture 14 theoretical domains that may influence direct observation. Interview transcripts were independently coded using direct content analysis by two researchers, and specific beliefs were generated by grouping similar responses. Relevant domains were identified based on the frequencies of beliefs reported, presence of conflicting beliefs, and perceived influence on direct observation practices. Results: Data saturation was achieved after 12 resident and 13 faculty interviews, with a total of 10 different specialties represented. Median postgraduate year among residents was 4 (range 1-6), and mean years of independent practice among faculty was 10.3 (SD=8.6). Ten TDF domains were identified as influencing direct observation: knowledge, skills, beliefs about consequences, social professional role and identity, intention, goals, memory/attention/decision-making, environmental context and resources, social influences, and behavioural regulation. Discord between faculty and resident intentions to engage in direct observation, coupled with the social expectation that residents should be responsible for ensuring observations occur, was identified as a key barrier. Additionally, competing demands identified across multiple TDF domains emerged as an important and pervasive theme. Conclusion: This study identified key barriers and enablers to direct observation. The influencing factors identified in this study provide a basis for the development of potential strategies aimed at embedding direct observation as a routine pedagogical practice in residency training.
Introduction: The 2015 CanMEDS framework requires all residency programs to increase their focus on Quality Improvement and Patient Safety (QIPS). We created a longitudinal (4-year), modular QIPS curriculum for FRCP emergency medicine residents at the University of Toronto (UT) using multiple educational methods. The curriculum addresses three levels of QIPS training: knowledge, practical skills at the microsystem level, and practical skills at the organization level. Aim Statement: To increase the UT FRCP emergency medicine residents absolute score on the QIKAT-R (Quality Improvement Knowledge Application Tool Revised) by 10% after the completion of the QIPS curriculum. Methods: Physicians and other healthcare professionals with QI expertise collaboratively designed and taught the curriculum. We used the QIKAT-R as the outcome measure to evaluate QI knowledge and its applicability. The QIKAT-R is a validated measure that assesses an individuals ability to decipher a QI issue within the healthcare context, and propose a change initiative to address it. The first cohort of residents completed the QIKAT-R prior to the first session in 2014 (pre) and at the completion of the curriculum in 2017 (post). Each response was anonymized and scored by physicians with QI expertise. The QIKAT-R scores and comments from course evaluations are used to make yearly iterative curriculum changes. Results: The QIPS curriculum was implemented in September 2014. All nine residents in the first cohort completed the curriculum; they demonstrated an absolute increase of 19.6% (5.3/27) in the mean QIKAT-R score (13.0 +/− 3.3 pre vs. 18.3 +/− 3.8 post, p=0.001). Of the pre-test responses, 26% were categorized as poor, 70% as good, and 4% as excellent, whereas of the post-test 11% of responses were categorized as poor, 37% as good, and 52% as excellent (p<0.001). Two iterative curriculum changes were made at the end of each academic year since 2014: (1) The time between sessions were decreased to promote knowledge retention, and (2) different PGY3 QI practical project options were provided to suit residents individual QI interests. QIKAT-R scores and resident feedback were used to evaluate the impact of the curriculum changes. Conclusion: A collaborative, modular, longitudinal QIPS curriculum for UT FRCP emergency medicine residents that met CanMEDS requirements was created using multiple educational methods. The first resident cohort that completed the curriculum demonstrated an absolute increase in QI knowledge and its applicability (as measured by the QIKAT-R) by 19.6%. Two PDSA cycles were completed to improve the curriculum with the change ideas generated from resident feedback. Ongoing challenges include limited staff availability to teach and supervise resident QI projects. Future directions include incentivising staff participation and providing mentorship for residents with a career interest in QI beyond what is offered by the curriculum.
Canadian emergency medicine Royal College residency training allows for pursuing extra training in enhanced competency areas. A wealth of enhanced competency training opportunities exist nationally. However, the search for the right fit is a challenging one because there is no centralized resource that catalogues all of these opportunities. A working group of the Canadian Association of Emergency Physicians (CAEP) Resident Section was assembled in 2016 to create a freely accessible and comprehensive directory of Canadian enhanced competency areas. The working group used stakeholder surveys (of residents, recent graduates, and faculty members), social media engagement, and program website searches. Information was collated into the first edition of a national enhanced competency directory, which is available at no cost at http://caep.ca/sites/caep.ca/files/enhancedcompdoc.pdf. Limitations include the scope defined by the working group and survey responses. A biannual update is also incorporated into the CAEP Resident Section portfolio to ensure it remains up-to-date.