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As a result of the coronavirus pandemic, the feasibility of holding secure closed-book examinations in medical education is compromised. In this Personal View, we compare the underlying reasoning for using open-book and closed-book exams. We rethink the role of open-book assessment and offer ways in which we believe they can complement closed-book exams. We highlight the gap in research, highlight future directions, and call on medical educators to seize our current golden opportunity to explore the impact of open-book examson their own or combined to closedbook tests, as a blended approachon learners, educators, and licensing bodies.

Radiation (RT) and chemoradiation therapy (CRT) play an essential role in head and neck cancer treatment. However, both cause numerous side effects in the oral cavity, paranasal sinuses, and pharynx, having deleterious consequences on patients’ quality of life. Concomitant with significant advances in radiation oncology, much attention has turned to understanding the role of the microbiome in the pathogenesis of treatment-induced tissue toxicity, to ultimately explore microbiome manipulation as a therapeutic intervention. This review sought to discuss current publications investigating the impact of RT and CRT-induced changes on the head and neck microbiome, using culture-independent molecular methods, and propose opportunities for future directions. Based on 13 studies derived from a MEDLINE, EMBASE, and Web of Science search on November 7, 2021, use of molecular methods has uncovered various phyla and genera in the head and neck microbiome, particularly the oral microbiome, not previously known using culture-based methods. However, limited research has investigated the impact of RT/CRT on subsites other than the oral cavity and none of the studies aimed to examine the relationship between the head and neck microbiome and treatment effectiveness. Findings from this review provide helpful insights on our current understanding of treatment-induced oral mucositis, dental plaque, and caries formation and highlight the need for future research to examine the effect of RT/CRT on the sinonasal and oropharyngeal microbiome. In addition, future research should use larger cohorts, examine the impact of the microbiome on treatment response, and study the effect of manipulating the microbiome to overcome therapy resistance.

Introduction: As a result of the COVID-19 pandemic, the authors rapidly transitioned an in-person, learner-led medical education journal club (MEJC) to the virtual environment. The “interactive, no-prep” approach, using breakout rooms within a videoconferencing system, required no prior learner preparation. Methods: From March to May 2020, learners were invited to participate in a monthly 60-minute virtual MEJC. A needs assessment survey informed article selection. Facilitators developed a presentation to provide background and describe the article's research question(s). In breakout groups, learners generated study designs to answer the research question(s). After the actual study methodology and results were revealed, learners engaged in facilitated open discussion. After the session, learners completed an electronic survey to rate perceived usefulness and suggest improvement areas. Results: A total of 15 learners participated; most completed the survey (13/15; 87%). The MEJC was rated as very or extremely useful. Qualitative feedback indicated that it was convenient, allowed creativity, and enabled rich discussion without prior preparation. When possible, improvement suggestions were implemented. Discussion: The authors offer an evidence-based MEJC approach that is free, interactive with virtual breakout rooms and requires no prior learner preparation. Early indicators suggest that others navigating the COVID-19 crisis may want to implement this approach.

Objective To map current literature on the educational use of extended reality (XR) in Otolaryngology‐Head and Neck Surgery (OHNS) to inform teaching and research. Study Design Scoping Review. Methods A scoping review was conducted, identifying literature through MEDLINE, Ovid Embase, and Web of Science databases. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping review checklist. Studies were included if they involved OHNS trainees or medical students who used XR for an educational purpose in OHNS. XR was defined as: fully‐immersive virtual reality (VR) using head‐mounted displays (HMDs), non‐immersive and semi‐immersive VR, augmented reality (AR), or mixed reality (MR). Data on device use were extracted, and educational outcomes were analyzed according to Kirkpatrick's evaluation framework. Results Of the 1,434 unique abstracts identified, 40 articles were included. All articles reported on VR; none discussed AR or MR. Twenty‐nine articles were categorized as semi‐immersive, none used occlusive HMDs therefore, none met modern definitions of immersive VR. Most studies (29 of 40) targeted temporal bone surgery. Using the Kirkpatrick four‐level evaluation model, all studies were limited to level‐1 (learner reaction) or level‐2 (knowledge or skill performance). Conclusions Current educational applications of XR in OHNS are limited to VR, do not fully immerse participants and do not assess higher‐level learning outcomes. The educational OHNS community would benefit from a shared definition for VR technology, assessment of skills transfer (level‐3 and higher), and deliberate testing of AR, MR, and procedures beyond temporal bone surgery. Laryngoscope, 133:227–234, 2023

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