Multi‐institutional Study of Otolaryngology Resident Intraoperative Experiences for Key Indicator Procedures

Abstract

Objective There is concern that current otolaryngology residents may not receive adequate surgical training. We aimed to characterize residents’ surgical experiences at 5 academic centers performing the 14 key indicator procedures (KIPs) outlined by the Accreditation Council for Graduate Medical Education. Study Design Prospective study. Setting Five otolaryngology training programs. Methods Data were gathered from December 2019 to December 2020 with a smartphone application from the Society for Improving Medical Professional Learning. After each operation, residents and faculty rated trainee autonomy on a 4-level Zwisch scale and performance on a 5-level modified Dreyfus scale. Results Residents and attendings (n = 92 and 78, respectively) logged 2984 evaluations. Attending ratings of resident autonomy and performance increased with training level ( P < .001). Resident self-assessments of autonomy and performance were lower than paired attending assessments ( P < .001). Among attending evaluations of KIPs performed by senior residents (postgraduate year 4 or 5), 55% of cases were performed with meaningful autonomy (passive help or supervision only). Similarly, attendings rated 55% of these cases as a practice-ready or exceptional performance. Senior residents had meaningful autonomy for ≥50% of cases for most KIPs, with the exception of flaps and grafts (40%), pediatric/adult airway (39%), and stapedectomy/ossiculoplasty (33%). Similarly, senior residents received practice-ready or exceptional performance ratings for ≥50% of cases across all KIPs other than pediatric/adult airway (42%) and stapedectomy/ossiculoplasty (33%). Conclusion In this multicenter study, resident surgical autonomy and performance varied across otolaryngology KIPs. The development of nationwide benchmarks will help programs and residents set educational goals. Level of evidence 2.

Factors affecting operative autonomy and performance during otolaryngology training: A multicenter trial

“…As there were very few assessments of PGY1 and PGY6 residents ( N = 32 and N = 1, respectively), they were excluded from the subsequent analyses. Ratings of performance/autonomy/case complexity for assessments at each PGY level of training were previously reported 10 …”

“…Ratings of performance/autonomy/case complexity for assessments at each PGY level of training were previously reported. 10…”

“…A limited number of studies have introduced the use of several instruments to evaluate resident operative experiences and operative skills. [7][8][9][10] However, little is known about potential factors that may cause variability across otolaryngology training experiences. Herein, we conducted a multicenter study to characterize the factors that affect operative skill training in otolaryngology.…”

“…Efforts to quantify, characterize and improve surgical education in otolaryngology have been scarce. A limited number of studies have introduced the use of several instruments to evaluate resident operative experiences and operative skills 7–10 . However, little is known about potential factors that may cause variability across otolaryngology training experiences.…”

The Lasting Impact of the COVID-19 Pandemic on Surgical Key Indicator Cases for Otolaryngology Residency Education

“…Nearly 20% of OHNS residents are unsure that by the time they graduated they would be able to perform KICs independently. 35 Extra care must be taken by programs to ensure that the COVID-19 pandemic does not have lasting effects on the confidence of residents to perform procedures. OHNS residents must be considered essential personnel in the operating room; they must be given ample time to develop the necessary skills and knowledge for the profession.…”