Office‐Based Procedure Training in Laryngology Fellowship Programs

Enver, Necati; Ramaswamy, Apoorva T.; Sulica, Lucian; Pitman, Michael J.

doi:10.1002/lary.29170

Cited by 5 publications

(13 citation statements)

References 21 publications

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“…Otherwise, fellows largely assisted or observed procedures performed at lower volumes. In contrast, when fellowship directors were surveyed, it was concluded that the impact of weekly office procedure volume was favorable for fellowship training, although it had no effect over allowing trainees as primary surgeons 12 …”

Section: Discussionmentioning

confidence: 95%

“…In contrast, when fellowship directors were surveyed, it was concluded that the impact of weekly office procedure volume was favorable for fellowship training, although it had no effect over allowing trainees as primary surgeons. 12 A notable exception to these trends involves laryngeal BoNT-A injection. This is a procedure performed at high volume (at least weekly) for most fellowship programs, but with which fellows reported inadequate opportunity to practice independently.…”

Section: Themes Suggestionmentioning

confidence: 99%

“…This was echoed in the survey of laryngology fellowship directors, with only 2/16 (12.5%) programs reporting use of procedural checklists or structured debriefing. 12 This is another area for potential quality improvement in the laryngology education realm. Development of objective structured assessment of technical skill (OSATS) for core laryngologic office-based procedures could set the expectation that fellows need to perform and practice these procedures and then have opportunities to be objectively assessed.…”

Section: Themes Suggestionmentioning

confidence: 99%

“…An attempt to assess the current practices and challenges of office-based procedures during fellowship in the United States has been recently explored. 12 Laryngology fellowship program directors were surveyed, providing insight on procedures taught, level of fellow involvement in the procedure, and expected competencies upon fellowship completion. Consensus suggested the current training state for office-based procedures is good, though improvements could be accomplished.…”

Section: Introductionmentioning

confidence: 99%

“…This however can limit the training experience and competency of trainees with such procedures. An attempt to assess the current practices and challenges of office‐based procedures during fellowship in the United States has been recently explored 12 . Laryngology fellowship program directors were surveyed, providing insight on procedures taught, level of fellow involvement in the procedure, and expected competencies upon fellowship completion.…”

Section: Introductionmentioning

confidence: 99%

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Training for Awake, Office‐Based Laryngeal Procedures—The Laryngology Fellow's Perspective

Shuman,

Dwyer

2023

The Laryngoscope

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ObjectiveThe aim was to explore recent laryngology graduates' perspectives on their experience, competency, and challenges learning office‐based procedures during fellowship training in the United States and Canada.MethodsAnonymous 22‐item questionnaire survey was distributed electronically to fellowship‐trained laryngologists having completed fellowship within past 5 years.ResultsNinety fellowship‐trained laryngologists between 2018 and 2022 were surveyed. Response rate was 48.9% (n = 44), 1 declined participation, with 20 different fellowship programs represented. Fellows were frequently provided the opportunity to act as primary surgeon for most procedures, except for laryngeal botulinum toxin injection, diagnostic laryngeal electromyography, trans‐nasal esophagoscopy, secondary tracheoesophageal puncture, and high‐resolution pharyngeal manometry. A majority reported high (n = 27, 62.8%) or moderate (n = 12, 27.9%) confidence with vocal fold injection augmentation. Various techniques were taught: transoral (74.4%), cricothyroid (74.4%), thyrohyoid (69.8%), transcartilagenous (14.0%), and catheter‐needle (25.6%). Numerous statistically significant associations with independent procedure involvement and competence were identified. Laryngeal botulinum toxin injection was a procedure performed with high frequency but low volume of independent fellow involvement, and the procedure with which fellows reported wanting more practice learning. Most common training barriers included patient being awake, patient consenting to trainee performing the procedure, and the technical challenge/complexity of the procedure. Teaching methods/tools largely focused on informal debriefing (97.3%) and case by case troubleshooting (81.1%).ConclusionsLaryngology fellows are well trained with favorable perceived levels of competence for numerous office‐based procedures, particularly vocal fold injection augmentation. Procedures for which fellows reported a low level of independent participation trended towards lower perceived competency.Level of EvidenceLevel 5 Laryngoscope, 2023

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Section: Discussionmentioning

confidence: 95%

Section: Themes Suggestionmentioning

confidence: 99%

Section: Themes Suggestionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Training for Awake, Office‐Based Laryngeal Procedures—The Laryngology Fellow's Perspective

Shuman,

Dwyer

2023

The Laryngoscope

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Quality of Office‐based Procedure Training During Laryngology Fellowship

Enver,

Axiotakis,

Sulica

et al. 2023

The Laryngoscope

Self Cite

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ObjectivesThe primary objective was to assess the perspectives of recent laryngology fellowship graduates on office‐based procedure training, with a secondary objective to compare this with previous research on perspectives of fellowship directors.MethodsRecent laryngology fellowship graduates were surveyed via an online survey platform regarding post‐fellowship practice and various aspects of office‐based procedure training, including perceived competence, mentorship, and barriers.ResultsThere were 51 respondents. Seventy‐six percent of respondents felt they “definitely” received adequate office procedure training. Number of procedures as primary surgeon was significantly associated with perception of adequate training (OR 1.54, 95% CI: 1.08–2.19, p = 0.018) and high post‐fellowship office procedure volume (OR 1.56, 95% CI: 1.02–2.39, p = 0.040). Fellows reported a lower percentage of procedures as primary surgeons compared with program directors (46.8% vs. 61.9%, p = 0.028). Fellows and directors agreed that informal debriefs were more commonly employed than more structured training elements such as checklists and simulators. Of nine office procedures, laryngeal electromyography, KTP laser, and transnasal esophagoscopy had the greatest decreases in practice after training.ConclusionAlthough most recent laryngology fellowship graduates endorse adequate office‐based procedure training, a range of individual experiences exists, and office procedure volume, both overall and across individual procedures, may decrease after fellowship. Fellows performing office procedures as primary surgeons may be linked to perceived quality of training and post‐fellowship volume.Level of EvidenceN/A Laryngoscope, 2023

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Development and Validation of a Laryngeal Microsurgery Simulation Training System for Otolaryngology Residents

Santander

Sepúlveda

Iribarren

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveThis study aims to create a synthetic laryngeal microsurgery simulation model and training program; to assess its face, content, and construct validity; and to review the available phonomicrosurgery simulation models in the literature.Study DesignNonrandomly assigned control study.SettingSimulation training course for the otolaryngology residency program at Pontificia Universidad Católica de Chile.MethodsResident (postgraduate year 1 [PGY1]/PGY2) and expert groups were recruited. A laryngeal microsurgery synthetic model was developed. Nine tasks were designed and assessed through a set of programmed exercises with increasing difficulty, to fulfill 5 surgical competencies. Imperial College Surgical Assessment Device sensors applied to the participants' hands measured time and movements. The activities were video‐recorded and blindly assessed by 2 laryngologists using a specific and global rating scale (SRS and GRS). A 5‐point Likert survey assessing validity was completed by experts.ResultsEighteen participants were recruited (14 residents and 4 experts). Experts performed significantly better than residents in the SRS (p = .003), and GRS (p = .004). Internal consistency was demonstrated for the SRS (α = .972, p < .001). Experts had a shorter execution time (p = .007), and path length with the right hand (p = .04). The left hand did not show significant differences. The survey assessing validity resulted in a median 36 out of 40 points score for face validity; and 43 out of 45 points score, for global content validity. The literature review revealed 20 available phonomicrosurgery simulation models, only 6 with construct validity.ConclusionThe face, content, and construct validity of the laryngeal microsurgery simulation training program were established. It could be replicated and incorporated into residents' curricula.

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Office‐Based Procedure Training in Laryngology Fellowship Programs

Cited by 5 publications

References 21 publications

Training for Awake, Office‐Based Laryngeal Procedures—The Laryngology Fellow's Perspective

Training for Awake, Office‐Based Laryngeal Procedures—The Laryngology Fellow's Perspective

Quality of Office‐based Procedure Training During Laryngology Fellowship

Development and Validation of a Laryngeal Microsurgery Simulation Training System for Otolaryngology Residents

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