The future of otolaryngology training threatened: the negative impact of residency training reforms.
ABSTRACT Resident training regulations developed by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 have limited resident work hours and autonomy. Proposed to improve patient safety and resident education, these regulations have not had their intended effects. They have acted to dilute otolaryngology residents' experiences, thereby weakening their training. The ACGME is currently considering tightening these regulations. By advocating for residency guidelines that are more conducive to the needs of otolaryngology education, otolaryngologists can guarantee continued superlative training for future residents.
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ABSTRACT: In the National Institute for Health and Clinical Excellence (NICE) guidance on cancer services published in 2004, it was recommended that specialist clinics should be set up for the assessment of patients with neck lumps, structured in a similar way to one-stop breast lump clinics with a cytopathologist present and preferably ultrasound guidance. The aim of this study was to audit the performance of ultrasound-guided fine needle aspiration (FNA) with on-site cytology in a one-stop neck lump clinic at The Royal Liverpool University Hospital. Data were collected between November 2008 and May 2009 (7 months). Details of the adequacy rate for the FNA were recorded and whether multiple passes were required. The likely adequacy rate if ultrasound guidance was not available was also calculated. A total of 274 patients were included in the audit. Of these, 227 (83%) patients required a single pass for adequate diagnostic material. Of the remaining, 45 (16%) required two passes and 2 (1%) required three passes. The overall sample inadequacy rate was 11 of 274 (4%). From these results, it could be predicted that, if immediate cytological evaluation was unavailable, the inadequacy rate would have been 41 of 274 (15%). This audit has illustrated the benefits of a one-stop clinic with on-site cytology in providing a rapid diagnostic head and neck cancer service.Annals of The Royal College of Surgeons of England 11/2010; 92(8):660-4. · 1.22 Impact Factor
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ABSTRACT: To investigate workflow in an otolaryngology-head and neck surgery residency program over 1 year and identify areas for improvement in the efficiency of resident education and training. Time-motion study. An urban, county hospital and a Veterans Affairs medical center hospital. Subjects and Methods. Eight otolaryngology residents (4 residents at postgraduate year [PGY] 2 and 4 at PGY 4) were studied using direct observations early and late in the 2008-2009 academic year. Resident activities were categorized, and a database program was generated for a handheld computer to facilitate time entry. Resident activities were classified into a taxonomy of tasks and their educational value was assessed. For each PGY level studied, observations were made for clinic and operative days. Residents spent their day on direct patient care (43.5%), indirect patient care (33.7%), didactic education (9.6%), personal activities (7.5%), and transit (5.8%), with activities of marginal educational value consuming 16% of their time. Major inefficiencies included managing administrative tasks, scheduling, and technical difficulties. On average, residents devoted significantly more time to marginal tasks on clinic days (19%) than on operative days (12%; P < .001). These data were compared with previously published data obtained during the pre–Accreditation Council for Graduate Medical Education (ACGME) duty hour mandates era. This study evaluates resident workflow and efficiency over the course of a PGY in an ACGME-accredited otolaryngology residency program. By understanding the time motion of residents, interruptions and inefficiencies in workflow can be identified to direct future changes to enhance resident education and training in the era of the ACGME duty hours mandate.Otolaryngology Head and Neck Surgery 02/2011; 144(5):708-13. · 1.72 Impact Factor