The future of otolaryngology training threatened: The negative impact of residency training reforms
Department of Otolaryngology, State University of New York-Downstate Medical Center, Brooklyn, NY 11203, USA. Otolaryngology Head and Neck Surgery
(Impact Factor: 2.02).
03/2010; 142(3):303-5. DOI: 10.1016/j.otohns.2009.12.010
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.
Available from: Paul Nixon
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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.
Available from: Masayoshi Takashima
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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.
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.
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Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon.Study DesignCase series with chart review.SettingTertiary care center and residency program.Subjects and Methods
Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data.ResultsFive of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs.Conclusion
Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.
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