2019 HSC Section 2 - Practice Management

Reprinted by permission of Laryngoscope. 2015; 125(8):1816-1821.

The Laryngoscope V C 2015 The American Laryngological, Rhinological and Otological Society, Inc.

A Randomized Controlled Trial of Simulation-Based Training for Ear, Nose, and Throat Emergencies

Matthew Edward Smith, MA, MRCS, DOHNS; Annakan Navaratnam, BSc, MRCS (ENT); Lily Jablenska, MRCS, DOHNS; Panagiotis A. Dimitriadis, MSc, MRCS (ENT); Rishi Sharma, MA, MRCS, DOHNS

Objectives/Hypothesis: Life-threatening ear, nose, and throat (ENT) emergencies are uncommon but require immediate skilled management. We investigated if traditional lecture-based teaching can be improved by a simulation and lecture hybrid approach. Study Design: A single-blinded, prospective, randomized controlled trial. Methods: Two groups of interns with no previous ENT experience were randomized to one of two training groups: a simulation/lecture hybrid group or a lecture-only control group. Both groups received 90 minutes of training covering the assessment of critically ill patients and four ENT emergency topics. Both groups received the same initial lecture slides. The control group received additional slides, and the simulation group received simulated emergency scenario training using basic mannequins. Following the training, candidates were asked to provide feedback on their perception of training, and they were formally assessed with a standardized one-to-one viva. Results: Thirty-eight interns were recruited: 18 in the control group and 20 in the simulation group. The candidates in the simulation group performed significantly better in all viva situations ( P < .05) and had better perception of learning ( P < .05). Additionally, the simulation group was more likely to recommend the training to a colleague ( P < .05). Conclusions: We have demonstrated that replacing traditional lecture-based training with a mixture of lectures and emergency scenario simulation is more effective at preparing junior doctors for ENT emergencies, and better met their learn- ing needs. Implementing this kind of teaching is feasible with a minimum of additional resources or time. Key Words: Simulation, training, education, otolaryngology, emergencies. Level of Evidence: 1b Laryngoscope , 125:1816–1821, 2015

this may give rise to patient safety issues when it comes to ward and emergency cover. It is clear that junior doc- tors often require additional training, either as part of the early years curriculum or as an induction, prior to start- ing a, ENT job, the emergency department, or a position that requires out-of-hours care of ENT inpatients. Use of simulation is now widespread in medical education, with applications in teaching laparoscopic surgery, endoscopy, suturing skills, emergency resuscita- tion, team leadership, and basic clinical examination skills among its published uses. 4 It is of particular use in allowing clinicians to practice individual and team management of emergency situations. 5 Simulation has been shown to be an effective method of teaching of both individual procedures 6 and systematic care. 7 We aimed to investigate whether traditional lecture- based teaching on the management of ENT emergencies could be improved without additional time requirements by replacing it with a hybrid of lecture and simulation- based training. In particular we were interested in both the trainees’ perception of the training and its impact on their subsequent individual performance.

INTRODUCTION Ear, nose and throat (ENT) emergencies such as air- way obstruction and uncontrolled epistaxis are not com- mon, but may be rapidly life-threatening and require immediate skilled management. These situations often initially present to junior doctors working in the emer- gency department and on the wards, rather than an expe- rienced specialist. Work over the last few years has shown that junior doctors have a poor knowledge of ENT emer- gencies, 1 and little or no experience or training in their initial management. 2 The problem stems from a lack of teaching at medical school and as a junior doctor, 3 and Additional Supporting Information may be found in the online version of this article. From the Department of ENT Surgery ( M . E . S .), Addenbrooke’s Hos- pital, Cambridge, United Kingdom; and the Department of ENT Surgery ( A . N ., L . J ., P . D ., R . S .), Luton and Dunstable Hospital, Luton, United Kingdom Editor’s Note: This Manuscript was accepted for publication January 6, 2015. This research was conducted in the Department of ENT Surgery, Luton and Dunstable Hospital, Luton, United Kingdom, by all authors. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Matthew Smith, Department of ENT Surgery, Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom. E-mail: mes39@cam.ac.uk

MATERIALS AND METHODS A single-blinded, prospective, randomized controlled trial method was employed. Junior doctors in foundation year two

DOI: 10.1002/lary.25179

Laryngoscope 125: August 2015

Smith et al.: Simulation Training for ENT Emergencies

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