2019 HSC Section 2 - Practice Management

candidates after a few months to assess if indeed simula- tion results in better retention. The candidates in our study had no previous expe- rience of working in an ENT department or covering ENT patients out of hours. However, we did not assess their prior knowledge before training was delivered, which is a limitation of the study. To rectify this, we could have assessed the candidates using the same viva they took after training, although this may have affected the way the candidates approached the train- ing. Candidates were asked prior to the study if they had completed any other formal training with a simula- tion component, and all but two had completed ALS courses, whereas only one candidate had received ATLS training. It may be that previous simulation training enhances learning, but this should have been matched between groups. With the benefit of experience and candidate feed- back, our simulations can be improved, and some expansion of the session may prepare candidates better for future work. There are also many opportunities to introduce higher fidelity simulation. Our simulated sce- narios and the equipment used were straightforward, with the use of basic passive mannequins with a poly- vinyl chloride and silicon airway and nasal cavity. Other groups have used epistaxis mannequins, with fake blood and active bleeding, and porcine larynx is often used to facilitate surgical airway practice. 20 Cadavers have traditionally been used to practice tem- poral bone dissection or sinus surgery, but have also been used in emergency simulation such as epistaxis or post-tonsillectomy bleeding. 13 Technologically advanced mannequins are also available that can be programmed to simulate presentations such as stridor, pharyngeal edema, or trismus, with realistic functions such as tachycardia and altered ventilation. Apart from high- fidelity simulators, placing the simulation session into an authentic clinical context can improve realism and enhance the students’ learning experience. A number of studies have concluded that simulation is most effective when it is undertaken in environments similar to the workplace. 21–23

Fig. 4. Epiglottitis viva score for both training groups.

candidates a chance to demonstrate both knowledge con- tent and an ability to systematically work through the management of a sick patient. This was felt to be a bet- ter method of testing that a written paper, which can lack continuity and tends to prompt answers. We chose to use a subsection (Perception of Learn- ing) of the validated DREEM questionnaire as an assess- ment of the candidate’s opinion regarding the simulation, as this part of the overall score relates to the teaching itself, rather than the teacher or environment. Scores from both study groups were tightly grouped, as shown in Figures 3 and 4. Although statistically less well thought of, scores for the control setting were also good, confirming that the control teaching was of high quality and a good comparator (as should be expected when the majority of the slides that were presented to each group were the same). The results from the modi- fied DREEM questionnaire and recommendation ques- tion are in line with other studies that have shown that simulation is popular with trainees, boosts confidence, and is perceived as an effective method of training. 4,7,13 The study design and collection of both quantitative candidate performance data and participant feedback allows us to form a clear picture of the efficacy of simu- lation in this area, and we feel that there is a strong case for widespread adoption of more simulation-based training for ENT emergencies. In perhaps the most similar trial to our own, Mad- dry et al. conducted a randomized controlled trial of mannequin simulation versus lecture for toxicology training in emergency medicine residents. 19 They found that immediately postintervention, the lecture group showed a greater improvement in written test scores compared to the simulation group, but that at 3 months post-training, the simulation group showed greater retention. Aside from the differences in content, unlike our study, Maddry et al. primarily provided simulation alone, with some supplementary teaching as time allowed. It may be that by providing lecture instruction first in our case, the simulation was more effective as it allowed practice and reinforcement of the newly acquired knowledge. It would be interesting to retest our

Fig. 5. Modified Dundee Ready Education Environment Measure (DREEM) scores for both training groups.

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