Showing papers by "Neil Tolley published in 2014"

Feasibility of a synthetic temporal bone for training in mastoidectomy: face, content, and concurrent validity

Abstract: OBJECTIVE To investigate the face, content, and concurrent validity of the synthetic Pettigrew temporal bone (PTB) for mastoidectomy training as compared with cadaveric temporal bone (CTB). STUDY DESIGN A prospective evaluation study. METHODS Participants were invited to perform a step-by-step modified radical mastoidectomy using both bones and complete a 22-item, 5-point Likert scale questionnaire. The questionnaire is divided into 4 domains: face validity (FV), global content (GC), task-specific content (TSC), and curriculum recommendation (CR). RESULTS Thirty-six experts and 89 trainees completed all tasks, 63 using CTB and 62 using PTB. The PTB median FV was 4 (IQR: 4-5), GC of 4 (IQR: 4-5), TSC of 4 (IQR: 3-4), and CR of 4 (IQR: 4-5). The CTB was rated significantly higher than PTB by both groups in all domains; CTB FV: 5 (IQR: 4-5), GC: 5 (IQR: 4-5), TSC: 5 (IQR: 4-5), and CR: 5 (IQR: 5-5), p < 0.001 for each. Trainees rated PTB significantly higher than experts in all domains. There was no statistically significant difference between experts and trainees in rating the CTB in all domains. PTB gives similar haptic feedback to CTB, allows the use of suction and irrigation, has the important landmarks painted for identification, and contains articulating ossicles. The facial nerve anatomy was found to be inaccurate around the region of the second genu. CONCLUSION Participants found PTB to be valid for teaching some, yet not all, aspects of mastoid surgery, and experts agreed that it could improve global transferrable otologic skills. It is essential that the facial nerve anatomy is addressed before recommending this model.

Face and content validity of sheep heads in endoscopic rhinology training.

Abstract: Background The objective of this study was to assess the face and content validity of the sheep head model in endoscopic rhinology training. Methods This study was a prospective evaluation study. Experienced otolaryngologists and trainees were recruited to complete 7 endoscopic rhinology tasks on pre-prepared sheep heads. All participants completed a validated 20­item questionnaire using a 5-point Likert scale to assess the model across 4 domains: face validity (FV), global content (GC), task-specific content (TSC), and curriculum applicability (CTR). Results Participants, including 25 experienced otolaryngologists and 45 trainees, completed all tasks. There were no statistically significant differences between the 2 groups’ ratings for FV, GC, or CTR (p = 0.50.7, 0.278, and 0.157, respectively). The model achieved median face validity of 4 (interquartile range [IQR]: 4 to 5) with the agreement of experienced surgeons and trainees alike (95% and 90%, respectively). The median global content was 4 (IQR: 4 to 5 and agreement of 88% and 87%. There was some variation in the rating of task-specific content. A total of 6 tasks achieved validity with the agreement of experienced otolaryngologists. The highest-rated tasks were “examination under anesthesia” and “foreign body retrieval.” Participants agreed on curriculum incorporation, transferability, and recommendation to trainees (median: 5; IQR: 4 to 5 and 95% to 97% agreement). Conclusion The sheep head model achieved face and content validity for endoscopic rhinology training. It is safe, affordable, and can aid early-years trainees in acquiring a range of basic endoscopic rhinology skills.

Does direct observation of procedural skills reflect trainee's progress in otolaryngology?

Abstract: Background UK surgical trainees are required to undertake work-based assessments each year in order to progress in their training. Direct Observation of Procedural Skills (DOPS) is one of these assessments. We aim to investigate the validity of DOPS in assessing otolaryngology trainees at all levels. Methods A retrospective search of the portfolios of all otolaryngology trainees in North Thames was carried out to identify otolaryngology-specific DOPS. A score (Cs) was calculated for each DOPS based on the percentage of satisfactorily-rated items. The overall performance rating (Ps) was analysed as a separate variable and compared with Cs. The Ps and Cs results were then compared across trainee grades and levels within each grade: Core trainees (CT1-CT2) and specialty trainees (ST3-ST8). Results Seven hundred and sixty-seven otolaryngology DOPS were completed between August 2008 and September 2013. The tool was found to be reliable and internally consistent. Trainees in ST grade had higher Cs and Ps scores than CT grade (P < 0.001). Pairwise comparison showed that both Cs and Ps increased from CT1 to ST3 (P = 0.005) but not from ST4 onwards (P = 0.198). Conclusions Otolaryngology DOPS is a useful tool in assessing otolaryngology trainees especially from CT1-ST3 level. DOPS can also differentiate between junior and senior trainees. However, it was not able to demonstrate progress at levels above ST3, most likely due to the simplicity of the procedures which trainees tend to master in the first few years of training.

Binary versus 5-Point Likert Scale in Assessing Otolaryngology Trainees in Endoscopic Sinus Surgery

Abstract: Objectives:(1) Examine the discriminant validity of 2 validated assessment tools in endoscopic sinus surgery (ESS) training. (2) Compare the binary versus the 5-point Likert-scale tools in ESS asse...

Do flow volume loops alter surgical management in patients with a goitre

Abstract: SummaryIntroduction Flow volume loops (FVLs) are considered part of the workup of patients with thyroid enlargement presenting to the endocrinology clinic. They are used to detect upper airway obstruction (UAO) secondary to tracheal compression (TC) from a goitre. Surgical assessment in contrast tends to focus on clinical evaluation supplemented when required by imaging. The aim of this study was to investigate whether FVLs influence the decision to operate in patients with a goitre. Methods We identified patients with a goitre referred by the department of endocrinology for FVLs between 2006 and 2011. The results of the FVL were collated, and their impact on patient management was assessed. Results Ninety-six patients were referred for FVL. In 38 patients, the indication was specifically to evaluate the effects of a goitre. Of these, 33 were reported as normal. Five FVLs were reported as abnormal (3 suggesting lung pathology and 2 TC). Both patients with TC on FVL presented no CT evidence of TC and underwent surgery due to abnormal cytology. Of the 33 normal FVLs, 7 underwent surgery: 2 for local compression, 4 for abnormal cytology and 1 for Graves' disease. None of the FVLs influenced the decision to operate. Conclusion FVLs may detect subradiological TC, but rarely influence management in patients with a goitre. In view of this and the cost of £235 per investigation, FVL should be reserved for goitre patients with suspected primary lung pathology, where the distinction between large and small airway compression is likely to influence management.

Surgery of the Thyroid and Parathyroid Glands

Abstract: DESCRIPTION: This course is a 2 1/2 -day update of surgery of the thyroid and parathyroid glands, and has been offered since 1996 Preoperative workup of both thyroid and parathyroid surgical disease will be discussed, with an emphasis on fine needle aspiration and preoperative parathyroid localization imaging options Surgical techniques will be reviewed (recurrent laryngeal nerve monitoring, parathyroid identification and preservation, intraoperative PTH analysis) and minimally invasive surgical techniques will be discussed Molecular genetic analysis for medullary carcinoma and advances in oncogene research will also be presented Surgical philosophy regarding bilateral thyroid surgery, its risks, surgical treatment of the neck, and surgical treatment of invasive tracheal disease will be presented, and we will also review recognition and treatment of postoperative complications along with new advances in their treatment Panel discussions will center on expert targeted management pearls focusing on a variety of surgical management scenarios along with a second panel of difficult cases, both of which will include audience participation LEARNING OBJECTIVES: Upon completion of this course, participants will be able to: • Describe thyr oid nodule preoperative FNA cytopathologic categories, molecular testing options and their relationship to other preoperative information such as ultrasound in the preoperative evaluation, and surgical selection in patients with thyroid nodular disease • Acquire an in-depth compr ehension of voice and laryngeal function both before and after surgery • Explore re cently published voice and laryngeal examination guidelines, especially as they relate to patients with thyroid cancer and potential invasive disease • Discuss the advantages and limita tions of various options in preoperative imaging for patients with hyperparathyroidism to formulate a discriminating preoperative surgical plan This will include ultrasound, sestamibi scanning and 4D CT scanning • Identify standard metho ds and algorithms of application of intraoperative neural monitoring to assure high quality accurate neural monitoring, and monitoring data to optimize the surgical plan • Evalua te the use of intraoperative PTH management strategies for secondary hyperparathyroidism and renal patients • Optimize surgical outcome in patients with small par athyroid adenoma in primary hyperparathyroidism TARGET AUDIENCES: The course is intended to target physicians involved in the management of thyroid and parathyroid disease with a focus on surgeons and endocrinologists Targeted clinicians include both general surgeons, endocrine surgeons, otolaryngologists and head and neck surgeons In 2012 our audience was made up of 51% general surgeons, 41% otolaryngologists, and 8% endocrinologists Other associated specialists would include radiologists, pathologists, cytopathologists and nuclear medicine physicians The audience would also include fellows, residents, associated nurse practitioners and physician assistants The geographic focus includes US/Northeast as well as abroad ACCREDITATION: The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians The Harvard Medical School designates this live activity for a maximum of 21 AMA PRA Category 1 Credits™ Physicians should claim only the credit commensurate with the extent of their participation in the activity AMA PRA Category 1 Credits™ claimed by physicians attending live events certified and organized in the United States for AMA PRA Category 1 Credits™ can be claimed through the agreement on mutual recognition of credits between UEMS and AMA, considered as being equal to the European Continuous Medical Education Credits (ECMEC©) granted by the UEMS One AMA PRA Category 1 Credits™ is equivalent to one (1) hour of European EACCME Credit (ECMEC©), therefore up to 21 ECMEC© Credits are available Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity ACGME COMPETENCIES: This course is designed to meet one or more of the following Accreditation Council of Graduate Medical Education competencies: Patient care, Medical knowledge, Practice-based learning and improvement, Professionalism and Systems-based practice

Revision Thyroid Surgery

Abstract: Revision thyroid surgery is defined as second surgery on the thyroid or the central thyroid bed