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Objective: To describe the successes and challenges associated with developing an otolaryngology-head and neck surgery (OHNS) medical education app and website., Design: From 2010 to 2018, OHNS faculty across Canada contributed to the development of a smartphone app, LearnENT. LearnENT 1.0, was initially launched in 2012 using the Apple iOS 6 platform. The app utilized a novel user interface and interactive features to help learners develop approaches to OHNS clinical problems, review relevant anatomy, history, and physical examination skills. However, the release of iOS 7 necessitated a redesign and relaunch of LearnENT which occurred from 2015 to 2018 to produce the final version of the app, LearnENT 2.0. Through the relaunching process, the LearnENT team redesigned the app's interface, produced a web version of the app, and created a new content management system., Setting: OHNS departments across Canada., Participants: OHNS faculty members, residents, and medical students., Results: Through this approach, a sustainable, widely accessible, open access OHNS e-Learning resource was developed. Since the relaunch, the LearnENT app has 2728 user accounts and has been widely used across the globe with users in 36 countries outside of North America. LearnENT is currently the official learning app of the Canadian Society of OHNS, has been featured on several different medical education platforms and incorporated into medical school curricula at various institutions., Conclusions: The authors successfully created a novel e-Learning resource with the goal of improving OHNS medical education both nationally and internationally., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: Otolaryngology-head and neck surgery (OHNS) training has been found to be underrepresented in medical school curricula. The study aimed to assess (i) students' clinical OHNS exposure, (ii) their confidence managing OHNS conditions, and (iii) the correlation between OHNS exposure and confidence managing OHNS conditions., Methods: Fourth-year medical students at two Canadian Universities completed a survey assessing baseline characteristics, OHNS training, and confidence managing OHNS conditions., Results: Of 87 returned surveys, 46 students had no clinical OHNS exposure, while 29 felt there was adequate OHNS exposure. The majority of students lacked confidence recognizing conditions requiring emergent referral. Students with greater OHNS training had greater confidence managing OHNS conditions ( r  = 0.267, P  = .012)., Conclusion: The majority of medical students have minimal OHNS exposure. Students with greater OHNS exposure have greater confidence managing OHNS conditions. A review of Canadian medical school curricula is warranted to ensure adequate OHNS exposure.

Objective: Nontechnical skills (NTS) are essential to emergency crisis management. Due to the rarity of true emergencies, they are challenging to teach and assess within a competency-based curriculum. Our purpose is to evaluate the utility of the Non-Technical Skills in Surgery (NOTSS) scale in NTS assessment in simulated otolaryngology and head and neck surgery (OTO-HNS) emergencies and identify common challenges that residents encounter., Methods: Mixed methods analysis of 15 junior OTO-HNS resident teams in four simulated emergency scenarios. Six raters rated resident NTS performance using the NOTSS score. Constructivist-grounded theory was used to analyze scenario video transcripts to identify areas of learner difficulty to guide future simulation development., Results: Residents scored highest in situational awareness and lowest in leadership domains. Raters showed good consistency and reliability overall (Cronbach's alpha = 0.885). There was no statistical difference in ratings between surgical experts and nonexperts. Qualitative analysis demonstrated challenges with closed-loop communication and handling transitions of leadership with the scenarios., Conclusion: Simulation-based training is an effective modality to teach NTS in crisis resource management. The NOTSS rating scale is a reliable instrument for assessing NTS in simulated OTO-HNS emergencies. Incorporating the NOTSS scale for NTS assessment within a competency-based curriculum is recommended., Level of Evidence: NA. Laryngoscope, 128:2301-2306, 2018., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Simulation-based boot camps are growing in popularity and are effective in onboarding novice residents with new knowledge, skills, and behaviors. These intensive and immersive courses may be used to train residents and allied health professionals in specific procedures, teamwork, and management of rare clinical scenarios. A needs assessment of learners determines the course curriculum. Boot camps are designed to encourage active and hands-on participation with deliberate practice and immediate feedback. As surgical education shifts toward competency-based medical education, there may be an even greater role for simulation-based boot camps as a training and assessment tool., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Learners often utilize online resources to supplement formalized curricula, and to appropriately support learning, these resources should be of high quality. Thus, the objectives of this study are to develop and provide validity evidence supporting an assessment tool designed to assess the quality of educational websites in Otolaryngology- Head & Neck Surgery (ORL-HNS), and identify those that could support effective web-based learning. METHODS: After a literature review, the Modified Education in Otolaryngology Website (MEOW) assessment tool was designed by a panel of experts based on a previously validated website assessment tool. A search strategy using a Google-based search engine was used subsequently to identify websites. Those that were free of charge and in English were included. Websites were coded for whether their content targeted medical students or residents. Using the MEOW assessment tool, two independent raters scored the websites. Inter-rater and intra-rater reliability were evaluated, and scores were compared to recommendations from a content expert., Results: The MEOW assessment tool included a total of 20 items divided in 8 categories related to authorship, frequency of revision, content accuracy, interactivity, visual presentation, navigability, speed and recommended hyperlinks. A total of 43 out of 334 websites identified by the search met inclusion criteria. The scores generated by our tool appeared to differentiate higher quality websites from lower quality ones: websites that the expert "would recommend" scored 38.4 (out of 56; CI [34.4-42.4]) and "would not recommend" 27.0 (CI [23.2-30.9]). Inter-rater and intra-rater intraclass correlation coefficient were greater than 0.7., Conclusions: Using the MEOW assessment tool, high quality ORL-HNS educational websites were identified.

Objectives/hypothesis: To assess the efficacy of a novel high-fidelity epistaxis simulator in teaching epistaxis management to junior otolaryngology head and neck surgery residents., Study Design: Prospective cohort study., Methods: A novel high-fidelity epistaxis task trainer was developed using a cadaver head, intravenous tubing, and a food coloring-filled saline bag to emulate blood. Learners were instructed on two techniques of nasal packing (formal nasal pack and nasal tampon) for the management of epistaxis using the task trainer. Learners were videotaped attempting to pack the nose of the task trainer pre- and postintervention (verbal instruction, and practice time with task trainer). Five board-certified otolaryngologists (blinded to pre- and postintervention status) evaluated the packing technique using standardized subjective outcome measures., Results: There were 13 junior otolaryngology residents enrolled in the study. This cohort showed a statistically significant increase in global rating scores (P < 0.05) in all items measured for both packing methods., Conclusion: This novel cadaveric epistaxis simulator has been successful in teaching and the practical application of various skills in epistaxis management. This task trainer appears to confer an educational benefit in technical skills acquisition in novice learners. Further studies are needed to determine long-term skill retention. Simulation is a promising educational adjunct that effectively enhances epistaxis management skills acquisition while maximizing patient safety., Level of Evidence: NA. Laryngoscope, 126:1501-1503, 2016., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To create and assess a novel high-fidelity peritonsillar abscess simulation task trainer with junior otolaryngology-head and neck surgery residents., Study Design: Prospective cohort study., Setting: Third annual Emergencies in Otolaryngology Head & Neck Surgery Bootcamp course at the Canadian Surgical Technologies & Advanced Robotics in London, Canada., Subjects and Methods: Fresh cadaveric material was obtained consisting of a head and neck. Abscess pockets were simulated with a finger of a latex glove containing vanilla pudding to represent pus, tied off with a silk suture. These abscess pockets were inserted into the peritonsillar space from the transected neck inferiorly, passing medial to the great vessels into the parapharyngeal space. Faculty members evaluated the models to test content validity. The primary outcome measure was a postbootcamp survey evaluation assessing specific domains: learning objectives, effectiveness of faculty, and the quality and realism of models., Results: When working with this model, learners were able to locate, visualize, and manipulate the abscess. The materials and positioning of the pockets created high-fidelity models that were realistic in appearance and haptics feedback., Conclusions: A novel high-fidelity task trainer has been successfully developed to teach the technique of peritonsillar abscess incision and drainage. This task trainer is currently the highest-fidelity model reported in the literature. This model allows learners to practice a high-stakes emergency skill in a controlled environment, affording the opportunity to practice localization, visualization, and drainage of the abscess with a high level of realism., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)

Objectives: To study the current selection of mobile applications (apps) relating to otolaryngology-head and neck surgery (OtoHNS). To conduct a review of the apps available in OtoHNS., Data Sources: App Store, Google Play, BlackBerry World, Windows Store., Methods: The Apple, Google, Windows, and Blackberry mobile app stores were searched for apps relating to OtoHNS. App information was analyzed based on in-store descriptions, and apps were downloaded and reviewed., Conclusions and Implications for Practice: There is a rapidly expanding collection of apps with a wide variety of functions available in OtoHNS. There are several high-quality apps for education and clinical use, which have been highlighted in our review. Mobile apps have the potential to become widely incorporated into OtoHNS, although there is a need for appropriate guidance from the specialty to ensure app quality and accuracy of content., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.)

Objectives/hypothesis: Medical students graduate with the knowledge and skills to be undifferentiated general physicians. Otolaryngology-head and neck surgery (OtoHNS) is an essential component of primary healthcare, but is disproportionately under-represented in undergraduate medical education (UME). Advances and innovations in educational technology may represent an exciting and creative solution to this important problem. Failure to meet this educational need will result in substantial downstream effects in primary healthcare delivery. The objectives of this study were to 1) demonstrate current deficits in OtoHNS teaching at the UME level; 2) develop, validate, and critically appraise educational innovations that may enrich OtoHNS teaching in medical school curricula; and 3) propose a process for standardization of learning objectives for OtoHNS in UME as it relates to development and deployment of such educational tools., Study Design: A white paper, prepared as a Triological Society thesis, which consolidates a prospective 10-year investigation of the problem of and potential solutions for under-representation of OtoHNS in UME. Cited datasets include multicenter surveys, cohort studies, and prospective, randomized controlled trials., Methods: A series of published and unpublished data were synthesized that addresses the following: 1) the current state of OtoHNS teaching at the UME level with respect to content, volume, structure, and methods; and 2) educational innovations including e-learning and simulation with emphasis on validity and learning effectiveness. Educational innovations specific to postgraduate (residency) training were excluded., Results: Data support the observation that there is uniformly disproportionate under-representation of OtoHNS within UME curricula. Medical school graduates, especially those pursuing primary care specialties, report poor overall comfort levels in managing OtoHNS problems. A series of novel teaching methods were developed and validated using e-learning and simulation. Selected technologies may have a role in medical student teaching. It has been shown that e-learning has limited value in teaching complex spatial anatomy to novice learners, but good value in teaching basic clinical knowledge and selected technical skills. The role of simulation as it pertains to the novice learner is evolving. Important factors to consider during development of these tools include: 1) knowledge base and learning style of the learner, 2) complexity and nature of the learning objectives, 3) understanding the features and limitations of different technological genres, and 4) a team approach to module development. There remains a role for traditional teaching paradigms such as lectures, labs, and standardized patients; however, the choice of instructional genre should be fundamentally tailored to the nature of the learning outcomes., Conclusions: Enriching OtoHNS teaching in medical school is essential optimize primary care delivered to patients. Although e-learning and simulation are broadly accepted and desirable by today's medical students, these technologies should be woven into the fabric of UME pedagogical principles judiciously, and only after empiric assessment. Foundational to the development and implementation of these technologies is the framework of standardized competency-based learning objectives, common to all graduating medical students., Level of Evidence: NA, (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: A 1-day intensive course (bootcamp) was developed, to teach junior otolaryngology-head and neck surgery (OTO-HNS) residents emergency procedural skills, clinical reasoning, and communication skills. This learning paradigm utilized a number of novel task trainers, panel discussions, and emergency simulations. The study objective was to assess the educational value of this bootcamp., Study Design: Prospective cohort survey., Methods: Residents were recruited from regional teaching centers within a 2000-km radius of the simulation center. Preceptors fluent in English and in French were in attendance. Pre-bootcamp outcome measures included the Kolb Learning Style Inventory and a self-administered survey measuring confidence levels in performing specific OTO-HNS tasks. Post-bootcamp outcome measures included a survey evaluating the bootcamp experience and a structured follow-up telephone interview., Results: Twenty-eight residents participated in the bootcamp from across the United States and Canada. When asked if they felt that "overall, the educational day was an effective learning process," the average score was 4.75/5.0. The vast majority of participants (92.9%) felt they would recommend the bootcamp to a future junior resident. Kolb learning styles that prefer active experimentation (acting, initiating, and deciding) were more common than those that utilize reflective observation (imagining, analyzing, reflecting), which favors a hands-on model of learning., Conclusion: This first Canadian OTO-HNS bootcamp demonstrated the feasibility and effectiveness of conducting a centralized bootcamp for regional training centers spanning multiple states/provinces and languages. Future bootcamps will be held annually and will ideally continue the natural evolution of surgical, hands-on training., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Increasing focus is being placed on Clerkship curriculum design and implementation in light of new undergraduate medical education research and accreditation standards. Canadian Otolaryngology-Head and Neck Surgery (OTOHNS) Clerkship programs are continually but independently evolving towards a common goal of improving Clerkship curriculum., Methods: An electronic survey was sent to undergraduate OTOHNS directors at all Canadian medical schools (n = 17) examining their Clerkship curricula. Themes included Clerkship format, teaching methods, faculty support and development, program strengths, and barriers., Results: Survey response rate was 76%. All responding schools had OTOHNS Clerkship programs ranging in type (mandatory, selective or elective) and length (<1 to 4 weeks). Learning modalities varied. Electronic learning tools were identified as increasingly important to curriculum delivery. Common strengths included wide clinical exposure and one-on-one mentoring. Multiple challenges were identified in curriculum implementation and evaluation. All schools expressed interest in developing national standards, objectives and e-learning resources., Conclusions: Significant variation exists in OTOHNS Clerkship experiences between Canadian medical schools. Many schools perceive barriers of insufficient time, space and curriculum standardization. Interested Canadian OTOHNS educators are eager to collaborate to improve the collective OTOHNS Clerkship experience.

Objectives: There is no standardized curriculum for laryngology within otolaryngology residency programs despite the fact that laryngology is a significant portion of the Royal College of Physicians and Surgeons of Canada examination. Our objective was to evaluate trainee perceptions of laryngology within otolaryngology residency programs., Design: Cross-sectional survey., Setting: Canadian otolaryngology residency programs., Methods: A Web-based, anonymous survey was conducted among otolaryngology residents. The survey was based on Royal College learning objectives for laryngology. The survey was administered using Dillman's Total Design Method and distributed in English and French., Results: Sixty-four of 150 (42.6%) residents responded to the survey (55.6% male; mean age 29.3 years). About half of the respondents agreed or strongly agreed that the amount of didactic and clinical laryngology instruction was adequate. About 41.0% agreed or strongly agreed that the amount of operative laryngology instruction was adequate. Cited areas for improvement included injection laryngoplasty, botulinum toxin injection, medialization thyroplasty, care of the professional voice, phonosurgery, and videostroboscopy. Areas of strength included flexible nasopharyngoscopy, laryngeal anatomy, hoarseness, stridor, laryngopharyngeal reflux disease, and vocal cord paralysis. Overall, 40.7% felt somewhat comfortable providing laryngology care. The presence of a laryngology fellowship at the training program, respondent interest in pursuing a fellowship, completion of a laryngology elective, and previous laryngology research did not affect the residency experience. Senior residents are more comfortable with providing laryngology care than juniors., Conclusions: Several areas of strengths and areas for improvement in laryngology appear to exist within otolaryngology residency programs as perceived by current trainees.

Objective: To evaluate a novel method of teaching laryngeal anatomy., Design: Prospective, randomized, controlled trial., Setting: University educational program., Methods: Computer model development: A three-dimensional (3D) educational computer model of the larynx was created from high-resolution computed tomography and magnetic resonance images of cadaveric necks using segmentation software (Amira) (Visage Imaging, Inc., Carlsbad, CA). E-learning authoring software (Articulate, Articulate Global, Inc, New York, NY) then was used to make the model interactive and multimedia. The model was launched on a Web-based platform. Model evaluation: One hundred students (age 23.8 +/- 2.2 years; 55% male) were randomized to either the 3D computer model group (3D group) (n = 50) or the standard written instruction group (SWI group) (n = 50)., Main Outcome Measures: The primary outcome measure was the score on a 20-question laryngeal anatomy test; the secondary outcome measure was a student opinion questionnaire., Results: The mean score on the laryngeal anatomy test was 14.2 +/- 2.8 (72.0 +/- 15.1%). The mean score for the 3D group was 13.6 +/- 3.0 (67.0 +/- 16.1%) versus 14.8 +/- 2.5 (76.0 +/- 12.7%) for the SWI group (t = 2.194, df = 98, p < .031). A majority of students felt that the 3D model was effective, clear, user-friendly, and a preferred supplement to traditional methods of instruction. The 3D group rated the computer model more enjoyable than the SWI group., Conclusions: A 3D educational computer model of the larynx was not shown to be superior to written lecture notes in its efficacy in teaching anatomy; however, it was judged to be a preferred and valuable supplement to traditional teaching methods.

Objectives: To create a 3-dimensional (3D) educational computer model of the larynx, to assess the feasibility of this learning module on a Web-based platform, and to obtain student feedback on the module., Design: Male and female adult cadaveric necks were scanned with microcomputed tomographic and magnetic resonance imaging scanners. Key structures were identified on each slice of the computed tomogram and/or magnetic resonance image and analyzed with a segmentation software package. Then, the images were exported into Microsoft Powerpoint. Visual text and audio commentary were added. Real cases of a child's larynx, an adult with a tracheostomy, and a patient with laryngeal carcinoma were included. The computer module was launched on a password-protected, Web-based platform., Participants: Fifty-eight first-year medical students (38% male; mean [SD] age, 23 [1.8] years) were invited to evaluate the module and to complete a survey., Results: Most students thought that the 3D computer module was effective (60%), clear (66%), and user friendly (72%); most students (81%) thought that it was easier to understand laryngeal anatomy when they could visualize it in 3D; and most students (83%) said that they would like lectures better if they were supplemented with 3D computer modules., Conclusion: A 3D educational computer model of the larynx has been successfully created and warmly received by medical students.

Objectives: To determine whether computer-assisted learning (CAL) is an effective tool for the instruction of technical skills., Study Design: Prospective blinded randomized-control trial conducted on a cohort of 47 first-year medical students., Methods: Students were instructed on two techniques of nasal packing (formal nasal pack and nasal tampon) for the management of epistaxis, using either a standard text-based article or a novel computer-based learning module. Students were evaluated on proper nasal packing technique using standardized subjective and objective outcome measures by three board-certified otolaryngologists. Blind assessments took place prior to and following instruction, using the assigned learning modality., Results: There were 47 participants enrolled in the study. Both groups demonstrated improvement in performance of both packing procedures following training. A significant post-training difference favoring CAL learners over text-based learners was observed, using the global assessment of skill for both packing techniques (P < .001). Additionally, a significant post-training difference favoring CAL learners over text-based learners was observed for all checklist items for the tampon pack and five of eight items on the formal pack checklist. The vast majority of students (94.6%) indicated that if given the choice, they would prefer to learn using CAL rather than by using text-based learning materials., Conclusions: CAL learners demonstrated significantly greater improvement across both subjective and objective outcome measures when compared to the text-based group. Additionally, students favored learning via the CAL modality, which further suggests that CAL is a valuable means of imparting procedural knowledge to novice medical trainees.

Objectives: To determine the feasibility and effectiveness of virtual-patient computer-assisted instruction (CAI) in pre-clerkship undergraduate otolaryngology education., Study Design: Prospective, randomized, controlled trial., Subjects and Methods: Second-year medical students at the University of Western Ontario, Canada, were randomized into two groups: group A was given a CAI module and group B was presented with two Internet review articles, both covered specific learning objectives for pediatric stridor. Students completed randomized pre- and post-tests and a questionnaire one week later., Results: Fifty-five students completed the study with 28 in group A and 27 in group B. Mean pretest scores were 59.1% in group A and 59.8% in group B (95% CI = -7.9% to 10.4%). Mean post-test scores were significantly elevated in group A (84.6%, P < 0.001) and group B (74.3%, P = 0.008). Group A had a significantly higher (P = 0.02) mean post-test score than group B (mean difference of 10.2%). Students spent significantly more time (P < 0.001) reading text articles (25.5 minutes) than completing the CAI (9.06 minutes). Forty-one (66%) students completed the survey. Thirty-six (88%) respondents indicated that they preferred CAI to online articles., Conclusion: CAI is a feasible, effective, and efficient means of enhancing self-directed learning as supplementation to the pre-clerkship undergraduate otolaryngology curriculum.

Objectives: Otolaryngologic problems are common in primary care but are underrepresented in undergraduate medical education (UME). A significant portion of the total structured teaching received by physicians in primary care specialties is spent in UME, but teaching of otolaryngology in UME is limited and not standardized across Canadian medical schools. This study assessed the content and structure of otolaryngology UME at Canadian undergraduate medical programs and postgraduate primary care programs and surveyed community otolaryngologists to identify important clinical topics for inclusion in an otolaryngology curriculum., Methods: A survey was created based on previously validated and published curriculum needs assessment instruments for medical education. Surveys were distributed to (1) undergraduate directors of otolaryngology, (2) postgraduate program directors of family and emergency medicine at English-language medical schools, and (3) community otolaryngologists in Canada., Results: There is large variation in the quantity of otolaryngology teaching in UME. Knowledge of otolaryngology is formally evaluated at half of the responding programs, although skills in otolaryngology are rarely tested. Clerkship rotations are not uniformly offered, and the length of these placements is limited. Opportunities in postgraduate training for formal education in otolaryngology are rare. Several important topics that are not uniformly taught include sudden sensorineural hearing loss, sleep apnea, and nasal trauma. Important skills that are not uniformly taught include treatment of benign paroxysmal positional vertigo and epistaxis., Conclusions: There is limited time for teaching otolaryngology in UME; therefore, it is essential to emphasize teaching key topics and skills, which are highlighted in the results of this study.

Objectives: To investigate the adequacy of otolaryngology teaching in undergraduate medical education (UME) and to determine the general level of comfort of family medicine residents in managing and assessing diseases affecting the ears, nose, and throat., Design: Cross-sectional survey., Methods: A sample of family medicine residents at the University of Western Ontario (N = 68) completed a questionnaire inquiring into their exposure to topics in otolaryngology during their UME. They were also asked to comment on their present comfort with knowledge and skills specific to otolaryngology., Results: Family medicine residents suggest that there is generally little otolaryngology training in UME; 66.7% of respondents who received UME in Canada suggested that they received very little classroom instruction and 75.6% received very little clinical otolaryngology instruction. Residents identified specific otolaryngologic conditions with which they felt particularly uncomfortable., Conclusions: This study demonstrated that students receive very little exposure to otolaryngology in UME and highlighted specific conditions and procedures that family medicine residents lack confidence in managing and performing.