ENT Training: Is the reality now virtual?

Dr M Adam Ali

Medical Education Fellow at MedShr and Health Education England

Adam Ali is a Health Education England fellow in Medical Education at MedShr, the world’s leading discussion platform for doctors. He also holds honorary posts as an Honorary Research Assistant at UCL Institute of Ophthalmology: Ocular Biology and Therapeutics, and an Honorary Research Fellow at Moorfields Eye Hospital.

Medical education for ENT residents has changed drastically due to COVID-19. Are collaborative teaching platforms, podcasts and interactive digital case discussion the way of the future?

COVID-19 has led to a necessary overhaul of the routine practice and delivery of medicine across all clinical specialties. With high risk for intraoperative COVID-19 exposure and drastic cuts to elective procedures, Otolaryngology has had to adapt especially rapidly to deliver the best care while protecting health professionals.

But what about the next generation of ear nose and throat (ENT) surgeons? With in-person learning curtailed, limited contact with other residents, and hands-on experience limited to urgent cases, how are ENT residents developing mastery?

Remote delivery of ENT medical education

In late March 2020, the Collaborative Multi-Institution Residency Education Program was founded at the University of Southern California to ensure continued curriculum delivery despite lockdown restrictions. This online teaching platform quickly expanded to the national level in the following weeks. Lectures by experts in all sub-disciplines were streamed online via Zoom, available free to residents in all clinical specialties, including otolaryngology.

Mobile-first learning content

Likewise, medical education providers and conferences have accelerated production of mobile-first digital content. One such resource for ENT residents and fellows is Headmirror’s podcast “ENT in a Nutshell”, with a library of high yield, focused, topical reviews.

ENT clinical case discussion and peer learning

Alongside essential changes to formal learning and accessible content, case discussion and peer learning were still needed to close the loop and give Residents the chance to consolidate their knowledge. With social distancing measures in effect, residents found themselves with fewer opportunities to connect with peers, to discuss cases and how to deal with challenging situations.

Now welcoming Residents and Fellows across all clinical specialties, MedShr’s Ear, Nose & Throat (ENT) Group gives them the opportunity to do just that. Using their smartphone, they can post and discuss cases with their local colleagues and supervisors as well as with peers around the world.

Mastery of ENT surgical skills  

At most institutions, safety and resource constraints have resulted in drastic cuts in elective procedures. Given otolaryngology’s relative proportion of elective surgeries and the high risk for intraoperative COVID-19 exposure, the impact has been especially felt. For many ENT trainees, surgical experience has been limited to trauma, emergencies, and oncologic procedures considered urgent enough to proceed.

ENT trainees may be required to focus clinical duties on supporting the COVID-19 response rather than on otolaryngology patients and, as a result, may not meet surgical key indicator thresholds prior to graduation. This raises the central question of whether “key indicator” numbers adequately reflect surgical skill acquisition: indeed this system can have trainees focus on obtaining numbers of cases rather than actual mastery. An alternative may include standardised and objective assessments of competence with similar component factors. With less hands-on surgical experience, surgical simulators, cadaveric dissection, and video atlases may be needed to mitigate some of COVID-19’s impact. However, they are not a substitute for learning in the surgical field, and surgical training will undeniably take a hit.

While challenging, this rapid transition to accessible, standardised, national high-quality teaching may confer real advantages over previously isolated educational efforts. This is especially true for smaller training programmes whose curriculum relies more on external interactions and national meetings. Other benefits include creating an inclusive sense of community for trainees and opportunities to connect with other ENT specialists around the world.

What do you think of the changes in ENT training? How do you think it will continue to evolve? 

Sources/references:
1.     Newsome HA, Davies OMT, Doerfer KW. Coronavirus Disease 2019-An Impetus for Resident Education Reform?. JAMA Otolaryngol Head Neck Surg. 2020;146(9):785-786. doi:10.1001/jamaoto.2020.1587
2.     Azizzadeh K, Hamdan US, Salehi PP. Effect of Coronavirus Disease 2019 and Pandemics on Global Surgical Outreach. JAMA Otolaryngol Head Neck Surg. 2020;146(9):783–784. doi:10.1001/jamaoto.2020.1520
3. https://www.entandaudiologynews.com/development/spotlight-on-innovation/post/digital-otoscopy-with-ai-diagnostic-support-making-diagnosis-of-ear-disease-more-accessible