Elsevier

Journal of Surgical Education

Volume 75, Issue 4, July–August 2018, Pages 1062-1069
Journal of Surgical Education

Original Reports
Ear Disease Knowledge and Otoscopy Skills Transfer to Real Patients: A Randomized Controlled Trial

https://doi.org/10.1016/j.jsurg.2017.12.011Get rights and content

Objective

To determine which teaching method—otoscopy simulation (OS), web-based module (WM), or standard classroom instruction (SI)—produced greater translation of knowledge and otoscopy examination skills to real patients.

Design

In a prospective randomized controlled nonclinical trial, medical students were randomized to 1 of 3 interventional arms: (1) OS, (2) WM, or (3) SI. Students were assessed at baseline for diagnostic accuracy and otoscopy skills on 5 volunteer patients (total of 10 ears), followed by the intervention. Testing was repeated immediately after intervention on the same patients. Student reported confidence in diagnostic accuracy and otoscopy examination were also captured. Assessors were blinded to the intervention group, and whether students were pre- or post-intervention.

Setting

Clinical Teaching Centre, Queen’s University.

Participants

Twenty-nine participants were initially randomized. Two students were unable to attend their specific intervention sessions and withdrew. Final group sizes were: OS—10, WM—9, SI—8. Five patients with external/middle ear pathologies were voluntarily recruited to participate as testing subjects.

Results

Baseline diagnostic accuracy and otoscopy clinical skills did not differ across the groups. Post-intervention, there were improvements in diagnostic accuracy from all groups: OS (127.78%, 2.30 ± 1.42, p = 0.0006), WM (76.40%, 1.44 ± 1.88, p = 0.0499), and SI (100.00%, 1.50 ± 1.20, p = 0.0093). For otoscopy skills, post-intervention improvements were noted from OS (77.00%, 3.85 ± 2.55, p < 0.0001) and SI (22.20%, 1.25 ± 1.20, p = 0.0011), with no significant improvement from WM (13.46%, 0.78 ± 1.92, p = 0.1050). Students across all groups reported significantly improved confidence in diagnostic accuracy (p < 0.0001) and otoscopy skill (p < 0.0001) after the intervention.

Conclusion

All 3 teaching modalities showed an improvement in diagnostic accuracy immediately post-intervention. Otoscopy clinical skills were found to have increased only in OS and SI, with the OS group demonstrating the largest improvement. Simulation-based medical education in Otolaryngology may provide the greatest transfer of medical knowledge and technical skills when evaluated with real patients.

Section snippets

Background

The development of simulation-based training models has drastically changed the educational environment of modern medical schools, allowing for more hands-on and active learning.1, 2, 3 Specifically within Otolaryngology, simulation has filled important learning gaps in both the undergraduate and postgraduate medical curricula.4, 5 For ear disease, there currently exists a number of commercially available simulators, including the web-based OtoTrain, the Life/form Diagnostic and Procedural Ear

Methods

This prospective randomized controlled nonclinical trial (RCT) was approved by the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board (#6019936) and the Queen’s University School of Medicine Undergraduate Medical Education Curriculum Committee.

Results

Twenty-nine participants were initially randomized, with 10 in the OS and WM groups, and 9 in the SI group. Two students were unable to attend their specific intervention sessions and withdrew. A total of 27 undergraduate medical students participated in the study (first year—23, second year—4). Final group sizes were: OS—10, WM—9, and SI—8. All students completed their assigned intervention and both testing sessions.

Discussion

This prospective RCT was the first of its kind to assess Otolaryngology knowledge and skill transfer from 3 different ear disease teaching modalities with real patients. The transferability of knowledge and skills into real-world scenarios is the ultimate test for assessing the utility and effectiveness of any educational modality.15, 16 Especially for simulation-based training, the fundamental assumption is that the skills and knowledge acquired are directly transferable to a clinical setting.

Conclusion

The results of this study demonstrated an improvement in diagnostic accuracy of ear pathologies across all groups, when tested with real patients. The simulation group demonstrated the most improved otoscopy skills. This study confirms the clinical relevance of otoscopy simulation. The authors believe OS is a vital part of Otolaryngology undergraduate medical education.

Acknowledgments

The authors would like to thank the Queen’s University Clinical Simulation Centre for their support through the Medical Student Simulation Research Grants to V.W. and J.S. This study received material support (use of OtoSim) from the Department of Otolaryngology, Queen’s University.

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