Virtual reality cricothyrotomy - a case-control study on gamification in emergency education.

BACKGROUND: Cricothyrotomy is an invasive and rare emergency intervention to secure the airway in a "cannot intubate, cannot ventilate" situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool. METHODS: We programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps. RESULTS: The majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group (p > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group (p < 0.05). CONCLUSIONS: Virtual reality is an innovative learning tool to improve teaching of emergency procedures. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This is of great value when focusing on extension of factual knowledge. TRIAL REGISTRATION: DRKS00031736, registered on the 20th April 2023.

[Virtual training of practical competences in sonography]. / Sonographie als Gegenstand virtuellen Wissenstransfers zum praktischen Kompetenzerwerb.

OBJECTIVE: During the COVID-19 pandemic, a particular challenge in the transition to digital teaching was to teach practical skills such as sonography of the head and neck online. The aim of this study was to validate the digital sonography course for medical students established at the Freiburg University Hospital ENT Department. METHODS: Participants were 178 students of human medicine. The study group simulated the sonography examination at home with a dummy transducer using the Peyton method under the guidance of a tutor via video seminar. In a subsequent learning success check, the results of the students in the online course were compared with those of the control group, who learned sonography in the classroom. RESULTS: Students of the online course achieved comparable results to the classroom group. CONCLUSION: This study shows that practical skills which require extensive equipment such as a sonography machine can be taught to a certain extent digitally or at least in a hybrid form.

[Views of assistant professors on digital transformation in otorhinolaryngology education : Current status and perspectives in undergraduate and advanced training]. / Ansichten von Lehrbeauftragten zur digitalen Transformation in der HNO-Lehre : Aktueller Stand und Perspektiven in Aus- und Weiterbildung.

BACKGROUND: Digital transformation in curricular teaching in medicine comprises the use of digital teaching and learning formats as well as the transfer of digital skills for medical staff. Concepts of knowledge transfer and competency profiles also have to be adapted and transferred in advanced training due to necessary changes. OBJECTIVE: The aim of this study was an evaluation of the current state of digital transformation in otorhinolaryngology teaching in undergraduate and advanced training at otorhinolaryngology departments of university medical centers in Germany. MATERIALS AND METHODS: A questionnaire with nine questions on digital transformation was sent to the assistant professors of 37 national university ENT departments. The anonymous survey was conducted online via the online platform SurveyMonkey®. RESULTS: Of the contacted assistant professors, 86.5% participated in the survey. Teaching sessions on digital skills for medical students are part of the curriculum in only 25% of ENT departments. Digital teaching formats are used by half of the departments in undergraduate training. Only 56.25% of the assistant professors receive support to realize the changes required by digital transformation. In 40.62% of departments, the issue of digital transformation is broached during advanced training, but only 28.12% use digital teaching methods to train junior doctors. CONCLUSION: Aspects of digital transformation are implemented mainly in undergraduate education, partly driven by the COVID 19 pandemic. Overall, there is still considerable backlog in undergraduate and advanced training in ENT.

[Feasibility of clinical examination scenarios under pandemic conditions]. / Möglichkeit von Prüfungsszenarien unter Pandemiebedingungen.

BACKGROUND: Due to the COVID-19 pandemic, contact restrictions occurred worldwide, which affected medical schools as well. It was not possible to hold classroom lectures. Teaching contents had to be converted to a digital curriculum within a very short time. Conditions for assessments posed an even greater challenge. For example, solutions had to be found for objective structured clinical examinations (OSCE), which were explicitly forbidden in some German states. The aim of this study was to evaluate the feasibility of an OSCE under pandemic conditions. MATERIALS AND METHODS: At the end of the 2020 summer semester, 170 students completed a combined otolaryngology and ophthalmology OSCE. Examinations were held in small groups over the course of 5 days and complied with strict hygiene regulations. The ophthalmology exam was conducted face to face, and the ENT OSCE virtually. Students were asked to rate the OSCE afterwards. RESULTS: Between 106 and 118 of the students answered the questions. Comparing the face-to-face OSCE with the virtual OSCE, about 49% preferred the face-to-face OSCE and 17% preferred the virtual OSCE; 34% found both variants equally good. Overall, the combination of an ENT and ophthalmology OSCE was rated as positive. CONCLUSION: It is possible to hold an OSCE even under pandemic conditions. For optimal preparation of the students, among other things, it is necessary to transform teaching contents to a digital curriculum. The combination of an ENT and ophthalmology OSCE was positively evaluated by the students, although the face-to-face OSCE was preferred. The overall high satisfaction of the students confirms the feasibility of a virtual examination with detailed and well-planned preparation.

[Is the use of virtual reality in otorhinolaryngology teaching automatically positively rated by students? : A questionnaire-based evaluation among students]. / Wird der Einsatz der virtuellen Realität in der HNO-Heilkunde-Lehre von Studierenden automatisch positiv bewertet? : Eine Fragebogenevaluation bei Studierenden.

BACKGROUND: Analogous to the situation in other disciplines, digital ENT teaching made significant progress during the pandemic. Most ENT clinics nationwide were able to offer a complete virtual teaching program in time. Innovative teaching methods were also used early on. This was recognized in student teaching evaluations. Due to the expansion of virtual reality (VR) in medical teaching, even greater satisfaction should be expected through improved teaching quality. MATERIALS AND METHODS: Surveys were performed with students (n = 180) of the ENT block internship in the summer semester of 2023. The aim of the evaluation was to determine the students' satisfaction with and subjective effectiveness of the newly implemented VR digital teaching method for teaching ear anatomy and coniotomy. A survey was also carried out among resident physicians. RESULTS: The ENT teaching was perceived favorably by the students, with an average rating of 11.7 out of 15. The learning effectiveness and the value of VR in the ENT learning portfolio was evaluated varyingly by the students. The physicians' assessment was different, with a more positive perception. CONCLUSION: Virtual reality represents an innovative component in the teaching portfolio of otolaryngology. This new teaching method is viewed and accepted as a future-oriented tool. Remarkably, the physicians involved voted consistently positively, while the students gave more critical assessments and pointed out limitations in the individual and subjective areas. These findings are in contrast to the further development of innovative teaching methods demanded by student interest groups.

[Use of virtual reality in ENT teaching: an alternative to the conventional anatomic model]. / Einsatz von Virtual Reality in der HNO-Lehre: eine Alternative zum konventionellen Anatomiemodell.

BACKGROUND: Assessment of the middle ear requires a complex three-dimensional understanding, the teaching of which is just as important for curricular teaching as for further medical training. OBJECTIVE: The extent to which virtual reality (VR) can be used as an alternative to conventional educational methods for teaching anatomy, physiology, and pathology was examined. The objective was to evaluate a VR-supported teaching method in comparison to conventional learning on an anatomic model. METHODS: The study was conducted as a prospective two-arm single-center trial in the summer semester of 2021 at the University Hospital of Freiburg. During a seminar on the topic of the middle ear, 177 students were randomly assigned to either a control or a study group. Demographic data were collected in advance and a quantitative evaluation regarding competence and personal attitude was performed. After processing the models, the groups were formatively tested and the results were analyzed comparatively. Ultimately, crossover of the models enabled a qualitative comparative evaluation of the models and a renewed quantitative evaluation was carried out. RESULTS: No significant differences between the groups were identified in the formative testing. The evaluations demonstrated increased self-assessment of knowledge competence, a tendency towards a highly positive attitude towards the VR method after completion of the course, and generally beneficial subjective aspects of the VR model. In addition, there was a positive effect and a positive perception of the delivery of anatomic content. CONCLUSION: Use of VR is suitable as an alternative to conventional teaching methods in curricular ENT teaching. The current evidence demonstrates the equality of VR and indicates its great potential for future educational tasks.

[Traumatology-an interdisciplinary task: exclusively for educational purposes?] / Traumatologie ­ eine interdisziplinäre Aufgabe: nur in der Lehre?

BACKGROUND: Traumatology of the head and neck region is not only a part of otorhinolaryngology, but also has a large overlap with neighboring disciplines of the head and neck region. In Freiburg, an interdisciplinary lecture on "ENT emergencies" was implemented in the 21/22 winter semester. The aim was to provide an even more realistic view on interdisciplinary patient care and to make evident the areas of intersection of four of the major head disciplines (otorhinolaryngology, neurosurgery, ophthalmology, and maxillofacial surgery). MATERIALS AND METHODS: A new, special lecture in otorhinolaryngology was implemented as part of the regular online lecture series accompanying the semester. With reference to the clinical care of ENT emergencies, possible overlaps with neighboring disciplines were identified and explained by the discipline representatives or discussed in front of and with the auditorium. At the end of the semester, all participating students (n = 173) were invited to evaluate the seminar using the survey tool "EvaSys" (EvaSys GmbH, Lüneburg, Germany). In total, 78 students participated in the evaluation process. RESULTS: The new lecture concept was very well accepted and immediately ranked top among the interdisciplinary lecture titles within the ENT lecture series. The clear communication of the term "interdisciplinarity" in the sense of a complementary clinical cooperation was also very successful and was appreciated accordingly by students during the evaluation process. CONCLUSION: Pragmatic presentation of ideal clinical patient care using an interdisciplinary approach is possible within the regular ENT lecture series. This realistic portrayal, beyond any technical and/or professional differences, is of great interest to students and is considered clinically relevant. Thus, interdisciplinary lectures provide a valuable tool to teach the fundamental values of clinical interdisciplinary management for the best possible patient care.

[How to impart scientific knowledge and writing skills? Digital education during the COVID-19 pandemic using the example of otorhinolaryngology]. / Wie kann wissenschaftliches Arbeiten in der Medizin vermittelt werden? Digitale Lehre in Zeiten der COVID-Pandemie am Beispiel der HNO-Heilkunde.

INTRODUCTION: To make a virtue out of necessity by establishing a digital teaching curriculum in otorhinolaryngology (ORL) during the COVID-19 pandemic, the authors created the concept of a new digital scientific seminar. Digital competence forms the basis for data literacy in medical and scientific education. In this study, the students' evaluation of the seminar focusing on digital and scientific skill acquisition is presented. METHODS: Included in this prospective monocentric questionnaire study were 265 students. The seminar started with an introduction on the criteria of a good publication, followed by the individual task of understanding the publication on a main ORL topic and writing its abstract. After the seminar, students completed the evaluation questionnaire. RESULTS: Overall, results showed that students rated the seminar well. Free-text comments added that although live teaching was preferred, students found their digital and scientific competence increased through the task of writing a publication abstract on their own. CONCLUSION: Digital education was not only rated well, but improved the students' subjective scientific competence, satisfied the students' wish for digital transformation, and likewise fulfilled the national goals of competence-based education.

[On the effectiveness of digital teaching of practical skills in curricular ENT education]. / Zur Effektivität der digitalen Vermittlung praktischer Fertigkeiten in der curricularen HNO-Lehre.

BACKGROUND: Due to the current COVID-19 pandemic, the curricular courses at faculties of medicine had to be digitalized within a short time. This poses a particular challenge regarding the teaching of practical skills. OBJECTIVE: To determine to what extent practical skills can be learned within the framework of a fully digitally implemented ENT mirror examination, the minimum number of teaching units (UE) required for competent execution, and the difficulty of the various examinations were identified. MATERIALS AND METHODS: During a period of 5 days of their ENT block internship, a total of 146 students learned six ENT mirror examinations in daily videoconferences. A subgroup (n = 48) was assessed formatively each day and the increase in performance was statistically analysed over the 5 days. On the fifth day, exams were carried out with the entire cohort. RESULTS: Over the course of the 5 days, a significant increase in performance was observed in the various examinations. Based on the evaluation of the increase in performance in the subsections, examinations could also be classified as "simple" and "difficult." Peak performance according to competence level 3a of the Nationaler Kompetenzorientierter Lernzielkatalog Medizin (NKLM) was achieved on day 4 after 5 UE had been completed. CONCLUSION: Practical skills can also be acquired through digital courses. Limitations result from the quality of the examination instruments and the diagnostic findings. Additionally, economical curriculum planning can be achieved by a suitable weighting of the focus of the examination.

[Objective and subjective assessment of a structured approach to computed tomography scans of the paranasal sinuses]. / Objektive und subjektive Bewertung eines strukturierten Vorgehens zur Beurteilung von Computertomographien der Nasennebenhöhlen.

BACKGROUND: Sound knowledge of individual anatomy is essential in sinus surgery to prevent potentially serious complications. For the paranasal sinuses, computed tomography (CT) is the imaging technique of choice to preoperatively analyze individual anatomy and the extent of disease. OBJECTIVE: The purpose of this study was to evaluate the usefulness of a CT checklist to identify relevant anatomic variants in CTs of the paranasal sinuses. MATERIALS AND METHODS: Junior and senior otolaryngology residents were asked to assess sinus CT scans for anatomic variants before and after implementation of the CLOSE mnemonic (cribriform plate, lamina papyracea, Onodi cell, sphenoid sinus pneumatization, and [anterior] ethmoidal artery). The rate of correctly identified variants was calculated. A questionnaire was distributed for subjective evaluation of the usefulness of the checklist. RESULTS: Six junior and six senior residents were included in the study. The rate of correctly identified anatomic variations significantly improved from 23.1 to 50.9% and 24 to 39.8%, respectively, after implementation of the CLOSE mnemonic. The subjective evaluation of the CLOSE criteria showed very positive results. CONCLUSION: The structured approach to sinus CT scans using CT criteria can improve identification of critical anatomic variants in CT scans of the paranasal sinuses and is rated highly positively by residents in training.

["Online from tomorrow on please": comparison of digital framework conditions of curricular teaching at national university ENT clinics in times of COVID-19 : Digital teaching at national university ENT clinics]. / "Ab morgen bitte online": Vergleich digitaler Rahmenbedingungen der curricularen Lehre an nationalen Universitäts-HNO-Kliniken in Zeiten von COVID-19 : Digitale Lehre an nationalen Universitäts-HNO-Kliniken.

BACKGROUND: The corona crisis not only affects professional activities but also teaching and learning at universities. Buzzwords, such as e­learning and digitalization suggest the possibility of innovative teaching approaches that are readily available to solve the problems of teaching in the current COVID-19 pandemic. The current conversion to digital teaching is not primarily driven by didactic rationale or institutional strategy but by external circumstances. OBJECTIVE: The aim of the study was to determine the teaching situation at national university ENT clinics and academic teaching hospitals at the start of the virtual corona summer semester in 2020. MATERIAL AND METHODS: A specifically self-designed questionnaire regarding the local situation and conditions as well as nationwide scenarios was sent to all 39 national university ENT clinics and 20 ENT departments at academic teaching hospitals. RESULTS: A total of 31 university hospitals and 10 academic teaching hospitals took part in the survey. There were obvious discrepancies between available resources and effectively available digital teaching and learning contents. Further criticism was expressed regarding the communication with the medical faculty, the digital infrastructure and particularly the frequent lack of collaboration with central support facilities, such as media, didactics and datacenters. CONCLUSION: There are positive examples of successful transformation of classroom teaching to an exclusively virtual summer semester 2020 within the university ENT clinics; however, critical ratings of assistant professors and medical directors regarding the current teaching situation predominated. A time-critical strategic advancement is urgently needed.

[Traditional vs. modern: possibilities and limitations of the new lecture concept in ENT teaching curricula]. / Tradition vs. Moderne: Möglichkeiten und Limitationen eines neuen Vorlesungskonzepts in der curricularen HNO-Lehre.

BACKGROUND: Due to steadily dwindling student attendance, a new blended learning lecture format was piloted at the Department of Otorhinolaryngology of the University Medical Center Freiburg in the winter semester (WS) 2017/18: the ENT 3D series. In order to present complex ENT topics (e.g., middle ear) in a more understandable, appealing, and clinically relevant manner, the clinical disciplines of otorhinolaryngology and radiology cooperated with the preclinical specialty of anatomy. The aim of the study was to evaluate this teaching format and investigate preferences that could encourage students to attend lectures. METHODS: In all lectures, participants of the ENT block internship in the 2017/18 WS were asked about the quality of the lecture using an evaluation card. In addition, the increase in knowledge was examined in each of the newly designed lectures. A final questionnaire asked the students about their preferences regarding teaching methods. RESULTS: Overall, the new courses were not rated better than the regular ones, although the new concept was generally rated positively. It was not possible to attract more lecture attendees. However, the traditional teaching format "lecture" is still regarded as up to date by a defined group of students. CONCLUSION: Despite a principally positive student assessment of a new lecture format, the 3D lectures did not achieve top marks in any category. This can be explained by the accumulation of unexpected student criticisms (quantity of the course content). Thus, the parameters intended as indicators (e-learning, quality of the course, use of modern teaching methods) could not fulfil their task. The result of the evaluation requires critical reflection and, if necessary, partial reorganization of the course (streamlining of content).

[Use and acceptance of the ORL logbook for final year students in German university and academic teaching hospitals]. / Einsatz und Akzeptanz des PJ­HNO­Basis-Logbuchs an deutschen Universitätskliniken und akademischen Lehrkrankenhäusern.

BACKGROUND: The current German medical licensing system from 2013 dictates the mandatory keeping of logbooks for final year students. A field-specific logbook for the practical year was created by the national otorhinolaryngology (ORL) society in 2012, which has been in use since then in all academic teaching and university hospitals nationwide. OBJECTIVE: After this time interval it seemed appropriate to evaluate this logbook for its usefulness by associate lecturers and students. The objectives were whether the actual learning targets could be considered relevant, suitable and feasible concerning department location, practical and clinical education for medical students. MATERIAL AND METHODS: A total of 165 associate lecturers of all registered national ORL departments were asked to participate using a 2-step evaluation. The logbook was evaluated by 77 lecturers in general and 17 lecturers also evaluated each of the 78 learning targets. Out of the 24 final year students from the Universities of Freiburg and Dresden who were contacted, 16 evaluated the logbook. RESULTS: Analysis demonstrated that the ORL logbook was used in 55% without alterations to the content and in 36% a medical faculty-specific logbook was used. The lecturers' judgement revealed no significant differences between the two logbooks. They approved the 78 learning targets with a majority vote of between 60-100%. Only 3 learning targets (otoacoustic emission, rhinomanometry and sonography) showed approval of less than 60%, associated with a request for modifications. Students evaluated the ORL logbook as being significantly better than the faculty's version concerning practical education. CONCLUSION: The results demonstrated the nationwide acceptance of the ORL logbook by lecturers and students. The amount of critical learning targets which will have to be changed is moderate. This evaluation confirmed the relevance and balance of the ORL logbook content in the practical year training and the possibility of use independent of the location of ORL departments.

[Mediation of data literacy in curricular education in otorhinolaryngology: watch and wait or anticipatory obedience?] / Vermittlung digitaler Kompetenzen in der curricularen HNO-Lehre: abwartende Haltung oder vorauseilender Gehorsam?

A comprehensive societal change is currently taking place, which also includes the medical field. The often heard "digital transformation" is also fundamentally transforming the health care system familiar to us, including the medical schools. While the Masterplan 2020 includes changes in the medical school structure and in the curricular content, it unfortunately focuses on special competencies, e.g., communication or scientific work, but not on digitization. However, precisely these skills are becoming increasingly indispensable in daily routine work. The seminar "Digitization in otorhinolaryngology (ORL)" was incorporated as a pilot project in the students' curriculum of the Department of ORL, at the University of Freiburg/Germany: the 141 medical students completed and evaluated this seminar as part of their 2 week rotation in otorhinolaryngology during the fall semester 2017/2018. The content of the seminar mediated digital competencies on the basis of practical examples. The evaluation showed high interest of the students in the topic in general, but also in more detailed subitems of the digitization topic. The students were generally open-minded concerning digitization but also critical of the topic. The acceptance of this newly implemented seminar was clearly positive. Another positive side effect is that this teaching concept can be transferred to other disciplines. Hence, we suggest to consider the training of digital competencies when implementing the Masterplan 2020.

[Social reimbursement-the Spanish-German ENT Society's (SDGHNO) Latin America project]. / Soziale Rückvergütung ­ das Projekt "Lateinamerika" der Spanisch-Deutschen HNO-Gesellschaft (SDGHNO).

Nowadays, social projects are usually oriented in such a way that after a given period of time, they can either support themselves independently or even allow a pecuniary reimbursement. In the latter case, experts speak of a profit-oriented reimbursement. On the other hand, there is so-called social reimbursement, which in contrast to the abovementioned form is not profit oriented, but, for example, considers its task fulfilled by the fact of successful knowledge transfer. The Spanish-German Society for ENT Medicine and Head and Neck Surgery (SDGHNO) launched the Latin America project in 2001 under the patronage of the then President Prof. Dr. Wolfgang Draf (Fulda). The goal of the SDGHNO was and is to create a professional as well as cultural platform for Spanish- and German-speaking ENT doctors. This platform can and should be used for professional purposes, e.g., for knowledge transfer. Since the beginning of its existence, the Latin America project has thus brought numerous scientific events into being and created specific contacts which have lasted until today or have even been continued and further developed. Particularly successful examples are Chile, Colombia, and Peru. This is a vivid example of social reimbursement, because the participating German-speaking members/speakers carried out their tasks on an entirely voluntary basis. Thus, the SDGHNO did not bear any travel, catering, or accommodation costs. The activities of the SDGHNO within the framework of the Latin America project are explained.

Clinical investigation of flat panel CT following middle ear reconstruction: a study of 107 patients.

OBJECTIVES: After middle ear reconstruction using partial or total ossicular replacement prostheses (PORP/TORP), an air-bone gap (ABG) may persist because of prosthesis displacement or malposition. So far, CT of the temporal bone has played the main role in the diagnosis of reasons for postoperative insufficient ABG improvement. Recent experimental and clinical studies have evaluated flat panel CT (fpCT) as an alternative imaging technique that provides images with high isovolumetric resolution, fewer metal-induced artefacts and lower irradiation doses. METHODS: One hundred and seven consecutive patients with chronic otitis media with or without cholesteatoma underwent reconstruction by PORP (n = 52) or TORP (n = 55). All subjects underwent preoperative and postoperative audiometric testing and postoperative fpCT. RESULTS: Statistical evaluation of all 107 patients as well as the sole sub-assembly groups (PORP or TORP) showed a highly significant correlation between hearing improvement and fpCT-determined prosthesis position. FpCT enables detailed postoperative information on patients with middle ear reconstruction. CONCLUSIONS: FpCT is a new imaging technique that provides immediate feedback on surgical results after reconstructive middle ear surgery. Specific parameters evaluated by fpCT may serve as a predictive tool for estimated postoperative hearing improvement. Therefore this imaging technique is suitable for postoperative quality control in reconstructive middle ear surgery. KEY POINTS: • Flat panel CT offers advantages with regard to artefacts and radiation dose. • FpCT provides higher isovolumetric resolution of temporal bone and middle ear implants. • FpCT allows prediction of the postoperative hearing outcome in patients. • FpCT is an important tool for immediate postoperative quality control. • FpCT improves postoperative management of patients with complications following ossicular replacement.