[ISOLATED FOURTH EXTENSOR COMPARTMENT TENOSYNOVITIS DUE TO EPIDEMIC RELATED CHANGES IN THE WORKPLACE].

INTRODUCTION: We report on cases of isolated fourth extensor compartment tenosynovitis without evidence of systemic inflammation that occurred in the context of alteration in the work environment due to the COVID-19 epidemic. Early identification of the deleterious effects of virtual/technologically-dependent work from home can aid in treatment and prevention of these conditions. We describe the phenomenon and suggest a treatment approach.

Pediatric Tracheostomy Safety: Implementation of an Airway Safety Placard.

BACKGROUND: First health care professionals arriving at the bedside in tracheostomy-related emergencies are rarely the surgical subspecialists who placed the tracheostomy and are unfamiliar with the relevant anatomy and tracheostomy specifications for the individual patient. We hypothesized that implementing a bedside airway safety placard would increase caregiver confidence, understanding of airway anatomy, and management of patients with a tracheostomy. METHODS: A prospective survey study was performed by distributing a tracheostomy airway safety survey before and after implementation of an airway safety placard in a 6-month study period. Placards emphasizing critical airway anomalies as well as emergency management algorithm suggestions designed by the otolaryngology team at the time of tracheostomy were placed at the head of the bed and traveled with the patient during transport around the hospital. RESULTS: Of 377 staff members requested to complete the surveys, 165 (43.8%) responses were obtained, and 31 (8.2% [95% CI 5.7-11.5]) paired pre- and post-implementation responses were recorded. Differences were found in the paired responses, including increases in the domains of confidence (P = .009) and experience (P = .01) post implementation. Less experienced providers (≤ 5 y of experience) (P = .005) and providers from neonatology (P = .049) demonstrated improved confidence post implementation, which was not observed in their more experienced (> 5 y) or respiratory therapy counterparts. CONCLUSIONS: Given the limitations of a low survey response rate, our findings suggest that an educational airway safety placard initiative can be a simple, feasible, and low-cost quality improvement tool to enhance airway safety and possibly decrease potentially life-threating complications among pediatric patients with a tracheostomy. The implementation of the tracheostomy airway safety survey at our single institution warrants a larger multi-center study and validation of the survey.

Spaced Effect Learning and Blunting the Forgetfulness Curve.

Medical education requires learners to absorb, retain, and apply vast amounts of information at every level of training. This process is constrained by the limitations of human memory, which were described by psychologist Hermann Ebbinghaus as a "forgetfulness curve." As he explained, material encountered during a lecture or study session is typically lost rapidly over the ensuing days. Ebbinghaus' solution to this problem-spaced repetition-involves revisiting studied content at multiple, specifically selected time intervals to reinforce learning and facilitate long-term retention. Using question-based repetition, as opposed to passive reading/listening modalities, can help optimize this process. Spaced learning has been used for training in multiple fields including finance, management and technology development. It has also been utilized by medical students preparing for exams and by select residency training programs. This article examines the range of ways spaced repetition has been employed in medical education, with a focus on applications in Otolaryngology training. It also discusses possible future avenues for use of this system to improve long-term retention in Otolaryngology residency and beyond.

Building Surgical Expertise Through Deliberate Practice.

OBJECTIVE: To characterize the role of deliberate practice in the changing landscape of surgical training. METHODS: A review examining various applications of deliberate practice was conducted, with a focus on the surgical training space and utility of this methodology in otolaryngology residency. RESULTS: With many programs turning to simulation-based practice and other learning modalities based outside the operating room, deliberate practice is emerging as a promising method for more efficient and efficacious learning. CONCLUSION: Identifying and addressing weak areas, maintaining motivation to continue to grow and reach new milestones, and continually responding to external feedback from instructors can lead to improvement in a variety of skills essential for success in surgical fields. Further implementation of deliberate practice methodology could improve surgical training at all levels.