[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.

[Structured oral examination ("guided questions") as a method for objectifying the ENT specialist examination in Germany]. / Strukturierte mündliche Prüfung ("guided questions") als Methode zur Objektivierung der HNO-Facharztprüfung in Deutschland.

On behalf of the federal Ministries of Health, the various German medical associations organize and conduct the board certification examinations for becoming an ENT specialist at the end of residency. The oral examination comprises a collegial discussion that should last at least 30 min and which rarely exceeds 45 to 60 min in practice. The current article describes the quality criteria upon which examinations in general should be based, and lists the most common mistakes during conduction of oral examinations. Using "oral guided questions" (OGQ or GQ) can guarantee a high degree of standardization, objectivity, transparency, and justiciability. The principles of a GQ-guided examination are described and specified by a typical example. Experiences with this form of examination from the federal states of Brandenburg and Thuringia are presented.

[The situation of education in ENT-residency-training in Germany]. / Die Weiterbildungssituation in der HNO-Heilkunde in Deutschland.

BACKGROUND: As a starting point for developing concrete suggestions for optimizing specialty training in German ENT departments, the present study analysed the current status of residency training in order to identify weaknesses. METHODS: Residents at German ENT departments were invited to participate in an online survey. The questionnaire comprised 78 individual questions. RESULTS: The questionnaire was answered by 223 ENT residents. Educational deficits such as a lack of regular feedback from supervisors, only moderately rated mediation of specialist competencies, capriciousness of the trainers in charge regarding the organisation of training, and time and personnel shortages were identified. Some of the mandatory recommendations of the specialty training regulations, including determination of concrete training goals during regular meetings or the use of a logbook, have only been implemented in limited cases. Demands for development of more external training opportunities (job shadowing/rotation) and an external objective review of the residency training (e.g., by a representative of the German Society of Otorhinolaryngology, Head and Neck Surgery, DGHNOKHC) in the sense of quality assurance are discussed. CONCLUSION: Implementation of structured and standardized ENT residency training in Germany, for which DGHNOKHC reviewal is also possible, can generate a basis for more effective compulsory residency training.

[Coupling of active middle ear implants-biomechanical aspects]. / Ankopplung aktiver Mittelohrimplantate ­ biomechanische Aspekte.

Active middle ear implants or implantable hearing aids are used to treat sensorineural or combined hearing loss. Their coupling to the middle ear structures has a large impact on the success of rehabilitation. Practical issues such as the coupling site, influence of middle ear status, and forward and backward excitation of the inner ear are discussed in the context of biomechanics. For this purpose, experimental studies, model simulations, and current literature data are evaluated. The explanations are intended to contribute to a better understanding of certain procedures in hearing rehabilitation with active implants.

[From reconstruction to function : Hands-on training in tympanoplasty using real-time feedback]. / Von der Rekonstruktion zur Funktion : Tympanoplastik-Training mit Real-Time-Feedback.

BACKGROUND: Surgery of the middle ear requires a very high level of fine motor skills. Due to the increased potential for complications in middle ear operations, it is appropriate to acquire these skills beforehand by operating on a model. OBJECTIVE: How satisfactory is the training on suitable models? Are the skills acquired from working on a model transferable to intraoperative situations? Will the type of model and its use for training influence ear surgery in the future? MATERIAL AND METHODS: Available publications and own experiences with the Dresden tympanoplasty model (DTM) are analyzed and discussed. RESULTS: Although middle ear surgery makes very high demands on the surgeon and there is a significant risk for severe complications to the ear as a sense organ, there are currently very few options to train surgeons in advance. The DTM is a validated training model, which is capable of closing this gap. Due to the possibility of using a real-time feedback variation of the model, the understanding for reconstruction quality and intraoperative acoustic stress can be improved. The translation of the real-time feedback idea into actual middle ear surgery can improve reconstruction quality in the future. CONCLUSION: Training on suitable models is indispensable, especially when training as a surgeon to carry out middle ear operations. Adding another sense perception to the internal and external quality assessment of tympanoplasty by inclusion of the real-time feedback option, can optimize learning and operating processes.

["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.

[Spectroscopic investigation of the middle ear mucosa]. / Spektroskopische Untersuchung der Mittelohrschleimhaut.

BACKGROUND: The middle ear mucosa (MEM) plays a central role in the middle ear due to its function of providing regular ventilation. To date, assessment of the state of the MEM is only possible subjectively by the surgeon. An objective characterization of the state of the MEM is desirable. OBJECTIVE: The aim of this study was to enable objective characterization of the MEM and test infrared (IR) spectroscopy as a possible diagnostic tool for clinical use. MATERIALS AND METHODS: During middle ear surgery, 48 MEM samples were collected and divided into four groups according to clinical appearance: group I: normal MEM; group II: sclerotic MEM; group III: inflammatory thickened MEM; group IV: granulated MEM. After collection, samples were analyzed by IR spectroscopy to identify characteristic IR spectra. RESULTS: In the supervised analysis of the selected images, the biochemical differences representing the decisive factors for classification into groups I to IV were characterized. The differences in amide bands, carbohydrates, lipids, and proteins permit reliable separation of the clinical categories. CONCLUSION: Spectroscopic investigations enable objective characterization of the MEM. Conclusions regarding biochemical differences make it possible to weigh up treatment options. Routine use of IR spectroscopy in the operating theater requires histopathological comparison and an extended dataset with reference values of the individual groups.

[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.

[Learning curve of the ENT mirror examination : Goal-oriented curriculum planning for psychomotor learning]. / Lernkurve der HNO-Spiegeluntersuchung : Zielgerichtete Lehrveranstaltungsplanung zu einer psychomotorischen Fertigkeit.

BACKGROUND: Learning complex psychomotor sequences requires a high number of training sessions to achieve precise execution. In the current student curriculum there are only few study sessions available to achieve this level of competence. OBJECTIVE: The objective of the current study was to record the learning curve of psychomotor proficiency using the example of the ENT mirror examination. Particular focus was on the number of practice sessions needed to achieve safe execution of the examination and the learning success as assessed in partial investigations. MATERIALS AND METHODS: During a 5­day period of their ENT block internship, students were taught and practiced the correct ENT mirror examination. At the end of each internship day, the learning progress of a total of 48 students was statistically evaluated by a checklist-based assessment. RESULTS: In the full study and in the partial studies, a significant increase in points was shown over the days, which proved a growing learning curve of the students. The students required at least five training sessions (each 45 min) for safe execution (Bloom taxonomy level 3) and six training sessions for routine execution (Bloom taxonomy level 4; Nationaler kompetenzorientierter Lernzielkatalog Medizin, NKLM, level 3a). CONCLUSION: Looking at the ENT mirror examination, an improvement in psychomotor skills was shown with an increasing number of practice sessions. This study is therefore representative as an example of resource-optimized curriculum planning based on the previously defined level of competence that students should have attained by the end of a course.

[State of the art of quality-of-life measurement in patients with chronic otitis media and conductive hearing loss]. / Aktueller Stand der Lebensqualitätsmessung bei Patienten mit chronischer Otitis media und Schallleitungsschwerhörigkeit.

The evaluation of results after middle ear reconstruction has been mainly based on functional parameters. In clinical practice as well as in otological research, the pure tone audiogram represents the gold standard in the assessment of the postoperative outcome. In order to assess the patient's subjective outcome, outcome analyzes focus increasingly on the health-related quality of life (HRQOL). However, the evaluation of HRQOL requires reliable and validated measuring instruments. A modest number of validated questionnaires for determination of the disease-specific HRQOL in patients with chronic otitis media and/or conductive hearing loss are currently available. Three of seven available questionnaires were developed and validated in the German-speaking countries, the Zurich Chronic Middle Ear Inventory 21 (ZCMEI-21), the Chronic Otitis Media Outcome Test 15 (COMOT-15) and the Stapesplasty Outcome Test 25 (SPOT-25). In this review, all seven available disease-specific measuring instruments as well as the generic questionnaires, which were used in previous clinical trials, are explained and current findings of quality-of-life research in patients with chronic otitis media and/or conductive hearing loss are presented.

[Development and validation of the Stapesplasty Outcome Test 25 (SPOT-25)]. / Entwicklung und Validierung des Stapesplasty Outcome Test 25 (SPOT-25).

BACKGROUND: Otosclerosis affects health-related quality of life (HRQOL). Until now, measurements have only been performed using audiometric data or non-validated quality of life questionnaires. OBJECTIVE: The objective of this study was to develop the first validated disease-specific HRQOL measuring instrument to determine HRQOL in otosclerosis. MATERIALS AND METHODS: After sequential analysis and item reduction of the initial Stapesplasty Outcome Test 47 (SPOT-47), the SPOT-25 was validated prospectively on 52 otosclerosis patients undergoing stapes surgery. In addition to the overall score, four subscores were defined (hearing function, tinnitus, social restrictions, mental condition). RESULTS: The SPOT-25 showed a high internal consistency (Cronbach's α > 0.7), allowed discrimination between otosclerosis patients and healthy subjects, and demonstrated acceptable test-retest reliability (r = 0.85). After stapes surgery, the HRQOL improved significantly. The responsiveness was high. CONCLUSION: The SPOT-25 is the first validated disease-specific instrument for HRQOL measurement in otosclerosis patients. It should be used routinely for quality control.

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.

[The Vibrant Soundbridge as an active implant in middle ear surgery]. / Die Vibrant Soundbridge als aktives Implantat in der Mittelohrchirurgie.

Implantable hearing aids are not only gaining importance for the treatment of sensorineural hearing loss, but also for treatment of mixed hearing loss. The most frequently used active middle ear implant is the Vibrant Soundbridge (VSB) system (Fa. MED-EL, Innsbruck, Österrreich). Following widening of the spectrum of indications for the VBS, various new coupling systems have been established. Based on the literature, available petrosal bone investigations and finite element model (FEM) calculations, this article summarizes the current knowledge concerning mechanical excitation by the VSB. Important concomitant aspects related to coupling, transmission and measurement are also discussed.