Stakeholders' perception on the implementation of Developmental Progress Assessment: using the Theoretical Domains Framework to document behavioral determinants.

BACKGROUND: The widespread implementation of longitudinal assessment (LA) to document trainees' progression to independent practice rests more on speculative rather than evidence-based benefits. We aimed to document stakeholders' knowledge of- and attitudes towards LA, and identify how the supports and barriers can help or hinder the uptake and sustainable use of LA. METHODS: We interviewed representatives from four stakeholder groups involved in LA. The interview protocols were based on the Theoretical Domains Framework (TDF), which contains a total of 14 behaviour change determinants. Two team members coded the interviews deductively to the TDF, with a third resolving differences in coding. The qualitative data analysis was completed with iterative consultations and discussions with team members until consensus was achieved. Saliency analysis was used to identify dominant domains. RESULTS: Forty-one individuals participated in the study. Three dominant domains were identified. Participants perceive that LA has more positive than negative consequences and requires substantial ressources. All the elements and characteristics of LA are present in our data, with differences between stakeholders. CONCLUSION: Going forward, we could develop and implement tailored and theory driven interventions to promote a shared understanding of LA, and maintain potential positive outcomes while reducing negative ones. Furthermore, ressources to support LA implementation need to be addressed to facilitate its uptake.

Assessing the acceptability of script concordance testing: a nationwide study in otolaryngology.

Background: Script concordance testing (SCT) is an objective method to evaluate clinical reasoning that assesses the ability to interpret medical information under conditions of uncertainty. Many studies have supported its validity as a tool to assess higher levels of learning, but little is known about its acceptability to major stakeholders. The aim of this study was to determine the acceptability of SCT to residents in otolaryngology ­ head and neck surgery (OTL-HNS) and a reference group of experts. Methods: In 2013 and 2016, a set of SCT questions, as well a post-test exit survey, were included in the National In-Training Examination (NITE) for OTL-HNS. This examination is administered to all OTL-HNS residents across Canada who are in the second to fifth year of residency. The same SCT questions and survey were then sent to a group of OTL-HNS surgeons from 4 Canadian universities. Results: For 64.4% of faculty and residents, the study was their first exposure to SCT. Overall, residents found it difficult to adapt to this form of testing, thought that the clinical scenarios were not clear and believed that SCT was not useful for assessing clinical reasoning. In contrast, the vast majority of experts felt that the test questions reflected real-life clinical situations and would recommend SCT as an evaluation method in OTL-HNS. Conclusion: Views about the acceptability of SCT as an assessment tool for clinical reasoning differed between OTL-HNS residents and experts. Education about SCT and increased exposure to this testing method are necessary to improve residents' perceptions of SCT.

Contexte: Le test de concordance de script (TCS) est une méthode objective d'évaluation du raisonnement clinique qui mesure la capacité d'interpréter les renseignements médicaux en contexte d'incertitude. Beaucoup d'études en appuient la validité en tant qu'outil pour évaluer l'enseignement supérieur, mais on en sait peu sur son acceptabilité auprès des principales parties prenantes. Le but de cette étude était de déterminer l'acceptabilité du TCS chez les résidents en otorhinolaryngologie ­ chirurgie de la tête et du cou (ORL ­ chirurgie tête et cou) et un groupe de référence composé d'experts. Méthodes: En 2013 et 2016, une série de questions de TCS, de même qu'un questionnaire post-test, ont été inclus dans l'examen national en cours de formation NITE (National In-Training Examination) pour l'ORL ­ chirurgie tête et cou. Cet examen est administré à tous les résidents en ORL ­ chirurgie tête et cou au Canada qui sont entre leurs deuxième et cinquième années de résidence. Les mêmes questions de TCS ont été envoyées à un groupe de chirurgiens en ORL ­ chirurgie tête et cou de 4 université canadiennes. Résultats: Pour 64,4 % des membres facultaires et des résidents, l'étude était leur première exposition au TCS. Dans l'ensemble, les résidents ont trouvé difficile de s'adapter à cette forme de test, même si les scénarios cliniques étaient clairs, et ils ont estimé que le TCS était peu utile pour évaluer le raisonnement clinique. En revanche, la grande majorité des experts ont jugé que les questions du test reflétaient la réalité des cas cliniques et recommanderaient le TCS comme méthode d'évaluation en ORL ­ chirurgie tête et cou. Conclusion: Entre les résidents et les experts en ORL ­ chirurgie tête et cou, les points de vue quant à l'acceptabilité du TCS comme outil d'évaluation du raisonnement clinique ont différé et il faudrait y exposer les résidents davantage pour améliorer leur perception du TCS.

Nationwide study of publication misrepresentation in applicants to residency.

OBJECTIVES: This study was conducted to assess the prevalence of research publication misrepresentation amongst Canadian Resident Matching Service (CaRMS) applicants to a single surgical subspecialty residency as a potential means of assessing professional behaviour. METHODS: The authors reviewed CaRMS application forms to Canadian otolaryngology residency programmes over a 3-year period (2006-2008) for peer-reviewed publications reported as 'published', 'accepted' and 'in press'. Citations were verified by searching PubMed, Google Scholar and electronic journals. Misrepresentation was defined as any of: (i) falsely claimed authorship of an existing article; (ii) claimed authorship of a non-existing article, and (iii) improper ordering of authorship. Outcomes included descriptive statistics, as well as sub-analyses pertaining to age, gender, affiliated medical school and academic degree, and number of publications per applicant. RESULTS: A total of 427 peer-reviewed publications were reported by 124 of 182 applicants (68% of applicants reported at least one publication). Of the 385 verifiable publications, 47 (12% of articles) were misrepresented by 29 applicants (23% of applicants claiming publication) self-reporting at least one publication. Age, gender, location of medical training, prior academic degree and number of citations per applicant did not relate to likelihood of misrepresentation (p > 0.05). CONCLUSIONS: This study documents the nationwide prevalence of publication misrepresentation amongst applicants to Canadian otolaryngology residency programmes. The high rate of misrepresentation aligns with data reported in the literature and highlights the need to institute measures to dissuade graduates from this form of unprofessional behaviour.

Proposed Quality Indicators for Aspects of Pediatric Acute Otitis Media Management.

BACKGROUND: The high incidence of pediatric acute otitis media (AOM) makes the implications of overdiagnosis and overtreatment far-reaching. Quality indicators (QIs) for AOM are limited, drawing from generalized upper respiratory infection QIs, or locally developed benchmarks. Recognizing this, we sought to develop pediatric AOM QIs to build a foundation for future quality improvement efforts. METHODS: Candidate indicators (CIs) were extracted from existing guidelines and position statements. The modified RAND Corporation/University of California, Los Angeles (RAND/UCLA) appropriateness methodology was used to select the final QIs by an 11-member expert panel consisting of otolaryngology-head and neck surgeons, a pediatrician and family physician. RESULTS: Twenty-seven CIs were identified after literature review, with an additional CI developed by the expert panel. After the first round of evaluations, the panel agreed on 4 CIs as appropriate QIs. After an expert panel meeting and subsequent second round of evaluations, the panel agreed on 8 final QIs as appropriate measures of high-quality care. The 8 final QIs focus on topics of antimicrobial management, specialty referral, and tympanostomy tube counseling. CONCLUSIONS: Evidence of variable and substandard care persists in the diagnosis and management of pediatric AOM despite the existence of high-quality guidelines. This study proposes 8 QIs which compliment guideline recommendations and are meant to facilitate future quality improvement initiatives that can improve patient outcomes.

Novel measurements of the length of the subglottic airway in infants and young children.

BACKGROUND: To date, the lengths of the subglottic and tracheal airway segments have been measured from autopsy specimens. Images of the head and neck obtained from computerized tomography (CT) provide an alternate method. Our objective in this study was to identify anatomic landmarks from CT scans in infants and young children to estimate the lengths of the subglottic and tracheal airway segments and to correlate these lengths with age. METHODS: We performed a retrospective analysis of CT images of the neck for various diagnostic indications in children ≤3 years. We obtained planes of reconstruction at the level of the vocal cords (VCs), cricoid cartilage, and carina (C) which were parallel to each other and perpendicular to sagittal long axis of the trachea. The lengths of the subglottic airway (LengthSG) and total length of the laryngotracheal airway (LengthVC-C) were measured from the distance between, respectively, the VC versus cricoid cartilage and the VC versus C planes of reconstruction. Tracheal length was then calculated as the difference between LengthVC-C and LengthSG. RESULTS: Fifty-six children met the inclusion criteria. There were 29 boys. The median weight was 10.7 kg (range 3.1-19.0 kg). Regression analysis yielded mean LengthSG (mm) = 7.8 + 0.03·corrected age (months), r(2) = 0.07, P = 0.056; lower and upper 95% confidence interval for ß = 0.03 were -0.001 and 0061. The mean LengthSG was 8.4 mm with an SD of 1.4 mm. The 95th percentile for LengthSG was 10.8 mm, and the 5% to 95% interquartile range was 4.9 mm. The estimate for the 95% confidence interval of the 95th percentile was between 10.2 and 11.3 mm. The LengthVC-C increased with age: mean LengthVC-C (cm) = 5.3 + 0.05·corrected age (months), r(2) = 0.7, P < 0.001. Tracheal length also increased with age: mean tracheal length (cm) = 4.5 + 0.05·corrected age (months), r(2) = 0.6, P < 0.001. CONCLUSION: We report a novel estimate method for the lengths of the airway segments between the VC and C in 56 infants and young children and suggest that the growth characteristics of the subglottic and tracheal airway may differ.

Cholesteatoma in Congenital Aural Atresia and External Auditory Canal Stenosis: A Systematic Review.

OBJECTIVE: Patients with congenital external auditory canal (EAC) abnormalities are at risk of developing cholesteatoma and often undergo surveillance imaging to detect it. The aims of this systematic review are to determine the incidence of cholesteatoma in patients with congenital aural atresia (CAA) and patients with congenital EAC stenosis and to investigate the most common age of cholesteatoma diagnosis. This information will help clinicians decide which patients require surveillance scanning, as well as the timing of imaging. DATA SOURCES: Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases. REVIEW METHODS: A systematic literature review following the PRISMA guidelines was performed. The data sources were searched by 2 independent reviewers, and articles were included that reported on CAA or congenital EAC stenosis with a confirmed diagnosis of cholesteatoma. The selected articles were screened separately by 3 reviewers before reaching a consensus on the final articles to include. Data collection on the number of patients with cholesteatoma and the age of diagnosis was performed for these articles. RESULTS: Eight articles met the inclusion criteria. The incidence of cholesteatoma was 1.7% (4/238) in CAA and 43.0% (203/473) in congenital EAC stenosis. The majority of patients with congenital EAC stenosis that developed cholesteatoma were diagnosed at age <12 years. CONCLUSION: CAA is associated with a low risk of cholesteatoma formation, and surveillance imaging is unnecessary in asymptomatic patients. EAC stenosis is strongly associated with cholesteatoma, and a surveillance scan for these patients is recommended prior to 12 years of age with close follow-up into adulthood.

Are Canadian general surgery residents ready for the 80-hour work week? A nationwide survey.

BACKGROUND: The purpose of this study was to describe Canadian general surgery residents' perceptions regarding potential implementation of work-hour restrictions. METHODS: An ethics review board-approved, Web-based survey was submitted to all Canadian general surgery residency programs between April and July 2009. Questions evaluated the perceived effects of an 80-hour work week on length of training, operative exposure, learning and lifestyle. We used the Fisher exact test to compare senior and junior residents' responses. RESULTS: Of 360 residents, 158 responded (70 seniors and 88 juniors). Among them, 79% reported working 75-100 hours per week. About 74% of seniors believed that limiting their work hours would decrease their operative exposure; 43% of juniors agreed (p < 0.001). Both seniors and juniors thought limiting their work hours would improve their lifestyle (86% v. 96%, p = 0.12). Overall, 60% of residents did not believe limiting work hours would extend the length of their training. Regarding 24-hour call, 60% of juniors thought it was hazardous to their health; 30% of seniors agreed (p = 0.001). Both senior and junior residents thought abolishing 24-hour call would decrease their operative exposure (84% v. 70%, p = 0.21). Overall, 31% of residents supported abolishing 24-hour call. About 47% of residents (41% seniors, 51%juniors, p = 0.26) agreed with the adoption of the 80-hour work week. CONCLUSION: There is a training-level based dichotomy of opinion among general surgery residents in Canada regarding the perceived effects of work hour restrictions. Both groups have voted against abolishing 24-hour call, and neither group strongly supports the implementation of the 80-hour work week.

Procedural Sedation in Minor Procedure Rooms for Pediatric Myringotomy and Tympanostomy: A Quality Improvement Initiative.

OBJECTIVE: Lengthy wait times for elective surgery is a widespread health care system conundrum that may increase patient distress and jeopardize health outcomes. The primary aim of this quality improvement project was to reduce the surgical wait time in patients undergoing tympanostomy tube insertion. METHODS: As of January 2018, our tertiary care institution implemented a novel protocol whereby healthy children may undergo tympanostomy tube insertion in a minor procedure room under ketamine sedation administered by pediatric emergency physicians to address lack of both physical and anesthesia staffing resources. A retrospective study of all children undergoing elective tympanostomy tube insertion was conducted between September 1, 2017, and May 8, 2019, to assess wait time to surgery, as well as anesthesia-related and surgical complications. RESULTS: Procedural sedation in minor procedure rooms effectively decreased surgical wait times by 53 days (from 134 to 81 days, P < .001) at 16 months postimplementation. This new protocol was found to be safe and effective for healthy children, with no major surgical or anesthesia-related complications noted in 113 patients having undergone the procedure in the novel setting. DISCUSSION: Although conscious sedation by emergency physicians has been well studied across a variety of surgical procedures, its novel use in pediatric tympanostomy tube insertion requires careful patient selection to enhance accessibility while maintaining anesthetic safety. IMPLICATIONS FOR PRACTICE: This quality improvement project describes a novel combination of processes, using a minor procedure room space and ketamine-based procedural sedation to address surgical wait times in pediatric patients undergoing tympanostomy tube insertion.

Aerosolization in Endoscopic Sinus Surgery and Risk Mitigation in the COVID-19 Era: A Scoping Review.

Objective The continually evolving coronavirus disease 2019 (COVID-19) pandemic has created a dire need for rapid reorganization of health care delivery within surgical services. Ensuing initial reports of high infection rates following endoscopic sinus and skull base surgery, various expert and societal guidelines have emerged. We hereby provide a scoping review of the available literature on endoscopic sinus and skull base surgery, exploring both the risk of aerosolization and expert recommendations on surgical management during the pandemic. Methods A literature search of the PubMed database was performed up until May 9th, 2020. Additionally, websites and published statements from otolaryngology associations were searched for recommendations. This scoping review followed the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta Analyses Extension for Scoping Reviews. Results A total of 29 peer-reviewed publications and statements from expert recommendations or professional associations were included. Current expert guidance relies mainly on scarce, anecdotal evidence, and two cadaveric studies, which have demonstrated potential aerosolization during transnasal surgery. General consensus exists for delaying surgery when possible, ascertaining COVID-19 status preoperatively and donning of adequate personal protective equipment by all operating room staff (including at minimum an N95 mask). Cold, nonpowered surgical instruments are deemed the safest, while thermal instruments (electrocautery and laser) and high-speed drills should be minimized. Conflicting recommendations emerge for use of microdebriders. Conclusion Endoscopic sinus and skull base surgery impart a potential risk of aerosolization. Hence, surgical indications, protective measures for health care workers, and surgical instrumentation must be adapted accordingly in the COVID-19 context.

Conducting an Endoscopic Sinus Surgery Dissection Course via Telesimulation: An Initial Experience.

Objective: Medical education has been severely disrupted by the COVID-19 pandemic, with many in-person educational activities transitioned to distance learning. To overcome this challenge, we utilized telesimulation to conduct an endoscopic sinus surgery (ESS) dissection course. Our objectives were to evaluate the effectiveness and acceptability of telesimulation as an alternative to in-person dissection courses for resident training. Study Design: Cross-sectional study. Setting: Academic medical centers. Methods: The course, consisting of lectures and hands-on dissection, was conducted entirely over the Zoom platform. The participants were allocated outpatient clinic rooms at 2 hospitals, while the instructors supervised remotely. We utilized the camera systems in the clinics and 3-dimensional-printed sinus models for the dissection. Laptops with cameras were used to capture the endoscopic image and the dissector. We evaluated the effectiveness of telesimulation, the surgical skills of the participants, and the course by way of pre- and posttest and a questionnaire. Results: A total of 8 participants and 7 instructors participated in the study. Telesimulation was found to be effective in helping participants gain knowledge and skills in ESS. All participants improved on their pretest scores (31.5% vs 73.4%, P = .003) and felt more comfortable with ESS postcourse (1.9 vs 3.2, P = .008). Participants and instructors opined that telesimulation is an acceptable alternative to in-person dissection courses. Conclusion: Telesimulation is an effective, acceptable, and viable alternative to in-person dissection courses. It also has the advantage of overcoming temporal and geographic constraints to surgical training in residency.

Evaluating Strength of Evidence of Pediatric Otolaryngology Research Literature: A 20-Year Review.

OBJECTIVES/HYPOTHESIS: Quantity and quality of Otolaryngology-Head and Neck Surgery (OTL-HNS) research are increasing, yet patterns within Pediatric OTL-HNS publications are unknown. This study examines trends in the level of evidence of pediatric OTL-HNS articles over a 20-year period to quantify the growth and characterize contributing factors. STUDY DESIGN: Review article. METHODS: A retrospective review was conducted on 12 peer-reviewed OTL-HNS journals at three time-points: 1996, 2006, and 2016. Pediatric-specific OTL-HNS journals were selected; all were among the top 10 highest impact factor journals, with one pediatric-specific and one Canadian journal. Publication details, author characteristics, and study focus were collected. Papers were classified based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence by two independent reviewers. RESULTS: Of the 1,733 articles reviewed, 727 met inclusion criteria. A greater absolute number of pediatric OTL-HNS articles were published over the years studied: from 95 in 1996 to 359 in 2016 (P < .001). As well, the absolute number of high-quality studies has increased over the study period, from 28 articles in 1996 to 100 articles in 2016. However, the relative percentage of high-quality papers remained stable between 27.9% and 32.2% with an average of 29.7% (P = .89). Higher impact factor journals did not tend to publish higher-quality pediatric OTL-HNS articles (P = .48). CONCLUSIONS: Over the past 20 years, there is no appreciable improvement in the proportion of high-quality publications in pediatric OTL-HNS; however, there is an overall greater number of high-quality papers within OTL-HNS literature. These findings likely relate to challenges of research within pediatric surgical specialties. LEVEL OF EVIDENCE: NA Laryngoscope, 132:1869-1876, 2022.

Factors Affecting the Use of Medical Articles for Citation and Academic Reference.

Introduction: Increases in publication quantity and the onset of open access have increased the complexity of conducting a literature search. Bibliometric markers, like impact factor (IF), have traditionally been used to help identify high-quality research. These markers exist amongst a variety of other factors, which poses the following question: what factors are examined when considering articles for clinical and academic research? Objective: To determine what factors are involved when authors choose citations to include in their publications. Methods: A voluntary and anonymous questionnaire-based survey was distributed to medical students, residents, and faculty from multiple medical schools across Canada during the 2020/2021 academic year. Survey ratings were scored on a 5-point Likert scale and open word response. Results: The study collected 156 complete sets of responses including 78 trainees (61 medical students and 17 residents), and 78 faculty. Language of the article (3.93) and availability on PubMed/Medline (3.77) were found more important than country of origin (2.14), institution (2.26), and IF (2.97). Trainees found the following factors more important than faculty: year of publication (3.94 vs 3.47, p = 0.0016), availability on Google/Google Scholar (2.51 vs 1.88, p = 0.0013), Open-access (2.46 vs 1.87, p = 0.0011), and Free access (2.73 vs 2.31, p = 0.049). Conclusion: Our study identified differences in faculty and trainee literature search preferences, bias towards English language publications, and the movement towards online literature sources. This knowledge provides insight into what biases individuals may be exposed to based on their language and literature search preferences. Future areas of research include how trainees' opinions change over time, identifying trainee ability to recognize predatory journals, and the need for better online journal article translators to mitigate the language bias. We believe this will lead to higher quality evidence and optimal patient care amongst healthcare workers.

Comprehensive metrics for evaluating surgical microscope use during tympanostomy tube placement.

PURPOSE: Learning to use a surgical microscope is a fundamental step in otolaryngology training; however, there is currently no objective method to teach or assess this skill. Tympanostomy tube placement is a common otologic procedure that requires skilled use of a surgical microscope. This study was designed to (1) implement metrics capable of evaluating microscope use and (2) establish construct validity. STUDY DESIGN: This was a prospective cohort study. METHODS: Eight otolaryngology trainees and three otolaryngology experts were asked to use a microscope to insert a tympanostomy tube into a cadaveric myringotomy in a standardized setting. Microscope movements were tracked in a three-dimensional space, and tracking metrics were applied to the data. The procedure was video-recorded and then analyzed by blinded experts using operational metrics. Results from both groups were compared, and discriminatory metrics were determined. RESULTS: The following tracking metrics were identified as discriminatory between the trainee and expert groups: total completion time, operation time, still time, and jitter (movement perturbation). Many operational metrics were found to be discriminatory between the two groups, including several positioning metrics, optical metrics, and procedural metrics. CONCLUSIONS: Performance metrics were implemented, and construct validity was established for a subset of the proposed metrics by discriminating between expert and novice participants. These discriminatory metrics could form the basis of an automated system for providing feedback to residents during training while using a myringotomy surgical simulator. Additionally, these metrics may be useful in guiding a standardized teaching and evaluation methodology for training in the use of surgical microscopes.

A national study of choanal atresia in tertiary care centers in Canada - part II: clinical management.

BACKGROUND: To evaluate the clinical management of choanal atresia (CA) in tertiary centers across Canada. METHODS: Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with choanal atresia to a participating center. RESULTS: The health charts of 215 patients (59.6% female) with choanal atresia (CA) were reviewed. Mean age of initial surgical repair was 0.8 months for bilateral CA, and 48.6 months for unilateral CA. Approaches of surgical repair consisted of endoscopic transnasal (31.7%), non-endoscopic transnasal (42.6%), and transpalatal (25.2%). Stents were used on 70.7% of patients. Forty-nine percent of patients were brought back to the OR for a planned second look; stent removal being the most common reason (86.4%). Surgical success rate of initial surgeries was 54.1%. Surgical technique was not associated with rate of restenosis [χ2 (2) = 1.6, p = .46]. CONCLUSIONS: The present study is the first national multi-institutional study exploring the surgical outcomes of CA over a 30-year period. The surgical repair of CA presents a challenge to otolaryngologists, as the rate of surgical failure is high. The optimal surgical approach, age at surgical repair, use of stents, surgical adjuncts, and need for planned second look warrant further investigation.

A national study of choanal atresia in tertiary care centers in Canada - part I: clinical presentation.

BACKGROUND: To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada. METHODS: Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center. RESULTS: The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome. CONCLUSIONS: The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted.

Choosing Wisely Canada - pediatric otolaryngology recommendations.

The Choosing Wisely Canada campaign raises awareness amongst physicians and patients regarding unnecessary or inappropriate tests and treatments. Using an online survey, members of the Pediatric Otolaryngology Subspecialty Group within the Canadian Society of Otolaryngology - Head & Neck Surgery developed a list of nine evidence based recommendations to help physicians and patients make treatment decisions regarding common pediatric otolaryngology presentations: (1) Don't routinely order a plain film x-ray in the evaluation of nasal fractures; (2) Don't order imaging to distinguish acute bacterial sinusitis from an upper respiratory infection; (3) Don't place tympanostomy tubes in most children for a single episode of otitis media with effusion of less than 3 months duration; (4) Don't routinely prescribe intranasal/systemic steroids, antihistamines or decongestants for children with uncomplicated otitis media with effusion; (5) Don't prescribe oral antibiotics for children with uncomplicated tympanostomy tube otorrhea or uncomplicated acute otitis externa; (6) Don't prescribe codeine for post-tonsillectomy/adenoidectomy pain relief in children; (7) Don't administer perioperative antibiotics for elective tonsillectomy in children; (8) Don't perform tonsillectomy for children with uncomplicated recurrent throat infections if there have been fewer than 7 episodes in the past year, 5 episodes in each of the past 2 years, or 3 episodes in each of the last 3 years; and (9) Don't perform endoscopic sinus surgery for uncomplicated pediatric chronic rhinosinusitis prior to failure of maximal medical therapy and adenoidectomy.

Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus.

OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN: Blinded modified Delphi consensus process. SETTING: Tertiary care center. METHODS: A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS: The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS: It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE: 5. Laryngoscope, 131:1168-1174, 2021.

Surgical Errors Happen, but Are Learners Trained to Recover from Them? A Survey of North American Surgical Residents and Fellows.

BACKGROUND: Surgical training necessitates graded supervision and supported independence in order to reach competence. In developing surgical skills, trainees can, and will, make mistakes. A key skill required for independent practice is the ability to recover from an error or unexpected complication. Error recovery includes recognizing and managing a technical error in order to ensure patient safety and may be underrepresented in current educational approaches. OBJECTIVE: The purpose of this study is to explore residents' experiences and perceptions of error recovery training in surgical procedures. METHOD: An online survey was sent to surgical program directors in the United States and Canada using the Accreditation Council for Graduate Medical Education and the Royal College of Physicians and Surgeons of Canada distribution lists. Participating programs distributed the survey to their residents and fellows. The survey was composed of Likert-scale items, yes/no questions as well as open-ended questions focused on perceptions, experiences, and factors that influence to error recovery training in the operating room. RESULTS: A total of 206 surveys were completed. Overall, 99% (n = 203) agreed or strongly agreed that error recovery is an important competency for future practice. This was reflected in free-text response: "Errors can be minimized but they are inevitable, so certainly believe a surgical curriculum that addresses error recovery is of paramount importance." While 83% (n = 170) feel confident recovering from minor errors, only 34% (n = 68) feel confident that they could recover from major errors that are likely to have serious consequences on patient safety. Overall, residents do not consider that they have adequate training in error recovery, with only 37% (n = 72) felt they were adequately trained to recover from major errors. It was also mentioned "The quality of learning regarding error recovery depends entirely on the attending." CONCLUSIONS: Opportunities to learn to recover from technical errors in the operating room are valued by surgical trainees, but they perceive their training to be both inadequate and variable. This contributes to a lack of confidence in error recovery skills throughout their surgical training. There is a need to explore how best to integrate error recovery into more formal surgical curricula in order to better support learners and, ultimately, contribute to increased surgical safety.