LeKok K, Hayhurst C, Uppal H, Wilson P S

Keywords

Otolaryngology; Training;

Abstract

Aim: To determine the current practice within the West Midlands Deanery with regard to training senior house officers at induction in the use of specialised ENT equipment.

Methods: A confidential telephone survey using a standardised questionnaire, interviewing senior house officers identified within 14 departments.

Results: Despite the majority of interviewees (74%) attending a formal clinical induction programme there was a distinct lack of training in the use of basic ENT equipment. The thudicums nasal speculum represented the only instrument in which over half the respondents had formal training, training in all other instruments / equipment fell below this figure. With regards to ENT emergencies, nasal packing represented the only practical procedure in which the majority (73%) of respondents had formal training. When asked if a formal training session in the use of equipment at the start of their ENT placements would be beneficial, all interviewees responded positively.

Conclusions: The survey demonstrates wide variations in the standard of the induction programmes. There is a distinct lack of programmes dedicated to training in the practical aspects of equipment use. In the current climate of clinical governance, this raises important questions about the safe and appropriate use of medical equipment, risk management and ultimately litigation.

Introduction

Otolaryngology as a speciality represents a unique challenge to basic surgical trainees. Exposure to the speciality at medical school level is at best limited. The majority of students spend a finite time attached to an Otolaryngology firm, limiting the time available to develop the skills necessary to examine the head and neck adequately. In addition, there is little exposure to the basic equipment used in examining the region.

Consequently, the new arrival faces the daunting task of quickly familiarising themselves with the specialised equipment which represents the armamentarium of the ENT surgeon.

Often junior trainees find themselves running emergency ENT clinics with little or no supervision (1). It is imperative that they have a sound knowledge of the safe and appropriate use of basic ENT equipment. As unfamiliarity and poor technique may lead to complications and increased patient morbidity. In addition, in the current climate of clinical governance it raises important health and safety questions about the safe and appropriate use of medical equipment, risk management and ultimately litigation

There do not appear to be any specific guidelines in place for ENT SHO training at present (2). The majority of training occurs informally from specialist registrars and consultants.

Most departments have a formal induction programme that new trainees attend on commencing a post. But there appears to be great variability on the contents and timing of such programmes (1).

The aim of this study was to evaluate the current practice of Otolaryngology units within the West Midlands Deanery with particular emphasis on training in the use of specialised equipment.

Materials and Methods

All Otolaryngology departments within the West Midlands Deanery were identified, and their SHOs interviewed individually. A standardised questionnaire was used and all interviews were carried out by KK and HC respectively.

Aspects chosen for assessment included; the presence or absence of a formal clinical induction, training in the use of the microscope, microsuction, auriscope, nasendoscopy, thudicums speculum, indirect laryngoscopy and tracheostomy management.

In addition, training in the practical aspects of nasal packing, quinsy drainage and foreign body removal from the ear, nose and throat was also questioned. At the end of the interview, trainees were asked if a formal training day in the use of ENT equipment at the beginning of their jobs would be beneficial.

Results

44 SHOs in 14 otolaryngology departments were identified in the West Midlands region. Among these firms, 11 out of 14 (79%) had a formal clinical induction at the beginning of a 6 month placement, of which 34 out of a possible 38 (89%) trainees attended. Of the 4 that did not attend, 3 were locums covering for SHOs who had left halfway through their jobs and therefore did not start at the beginning of the 6 month period. The other non-attendee had previous ENT experience and did not feel that induction would have been beneficial to him.

During the clinical induction, 4 out of 11 firms (36%) taught trainees how to use the microscope. A similar number of firms taught the proper use of the auriscope (36%). Three out of 11 firms (27%) demonstrated the correct use of microsuction. Five out of 11 firms (45%) taught the practical aspects of nasendoscopy. This was similar with respect to quinsy drainage and foreign body removal from the ear, nose and throat. Six out of 11 firms (55%) demonstrated the correct use of the thudicums speculum. Eight out of 11 firms (73%) taught trainees how to pack nasal cavities and only 1 out of 11 firms (9%) talked about practical aspects of tracheostomy management. This was similar to indirect laryngoscopy (1 out of 11 firms).

All of the interviewees (44 out of 44) responded yes when asked if it would be beneficial to them to have a formal training day in the use of ENT equipment at the start of their jobs. The results are summarised in tables 1 and 2 respectively.

Table 1

Table showing type of equipment and corresponding number of firms training in their use (out of a total number of 11 firms)

Table 2

Table showing types of practical procedures and corresponding number of firms involved in training (out of a total number of 11 firms)

Discussion

The ENT SHO is often the first to see the majority of acute referrals. As such they must be well versed in the use of the appropriate instruments used in the diagnosis and treatment of common emergencies.

The results of the survey show that the majority (74%) of respondents had a formal clinical induction on commencing their posts. However, there was a distinct lack of training in the practical aspects of using equipment. The thudicum nasal speculum represented the only instrument where over half the respondents had any formal training in. Training in the use of all other instruments fell to below fifty percent, and in the use of the microscope, probably the most technically difficult piece of equipment, fell to 36%. Worryingly, only 1 out 11 firms taught the practical aspects of tracheostomy management.

With regard to ENT emergencies, under half the firms taught the techniques for quinsy drainage and removal of foreign bodies, however the response for nasal packing was better (73%).

The study demonstrates wide variations in the standard of the induction programmes. There is a distinct lack of programmes purely dedicated to training in the practical aspects of equipment use.

The problem has been highlighted at a national level (1), and attempts have been made to address it at some centres. Kanegaonkar et al (3) describe their own induction programme, which consist of a two day introductory course, including lectures and practical sessions on equipment use.

Although it is accepted that a large proportion of SHO training is informally taught by consultants and specialist registrars throughout the 6 month period of an SHO placement. This training may be somewhat haphazard and poorly structured. Logic dictates that the ideal timing for such instruction would be at the beginning of a placement.

References

1. Murphy J, Murphy JT, Kothari PS, Jefferies AF. A national audit of the SHO in the Emergency ENT clinic. Ann R Coll Surg Engl (Suppl) 2003;85:130-131

2. The Royal College of Surgeons of England. The Manual of Basic Surgical Training. London; 1998

3. Kanegaonkar RG, Vaz F, Desai K. Improving ENT SHO training. Ann R Coll Surg Engl (Suppl) 2003;85:351