No CrossRef data available.
Article contents
Trainee–trainer outcomes in mastoid surgery: a comparative study
Published online by Cambridge University Press: 27 October 2021
Abstract
Background
Mastoid exploration remains an advanced, mainstay operation within ENT, in which the surgical trainees’ role has been debated. This audit compares mastoid exploration outcomes between trainees and consultants.
Methods
Cortical mastoidectomy, atticotomy, atticoantrostomy, modified radical mastoidectomy, combined-approach tympanoplasty and revision mastoidectomy operations performed between 2009 and 2020 were reviewed. Complications assessed were: facial palsy, labyrinth injury, dead ear, disease recurrence and time to recurrence. The chi-square test was used to determine significant associations.
Results
A total of 118 operations were surveyed. Thirty-five per cent of procedures (n = 41) were performed by trainees under supervision, and 65 per cent (n = 77) were carried out solely by consultants. Patients from 5 per cent of trainees’ operations (n = 2) developed recurrence, compared with 7.8 per cent of consultants’ (n = 6) (p = 0.55). No other complications developed in either group.
Conclusion
The results corroborate those of other studies, indicating no significant increase in complication rate from consultants to trainees. Trainees likely completed less complicated cases. The stepwise incorporation of trainees did not compromise patient safety.
Keywords
- Type
- Main Article
- Information
- Copyright
- Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED
Footnotes
Mr MF Flynn takes responsibility for the integrity of the content of the paper
References
Duckworth, E, Silva, F, Chandler, J, Batjer, H, Zhao, J. Temporal bone dissection for neurosurgery residents: identifying the essential concepts and fundamental techniques for success. Surg Neurol 2008;69:93–8CrossRefGoogle Scholar
Pollak, N. Endoscopic and minimally-invasive ear surgery: a path to better outcomes. World J Otorhinolaryngol Head Neck Surg 2017;3:129–35CrossRefGoogle ScholarPubMed
Fonseca, A, Bento, R. A brief history of mastoidectomy. Int Arch Otorhinolaryngol 2014;17:168–78CrossRefGoogle Scholar
Kashikar, T, Kerwin, T, Moberly, A, Wiet, G. A review of simulation applications in temporal bone surgery. Laryngoscope Investig Otolaryngol 2019;4:420–4CrossRefGoogle ScholarPubMed
Bath, A, Wilson, T. Objective assessment of surgical competency – ENT trainees. Clin Otolaryngol 2007;32:475–9CrossRefGoogle ScholarPubMed
Hilmi, OJ, Bolton, P, Ahsan, F, Nunez, DA. Training opportunities for specialist registrars post-calmanization: audit of trainees’ exposure to repair of the tympanic membrane. J Laryngol Otol 2004;118:409–12CrossRefGoogle ScholarPubMed
Writing group; Project steering group; AsiT/BOTA Lost Tribe Study Group. Early years postgraduate surgical training programmes in the UK are failing to meet national quality standards: an analysis from the AsiT/BOTA Lost Tribe prospective cohort study of 2,569 surgical trainees. Int J Surg 2018;52:376–82CrossRefGoogle Scholar
Paisley, A, Praseedom, RK, Madhavan, KK, Garden, OJ, Paterson-Brown, S. Role of the surgical trainee in upper gastrointestinal resectional surgery. Ann R Coll Surg Engl 1999;81:40–5Google ScholarPubMed
Baron, R, Sujendran, V, Maynard, N. Should oesophagectomies be performed by trainees? The experience from a single teaching centre under the supervision of one surgeon. Ann R Coll Surg Engl 2008;90:305–9CrossRefGoogle ScholarPubMed
Praseedom, RK, Paisley, A, Madhavan, KK, Garden, OJ, Carter, DC, Paterson-Brown, S. Supervised surgical trainees can perform pancreatic resections safely. J R Coll Surg Edinb 1999;44:16–18Google ScholarPubMed
Jones, CE, Smyth, R, Keys, SC, Ron, O, Stanton, MP, Kitteringham, L et al. Repair of oesophageal atresia by consultants and supervised trainees results in similar outcomes. Ann R Coll Surg Engl 2020;102:510–13CrossRefGoogle ScholarPubMed
Renwick, AA, Bokey, EL, Chapuis, PH, Zelas, P, Stewart, PJ, Ricard, MJ et al. Effect of supervised surgical training on outcomes after resection of colorectal cancer. Br J Surg 2005;92:631–6CrossRefGoogle ScholarPubMed
Hassan, I, Koller, M, Kluge, C, Hoffmann, S, Zielke, A, Rothmund, M. Supervised surgical trainees perform thyroid surgery for Graves’ disease safely. Langenbecks Arch Surg 2006;391:597–602CrossRefGoogle ScholarPubMed
Karlsson, TR, Shakeel, M, Al-Adhami, A, Suhailee, S, Ram, B, Ah-See, KW. Revision nasal surgery after septoplasty: trainees versus trainers. Eur Arch Otorhinolaryngol 2013;270:3063–7CrossRefGoogle ScholarPubMed
Hey, SY, Koo Ng, NKF, McGarry, GW. Endoscopic sphenopalatine artery ligation: general applicability in a teaching unit. Ear Nose Throat J 2019;98:85–8CrossRefGoogle Scholar
Mahendran, S, Bennett, AM, Jones, SE, Young, BA, Prinsley, PR. Audit of specialist registrar training in tympanomastoid surgery for chronic otitis media. J Laryngol Otol 2006;120:193–9CrossRefGoogle ScholarPubMed
Vartiainen, E. The results of chronic ear surgery in a training programme. Clin Otolaryngol Allied Sci 1998;23:177–80CrossRefGoogle Scholar
Aitken, RJ. Lost opportunity cost of surgical training in the Australian private sector. ANZ J Surg 2012;82:145–50CrossRefGoogle ScholarPubMed
Rowlands, RG, Harris, R, Hern, JD, Knight, JR. Day-case paediatric mastoid surgery. Int J Pediatr Otorhinolaryngol 2003;67:771–5CrossRefGoogle ScholarPubMed
Majed, AR, Riaz, AA, Das-Purkayastha, P, Martin, W, Gregg-Smith, SJ. Surgical trainees benefit from good consultant working practices: an audit on the effect on training of a new consultant rota. Postgrad Med J 2006;82:542–4CrossRefGoogle ScholarPubMed
Ruckenstein, MJ, Staab, JP. Who is performing stapedectomy surgery? Implications for residency and fellowship training. Laryngoscope 2008;118:1224–7CrossRefGoogle ScholarPubMed
Navaratnam, AV, Hariri, A, Ho, C, Machin, J, Briggs, T, Marshall, A. Otorhinolaryngology litigation in England: 727 clinical negligence cases against the NHS. Clin Otolaryngol 2021;46:9–15CrossRefGoogle Scholar
Certification Guidelines For Otolaryngology. Joint Committee on Surgical Training London, 2017. In: http://file:///N:/Downloads/Certification%20guidelines%20%20ENT%202017%20FINAL.pdf. [4 March 2022]Google Scholar
Carr, M. Program directors’ opinions about surgical competency in otolaryngology residents. Laryngoscope 2005;115:1208–11CrossRefGoogle ScholarPubMed
Fischer, H, Zehlicke, T, Gey, A, Rahne, T, Plontke, S. Multimodal training concept for temporal bone surgery [in German]. HNO 2021;69:545–55CrossRefGoogle Scholar
Moulton, CA, Dubrowski, A, Macrae, H, Graham, B, Grober, E, Reznick, R. Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg 2006;244:400–9CrossRefGoogle ScholarPubMed
Shea, C, Lai, Q, Black, C, Park, J. Spacing practice sessions across days benefits the learning of motor skills. Hum Mov Sci 2000;19:737–60CrossRefGoogle Scholar
Kanona, H, Virk, JS, Owa, A. Endoscopic ear surgery: a case series and first United Kingdom experience. World J Clin Cases 2015;3:310–17CrossRefGoogle ScholarPubMed
Baruah, P, Lee, J, Pickering, C, de Wolf, M, Coulson, C. The learning curve for endoscopic tympanoplasties: a single-institution experience, in Birmingham, UK. J Laryngol Otol 2020;134:431–3CrossRefGoogle ScholarPubMed
Pothier, D. Introducing endoscopic ear surgery into practice. Otolaryngol Clin North Am 2013;46:245–55CrossRefGoogle Scholar