Training for Awake, Office-Based Laryngeal Procedures-The Laryngology Fellow's Perspective.
laryngology fellowship
laryngology training
office- based procedures
procedure competency
vocal fold injection
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
04 Sep 2023
04 Sep 2023
Historique:
revised:
08
08
2023
received:
10
06
2023
accepted:
22
08
2023
medline:
4
9
2023
pubmed:
4
9
2023
entrez:
4
9
2023
Statut:
aheadofprint
Résumé
The aim was to explore recent laryngology graduates' perspectives on their experience, competency, and challenges learning office-based procedures during fellowship training in the United States and Canada. Anonymous 22-item questionnaire survey was distributed electronically to fellowship-trained laryngologists having completed fellowship within past 5 years. Ninety fellowship-trained laryngologists between 2018 and 2022 were surveyed. Response rate was 48.9% (n = 44), 1 declined participation, with 20 different fellowship programs represented. Fellows were frequently provided the opportunity to act as primary surgeon for most procedures, except for laryngeal botulinum toxin injection, diagnostic laryngeal electromyography, trans-nasal esophagoscopy, secondary tracheoesophageal puncture, and high-resolution pharyngeal manometry. A majority reported high (n = 27, 62.8%) or moderate (n = 12, 27.9%) confidence with vocal fold injection augmentation. Various techniques were taught: transoral (74.4%), cricothyroid (74.4%), thyrohyoid (69.8%), transcartilagenous (14.0%), and catheter-needle (25.6%). Numerous statistically significant associations with independent procedure involvement and competence were identified. Laryngeal botulinum toxin injection was a procedure performed with high frequency but low volume of independent fellow involvement, and the procedure with which fellows reported wanting more practice learning. Most common training barriers included patient being awake, patient consenting to trainee performing the procedure, and the technical challenge/complexity of the procedure. Teaching methods/tools largely focused on informal debriefing (97.3%) and case by case troubleshooting (81.1%). Laryngology fellows are well trained with favorable perceived levels of competence for numerous office-based procedures, particularly vocal fold injection augmentation. Procedures for which fellows reported a low level of independent participation trended towards lower perceived competency. Level 5 Laryngoscope, 2023.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The American Laryngological, Rhinological and Otological Society, Inc.
Références
Abdel-Aty Y, Howard BE, Lott DG. Assessing the breadth of laryngology training in otolaryngology residency programs. J Voice. 2021;35:936 e939-936 e915, 936.e9, 936.e15.
Balouch B, Alnouri G, Vontela S, Tipparaju P, Sataloff RT. Laryngology education in otolaryngology residency programs - a pilot study. J Voice. 2022;36:538-541.
Ossoff RH, Garrett CG, Sataloff RT. Laryngology fellowship. J Voice. 2008;22:517-519.
Sataloff RT. Education in laryngology: rising to old challenges. Ann Otol Rhinol Laryngol. 1999;108:1046-1052.
Bove MJ, Jabbour N, Krishna P, et al. Operating room versus office-based injection laryngoplasty: a comparative analysis of reimbursement. Laryngoscope. 2007;117:226-230.
Birkent H, Sardesai M, Hu A, Merati AL. Prospective study of voice outcomes and patient tolerance of in-office percutaneous injection laryngoplasty. Laryngoscope. 2013;123:1759-1762.
Whited CW, Lubin J, Marka N, et al. Pain experience and tolerance of awake in-office upper airway procedures: influencing factors. Laryngoscope. 2021;131:E1580-E1588.
Young VN, Smith LJ, Sulica L, Krishna P, Rosen CA. Patient tolerance of awake, in-office laryngeal procedures: a multi-institutional perspective. Laryngoscope. 2012;122:315-321.
Hantzakos AG, Khan M. Office laser laryngology: a paradigm shift. Ear Nose Throat J. 2020;100:145561320930648.
Hoffman MR, Francis DO, Mai JP, Dailey SH. Office-based steroid injections for idiopathic subglottic stenosis: patient-reported outcomes, effect on stenosis, and side effects. Ann Otol Rhinol Laryngol. 2020;129:361-368.
Wellenstein DJ, Honings J, Schutte HW, et al. Cost analysis of office-based transnasal esophagoscopy. Eur Arch Otorhinolaryngol. 2019;276:1457-1463.
Enver N, Ramaswamy A, Sulica L, Pitman MJ. Office-based procedure training in laryngology fellowship programs. Laryngoscope. 2021;131:2054-2058.
Mercier E, Chagnon-Monarque S, Lavigne F, Ayad T. Objective assessment of technical skills in otorhinolaryngology-head and neck surgery residents: a systematic review. Otolaryngol Head Neck Surg. 2018;158:54-61.
Mercier E, Guertin L, Bissada E, et al. Assessment of surgical competence for neck dissection: a pilot study. Can J Surg. 2022;65:E178-E187.
Ishman SL, Benke JR, Johnson KE, et al. Blinded evaluation of interrater reliability of an operative competency assessment tool for direct laryngoscopy and rigid bronchoscopy. Arch Otolaryngol Head Neck Surg. 2012;138:916-922.
Ishman SL, Brown DJ, Boss EF, et al. Development and pilot testing of an operative competency assessment tool for pediatric direct laryngoscopy and rigid bronchoscopy. Laryngoscope. 2010;120:2294-2300.
Reder L, Bertelsen C, Angajala V, O'Dell K, Fisher L. Hospitalized patients with new-onset vocal fold immobility warrant inpatient injection Laryngoplasty. Laryngoscope. 2021;131:115-120.
Anis MM, Memon Z. Injection medialization laryngoplasty improves dysphagia in patients with unilateral vocal fold immobility. World J Otorhinolaryngol Head Neck Surg. 2018;4:126-129.
Friedman AD, Burns JA, Heaton JT, Zeitels SM. Early versus late injection medialization for unilateral vocal cord paralysis. Laryngoscope. 2010;120:2042-2046.