Otolaryngologic clinics of North America
-
Technical skill is only one component of overall surgical competency, but it has been one of the most difficult to measure. Assessment methods are currently subjective and unreliable, and include techniques such as operative logs, end-of-rotation global assessments, and direct observation without criteria. ⋯ Following the example set in other fields in which high-stakes assessment is paramount, such as in aviation, virtual reality simulators have been introduced to surgical competency assessment and training. Significant work remains to integrate these assessments into both training programs and practice and to demonstrate a resultant improvement in surgical outcome.
-
Otolaryngol. Clin. North Am. · Dec 2007
Comparative StudyFellowship training in otolaryngology-head and neck surgery.
Fellowship training in otolaryngology-head and neck surgery is a relatively new phenomenon that reflects the increasing complexity of clinical medicine. Despite an expansion of fellowship opportunities over the last three decades, there is still incomplete regulation and standardization of fellowship training. ⋯ This article describes the fellowship opportunities that are currently available within the field of otolaryngology. Fellowship training serves as an avenue to gain further credentials and certification, although only the fields of neurotology, pediatric otolaryngology, and sleep medicine are accredited by the ACGME.
-
Otolaryngol. Clin. North Am. · Dec 2007
Historical ArticleThe evolution of surgical training: perspectives on educational models from the past to the future.
Surgical education and training have progressed through the centuries, with the most commonly used model being the apprentice model. With advances in medical knowledge and practice, the apprentice model has evolved and competing models have arisen. However, the apprentice model remains the gold standard today, but for future use, further evolutionary changes will need to be made to the apprentice model if it is to continue to remain an effective education paradigm.
-
The standard for the diagnosis of obstructive sleep apnea (OSA) is polysomnography (PSG). Although PSG helps identify individuals who have OSA and guides medical management, it does not identify the obstruction site or predict surgical results. ⋯ The ideal diagnostic study would identify individuals who have OSA, be cost-effective and readily accessible, and guide therapeutic, site-specific intervention with predictable results. In this article, the various modalities are reviewed in terms of their capability to effectively diagnose and guide treatment of OSA.
-
Otolaryngol. Clin. North Am. · Aug 2007
ReviewPreoperative and postoperative management of obstructive sleep apnea patients.
Safe perioperative management of patients with obstructive sleep apnea (OSA) requires special attention to preoperative and postoperative care. Patients with OSA are more likely to have comorbidities including hypertension, esophageal and laryngopharyngeal reflux disease, coronary artery disease, and obesity. ⋯ OSA increases the risk for anesthetic and postoperative complications. The recommendations for measures for preoperative and postoperative management of OSA presented in this article are based on a culmination of 20 years experience supported by the peer-reviewed medical literature.