Consistency of medical student education in otolaryngology.

Educating medical students is one of the most important responsibilities and privileges of any otolaryngologist affiliated with a medical school. Offering an excellent, diverse, exciting educational experience for medical students is important for many reasons. Such educational adventures have inspired many medical students to enter our specialty, and a continuing supply of excellent residency applicants requires a continuing supply of medical students who are excited by what they have learned and seen during otolaryngology rotations.

Excellent training is similarly essential for students who do not pursue careers in otolaryngology. Not only is it important for us to teach them the breadth and diversity of Oto-HNS so that they understand what we do and which patients should be referred for otolaryngologic consultation, but it is also critical for us to equip them with a core body of knowledge. Medical students who enter other specialties will treat many people with head and neck complaints. We are obligated to teach medical students enough to understand the complexities of our field, basic management of otolaryngologic disorders and, most importantly, how to recognize problems that exceed their expertise so that they can educate themselves further and/or make appropriate and timely referrals.

In many medical schools, we have a grand total of three weeks to achieve these goals, sometimes augmented by a few clinical correlation lectures and a couple of hours of physical examination training ("gag lab") during the first year or two of medical school.

As if this challenge weren't daunting enough, otolaryngology chairs and program directors commonly are faced with another logistic, academic, and political situation that often compounds the difficulty of assuring good education. In many medical schools, clinical education is conducted at multiple affiliate sites. In some cities, the medical student (and resident) experience at affiliate hospitals may equal or even exceed that at the university hospital (although often this is not the case), but there are invariably differences among various training sites. This can make it difficult not only to ensure reasonably comparable exposure to otolaryngologic diagnosis and surgery, but also to ensure comparable acquisition of core knowledge about otolaryngology at all sites.

Ideally, all affiliate sites are within easy commuting distance of the home institution, and students can spend an academic day or half-day at the university listening to lectures, taking advantage of research and publication opportunities, comparing experience at the different sites (among themselves and with faculty), and recognizing and compensating for any training gaps. However, at many medical schools, some rotation sites are too far distant to permit this approach. For example, although Drexel University College of Medicine is based in Philadelphia, we have academic campuses two hours away in northern New Jersey, and 300 miles away in Pittsburgh. Those centers have good case volume and are staffed by excellent otolaryngologists, or they would not be affiliate training sites; but the availability and consistency of didactic training vary.

Perhaps the most obvious solution to the problem would be videoconference lectures and rounds. While these sound like a good idea and should be encouraged, they present practical difficulties because of the different schedules and commitments at each site. They also may generate costs related to videoconferencing equipment and personnel (depending on the policies of each institution) for which funds usually have not been budgeted. This arrangement can also inspire some disagreement about whether such funding should be provided by the hospital, the medical school, the department, or some other source. Once commitments have been made and funds spent, there also may be repercussions if a faculty member has to cancel a lecture at the last minute.

While interactive videoconferencing is an excellent educational tool that should be used, we also have found online training to be practical. While the technology for this approach has been available for many years, it has not been adopted in otolaryngology as widely as might be desirable. This author would suggest that this approach is worthy of consideration and expansion within our curricula.

In many institutions, residents and faculty give the same lectures to medical students every month. This means leaving the clinic or operating room. Most lectures are good, but the lectures given by the chief resident one year are always somewhat different from the lectures on the same topic given by previous or subsequent chief residents; and it is impossible for the content of every lecture to be reviewed in detail by faculty. This is problematic even with single-site education. It also is questionable whether it is the best possible use of resident and faculty time, or the most useful educational process for the students.

In Philadelphia, we have changed the paradigm. Each medical student is required to listen to 12 online lectures and take a written examination on their content. These lectures were prepared by faculty and produced professionally. They can be taken at the convenience of the student, at times even before his/her otolaryngology rotation begins, if the student is sufficiently inspired. If there were a generally accepted, short, practical otolaryngology text designed to permit the study of otolaryngology during a two- to three-week rotation, that might provide an acceptable alternative. However, most of the current texts provide more information than students can absorb without guidance. In addition, current students find online education convenient, and they are comfortable with it. Requiring that this core knowledge be obtained through standardized online lectures provides a way of equalizing acquisition of core knowledge among the sites. Moreover, it allows faculty and residents to spend their time with the students discussing cases, pursuing problem-based learning, and interacting in ways that seem more meaningful than didactic lectures transmitting knowledge that can be learned equally well before students and faculty meet face-to-face.

Resources such as the online lectures are becoming more widely available. Our lectures were developed for the Graduate Education Foundation (GEF), a nonprofit organization accredited by the Accreditation Council for Continuing Medical Education. The otolaryngology lectures are 12 of approximately 130 lectures developed as CME educational offerings for family practitioners. The GEF (in which I have no commercial interest other than being a contributing author and unpaid advisor) makes these 130 lectures available for educational institutions at little cost, and the otolaryngology lectures can usually be obtained at even less cost (or free) through the GEE (To learn more, visit www.gefcme.org or contact GEF: e-mail: [e-mail] or phone: [phone].)

While these core lectures should not be considered a comprehensive education in otolaryngology, they do provide a start toward the solution to the problem of providing consistent, faculty-approved core knowledge to otolaryngology students. They also may be a useful starting point for other departments as they develop their own online materials. Such lectures are also extremely valuable for office staff, nurses, audiologists, and other interested colleagues. They have been well received by new otolaryngology residents as they enter our program, and by residents who rotate with us routinely from the departments of pulmonary medicine, family medicine, and ambulatory medicine.

It is important for each otolaryngology department to be comfortable that every medical student who completes an otolaryngology rotation has been exposed to the core body of knowledge that each chair considers essential for every practitioner of medicine. This editorial does not address the issue of consistency between institutions, or the advisability of adopting a national curriculum and agreeing on what constitutes minimum core information. That challenging topic may be addressed in a future editorial. However, standard use of faculty-approved online lectures and formal testing has proven useful to our students, residents, and faculty. Further consideration and development of this approach seem warranted.

Robert T. Sataloff, MD, DMA, FACS

Editor-in-Chief

EAR, NOSE & THROAT JOURNAL