IntroductionAirway hemorrhage requires rapid treatment to prevent adverse patient outcomes. Simulation education programs are challenged to recreate learning environments with adequate fidelity for team management of airway hemorrhage.MethodsWe developed Airway Hemorrhage Simulation Scenarios consisting of low-cost partial-task simulators to mimic airway hemorrhage (nasopharyngeal, oropharyngeal, expanding neck hematoma) and multiple methods to assess team leader performance in emergent airway management [Airway Team Leader Assessment Tool (ATLAT), Airway Checklist Performance, and Global Performance Rating]. We assigned trainees in Emergency Medicine (EM) and Critical Care (CC) sequentially to 1 of the 3 possible hemorrhage scenarios, and each trainee participated in a single 1-hour session composed of 3 repeated opportunities of deliberate practice of the assigned scenario. We assessed the trainees after session 1 and session 3 with independent expert evaluators of trainee performance using the ATLAT, Airway Checklist Performance, and Global Performance Rating.ResultsWe collected data on 26 trainees: 19 EM residents [postgraduate year (PGY) 1-3] and 7 CC fellows (PGY 4-7). Trainees had significant improvement for all ATLAT domain measures, Airway Checklist Total Score, and Global Performance Rating between session 1 and session 3.ConclusionsOur pilot evaluation suggests that deliberate practice of Airway Hemorrhage Simulation Scenarios improves airway team leader performance from multiple disciplines in managing high-acuity, low-occurrence airway hemorrhage.

BACKGROUND:To determine if the utilization of selective serotonin reuptake inhibitors (SSRIs) increases the risk of osteomyelitis as a sequela of dental implant failure. We also report the case of a patient on long-term SSRIs who presented with dental implant failure and subsequently developed mandibular osteomyelitis.METHODS:We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) in PubMed, Google Scholar and Embase, for all records pertaining to SSRIs, dental implants, and mandibular osteomyelitis.RESULTS:SSRIs are associated with increased risk of dental implant failure, and our results suggest that they may be independently associated with mandibular osteomyelitis in the setting of implant failure. Though there was no evidence of mandibular osteomyelitis specifically following SSRI-related dental implant failure, there were a few case reports on osteomyelitis resulting from failed dental implant osseointegration.CONCLUSIONS:In the context of long-term SSRI utilization, our findings suggest that osteomyelitis should be considered in the differential diagnosis of patients with recent dental implant placement or failure.

An understanding of system science is fundamental to addressing safety across all disciplines. As patient safety is a primary learning goal of all healthcare educational programs, acquiring an appreciation for the impact that system design has in either reducing, or (unfortunately) sometimes increasing, the risk of avoidable harm. The increasing use of simulation education across all domains of healthcare provides a unique opportunity to enhance this learning. This chapter reviews the unexpected educational benefit of simulation based use-error research in several studies by one of the authors (JE), and then proposes several innovative strategies that incorporate system educational objectives into standard simulation scenarios. These proposed strategies, as well as the potential expansion of simulation-embedded system science education to other learner groups, such as healthcare organizational leadership, is discussed.

Purpose of ReviewFrailty and polypharmacy are conditions commonly encountered in older otolaryngology patients and impact their symptoms as well as treatment decision-making.Recent FindingsA number of frailty assessment tools are available and in active use. Retrospective studies of large cohorts of patients identify a close correlation between measures of frailty and outcomes. Prospective assessment to inform decision-making remains challenging in clinical practice. The definition of "too many" medications, often termed polypharmacy, remains controversial. Management can be considered a form of "personalized medicine," as each patient has different goals and tolerance for unintended medication effect. The impact of medications on balance function is well recognized, however, reports on the role of medications on upper aerodigestive tract symptoms have been less salient or non-existent. It is the author's opinion this impact represents an opportunity for more extensive study.SummaryOtolaryngologists who manage older adults need to be cognizant of the current knowledge regarding frailty and polypharmacy as these conditions often dramatically impact decision-making in the management of patients with otolaryngologic disorders. Additional studies are needed to address the role of medications on upper aerodigestive tract physiology.

Previous research in the US Navy demonstrated that cross-training enhances teamwork and interpersonal collaboration. Limited data exists on cross-training effectiveness in medical education. This research aimed to assess whether cross-training would have similar effects on medical teams. A multidisciplinary pair of resident participants—consisting of one physician and one pharmacist—was randomly assigned to cross-training or current training condition. The training experience involved one video-based content module (training a pharmacist’s task of pharmacokinetic dosing and a physician’s task of intubation) and one simulation-based practice scenario (collaborative treatment of an unstable critically ill simulated patient). Interprofessional pairs randomized to cross-training condition participated in both the content module and practice scenario in the alternative professional role whereas pairs randomized to current training condition participated in their own professional role. Pairs also participated in pre- and post- training assessment scenarios in their own professional role. Teamwork and interprofessionalism were measured immediately following assessment scenarios. Knowledge assessments were conducted at the start and end of the scenario sequence. Multidisciplinary pairs experiencing cross-training showed a significant improvement in teamwork (increased by 6.11% vs. 3.24%, p < 0.05). All participants demonstrated significant improvement in knowledge scores (increase of 14% cross-training, p < 0.05, and increase of 13.9% control, p < 0.05). Our project suggests that cross-training can improve teamwork in interprofessional medical teams.

The VA has developed a tool to search its Corporate Data Warehouse, which provides easy access to patient data for better clinical decision making.

Objectives/HypothesisFellowship is the capstone of academic training and serves as preparation for an academic career. Fellows are expected to educate medical students and residents during and long after fellowship. However, little time is typically spent teaching fellows to become effective educators. We investigate a formal curriculum addressing teaching skills among fellows in otolaryngology–head and neck surgery (OHNS).Study DesignE‐mail survey.MethodsWe developed and implemented an educational program called Teach the Teacher to build skills as educators for fellows in OHNS. We conducted a survey of fellows from 2014 to 2017 in OHNS who participated in the course. The survey evaluated demographics, teaching experiences, and teaching limitations structured as yes/no and Likert‐style questions (1 = strongly disagree, 5 = strongly agree).ResultsThirty fellows were surveyed with a response rate was 80%. Fellowship was rated highly as an experience that will make fellows a better academic educator (mean ± standard deviation: 4.54 ± 0.64). The most important components of teaching during fellowship were role modeling (4.67 ± 0.62), followed by teaching psychomotor skills in the operating room (4.29 ± 0.89), diagnostic reasoning (4.25 ± 0.66), and evidence‐based medicine (4.25 ± 0.83). The Teach the Teacher course specifically was rated as a helpful experience (4.00 ± 0.90). The primary limitations to developing teaching skills during fellowship identified were lack of time, patient safety, and inexperience with hospital culture.ConclusionsFellowship is a key time to improve skills as academic educators. Fellows value formal efforts to teach academic skills.Level of EvidenceNA. Laryngoscope, 128:2034–2048, 2018

Sub-specialization within otolaryngology, like other specialties, is driven by accumulation of new knowledge and technology. For a variety of reasons, the establishment of a new subspecialty of geriatric otolaryngology is unlikely. Education of all otolaryngologists in the basic principles of gerontology and geriatric otolaryngology is achievable and represents a preferred strategy.

Frailty and Polypharmacy commonly impact disease processes and treatment of patients with otolaryngologic disorders. Although well known to geriatricians, the 2 concepts often elude other physicians, including otolaryngologists. This article reviews the common manifestations likely to be encountered in otolaryngology patients, reviews frailty measures in surgical patients, and makes recommendations regarding education of nongeriatricians.

Medical device use errors, such as instrument connection errors made with electrosurgical units (ESUs), can lead to adverse events. Current device acquisition processes at health care facilities do not typically include a proactive evaluation of use-error risk before device purchase. We conducted an evaluation to identify ESU user interface design features that can help prevent or mitigate instrument connection errors during clinical care. Thirty-six current ESU users participated in the evaluation. We used a randomized crossover design in which each participant used two ESU models in a simulated OR scenario. We compared participants' instrument connection accuracy, efficiency, and subjective feedback regarding the user interface design across the two ESU models. Overall, we found that the ESU model that incorporated more user interface design principles resulted in better performance and increased acceptance from users. Based on the results, we designed a decision-support tool to assess the risk of instrument connection errors before ESU purchase.

Geriatric dysphagia is an unrecognized and underdiagnosed problem with significant morbidity and potential mortality. It requires diligence by the clinician and a team approach for successful management. Careful history-taking is the key in the treatment of these patients and determines further workup, as well as treatment.

Balance disorders are common in the elderly and can lead to falls, with resultant severe morbidity and even mortality. Progressive loss of vestibular function begins in middle age and is affected by multiple disease processes. Polypharmacy impacts many disease processes in the elderly, with balance function being one of the most susceptible. Evaluation of the older patient with a balance disorder is critical for the well-being of these patients, as it may drive intervention. This article reviews balance disorders often encountered in older patients and makes recommendations regarding education of nonotolaryngologists.

Objective Several factors contribute to medication errors in clinical practice settings, including the design of medication labels. The objective of this study was to quantify the impact of label design on medication safety in a realistic, high-stress clinical situation. Methods Ninety-six anesthesia trainee participants were randomly assigned to either the redesigned or the current label condition. Participants were blinded to the study's focus on medication label design and their assigned label condition. Each participant was the sole anesthesia provider in a simulated operating room scenario involving an unexpected vascular injury. The surgeon asked the participant to administer hetastarch to the simulated patient because of hemodynamic instability. The fluid drawer of the anesthesia cart contained three 500-ml intravenous bags of hetastarch and one 500-ml intravenous bag of lidocaine. We hypothesized that redesigned labels would help participants correctly select hetastarch from the cart. If the participants incorrectly selected lidocaine from the cart, we hypothesized that the redesigned labels would help participants detect the lidocaine before administration. Results The percentage of participants who correctly selected hetastarch from the cart was significantly higher for the redesigned labels than the current labels (63% versus 40%; odds ratio, 2.61 [95% confidence interval, 1.1–6.1]; P = 0.03). Of the participants who incorrectly selected lidocaine from the cart, the percentage who detected the lidocaine before administration did not differ by label condition. Conclusions The redesigned labels helped participants correctly select hetastarch from the cart, thus preventing some potentially catastrophic medication errors from reaching the simulated patient.

A patient presented with esophageal adenocarcinoma, pulmonary small-cell carcinoma, and high-grade carcinoma, which is a rare occurrence that required a staged multidisciplinary approach to treatment.