Recruitment, Evaluation, Regionalization Among Novel Challenges to the Specialty

Much effort is being directed to create an effective assessment formula incorporating multiple evaluative elements. No single dependable formula exists to measure the graduate’s competencies in varied and disparate environments, he said.

Right now, technical skills are the most weakly assessed. A recent study of 72 US otolaryngology HNS program directors found that 69 used subjective evaluations, and objective structured assessments of technical skills was used in only 11 of the 72 programs.

In otolaryngology-HNS surgical training, the standards for the evaluation of surgical competency fall below a level that we should expect, he said. To improve this, Dr. Cummings suggested that the specialty draw on experiences from the aviation industry to improve standards in training and competency, as other medical researchers have suggested.

Paradigms from aviation that could be applied to surgical training include testing applicants for innate dexterity and personality traits; defining a designated learning objective for each clinical encounter; developing a checklist of objectives for residentt/fellowship rotations; dissecting benchmark operations into essential steps that are drilled with deliberate practice in skill trainers and the operating room; having a checklist of essential skills (for both operative and other tasks) for tracking residency training and competency; and having residents use the designated learning objectives in a way so that learning is more active than passive.

Global Participation

Looking at HNS from a more global perspective is useful for the profession too.

Globally, the volume of head and neck tumor cases is huge, and the number of experienced surgeons is relatively infinitesimal-a scenario that cries out for linkages to our surgical training programs and fellowships, Dr. Cummings said.

Having some of these cases treated by our trainees would elevate the quality of care for the afflicted and contribute in a most positive way for the trainee to gain the experience and judgment expected of the mature head and neck surgeon, he said. Worldwide, he noted, there is a shortage of 4.3 million health care workers, with Africa alone being short by a million even though it bears 25% of the global burden of disease.

Physicians have a responsibility to get involved in global foundations that help people in other parts of the world, he said. Not only will it help people in need, but it gives doctors a wide experience in terms of working with a variety of cases, as well as working under different circumstances.