This is the first in a series of upcoming articles from the Society of University Otolaryngologists-Head and Neck Surgeons (SUO). We are pleased to be able to contribute to ENT Today, and to inform the readership about the society’s activities.
Explore This IssueMay 2008
SUO was formed in the 1960s; its first meeting was in Ann Arbor, MI. The SUO, according to its mission statement, was created …to provide for the exchange of ideas and relevant information germane to the practice of medicine in an academic setting. SUO membership is for academic faculty.
To join SUO, an otolaryngologist-head and neck surgeon must fulfill the following:
- Hold a faculty appointment in an approved otolaryngology-head and neck surgery residency program, or hold a faculty position in a department/division at an approved medical school.
- Have completed an appropriate residency training program and show promise of a successful career in academic otolaryngology-head and neck surgery as a teacher and/or investigator.
SUO membership is open to faculty with MD or PhD degrees.
The annual meeting of the SUO is held over three days in the fall. The meeting begins Friday afternoon with a popular faculty development course with invited speakers. This course is organized every year by Jo Shapiro, MD, of Harvard Medical School, and is highly rated by attendees. The SUO then meets on Saturday, with an agenda planned by the current president. Typically an invited keynote speaker is included. The meeting concludes on Sunday morning with a short business meeting.
The topics of some recent faculty development courses have been Development and Refinement of Leadership Skills, Handling Disclosure and Apology, and Teamwork, Communication, and Error Prevention: Teaching and Assessing Teamwork Communication Skills. Recent Saturday SUO conferences have addressed Role Models and Mentoring, Challenges in Academic Otolaryngology, and Professionalism: How it is Defined, Measured, and Evaluated.
SUO meetings are collegial and participatory, with time for audience participation and discussion, and the agenda frequently includes panel discussion sessions along with podium presentations to encourage the exchange of ideas. In fact, a frequent SUO attendee has only half-jokingly described SUO meetings as group therapy. Seriously, the exchange of ideas and best practices is very stimulating, as well as being efficient for the specialty, with many tools and concepts circulating among departments after being first discussed at the meeting. Evening cocktail receptions also allow additional time for networking and discussion.
Addressing the Core Competencies
A frequent issue for discussion at SUO meetings is the residency training process. Some recent changes from the Accreditation Council for Graduate Medical Education (ACGME) have generated significant interest and discussion, including compliance with work-hours regulations, changes in the PGY-1 training year, and the implementation of the core competencies.
There are six core competencies that all residency programs must now teach and evaluate:
- Medical knowledge;
- Patient care;
- Systems-based practice;
- Communication and interpersonal skills; and
- Practice-based learning.
On balance, these seem like straightforward, desirable attributes that all practicing physicians should master. Therefore, teaching and assessing these core competencies should improve the overall quality and performance in practice of graduating residents. However, the process of evaluating performance in each of these areas is not easy, and several SUO sessions have provided attendees with tools they can take back to their own programs. For example, the use of portfolios prepared by the resident have been successfully used in the regular assessment of practice-based learning and systems-based practice. Similarly, professionalism and systems-based practice have been addressed using participation in multidisciplinary case-based conferences. Different types of questionnaires-differing in both question format and content-have also been presented. In addition, potential pitfalls with different approaches have been pointed out by speakers with experience in various evaluation techniques.
In another step to improve the lines of communication among residency programs, a residency program directors group has been organized through the SUO; this group will meet for the second time at the 2008 SUO meeting. This is an exciting development for otolaryngology, as most other specialties have similar groups that meet regularly to work on residency training-related issues. The otolaryngology program directors group is being led by a steering committee chaired by Christine Franzese, MD, from the University of Mississippi, in cooperation with members of the residency review committee, and with assistance from the American Board of Otolaryngology. The program directors group will likely become an important and integral part of the SUO in the future.
Even for otolaryngologists not affiliated with a residency program, the core competencies will likely still become part of your professional life in the near future, as the Joint Commission on Hospital Accreditation is encouraging hospitals to credential and evaluate their medical staff based on their competency in the same six areas.
For Further Information
If you are interested in joining or learning more about the SUO, please visit the society’s Web site at www.suo-aado.org . The theme of the 2008 SUO meeting, which will be held October 24-26 at the InterContinental Hotel in Chicago, will be Educational Excellence across the Spectrum: From Students to CME.
A New Feature for ENT Today
With this article, Michael G. Stewart, MD, President of the Society of University Otolaryngologists, begins a series of columns in ENT Today not only from the SUO, but also from other otolaryngology-head and neck surgery societies.
Having spent my career in academic otolaryngology, I feel a particularly close relationship with the SUO. Although I attend the excellent meetings of other groups, I find the SUO meetings the most relevant and interesting of all the meetings in which I participate. It is truly a gathering of individuals with common interests and issues specifically relating to academic otolaryngology. With its sessions on resident education, career development, and other very practical issues, the SUO provides an incredible opportunity for young academic otolaryngologists to learn from those who have been there, done that. We old dogs also learn a few new tricks as well. In addition, the opportunity for professional networking and the development of what has turned out to be for me strong, lifelong friendships have been some of the most important outcomes of membership in the SUO.
I strongly encourage anyone who is in academic otolaryngology to join the SUO and participate actively in the society. I believe you will find the SUO truly brings value to its members.
Robert H. Miller, MD, MBA
Chair, Editorial Board
News & Notes
Medical Students, Residents Hesitant about Disclosing Medical Errors to Patients
Even though patients endorse the disclosure of harmful medical errors, such disclosure seems to be uncommon. There is little data regarding trainees’ attitudes about and experiences with medical errors, or their experience in disclosing errors to patients. However, the available literature suggests that most trainees have been personally involved with errors and that discussing these with patients presents substantial challenges. The March issue of Academic Medicine contains a report on a multicenter cross-sectional survey of trainees that explored their attitudes and experiences with medical errors and their disclosure.
The questionnaire, which used the Institute of Medicine’s definitions of adverse event, medical error, and near miss, asked respondents-medical students, interns, and residents-about key safety topics, such as whether medical errors are a serious problem and how frequently these errors occur. Question topics included what types of errors should be disclosed, potential barriers to disclosure, and respondents’ personal experiences with errors and their disclosure.
Most respondents agreed that medical error is one of the most serious problems in health care, and believed that there are relatively common. Most respondents also reported personal involvement with errors. Although virtually all trainees agreed that serious errors should be disclosed to patients, almost all felt that disclosure would be difficult, and only one-third of residents reported ever disclosing a serious error to a patient. Only about one-third of trainees said that they had received education in error disclosure techniques, although almost all said that they were interested in such training.
The authors conclude from these results that trainees perceive significant barriers to error disclosure and that they will enter practice without adequate disclosure skills unless new training programs are implemented. They say that medical educators and institutions should develop and disseminate formal disclosure guidelines regarding the role of trainees in the disclosure process. Formal disclosure curricula, along with closely mentored opportunities to disclose errors to patients, could provide powerful learning opportunities. Disclosure education should include formal lecture material, coaching from attending physicians, and the opportunity to practice disclosure skills and receive feedback.
Does Maxillary Sinus Wash Improve Adenoidectomy Outcome?
The first line of treatment for chronic rhinosinusitis (CRS) in children is antibiotics, nasal steroid sprays, and nasal saline rinses. However, a small percentage of patients will continue to exhibit disease despite appropriate medical management, and therefore may require surgical intervention. Adenoidectomy as treatment for CRS has a high revision rate in younger children. Previous studies have suggested that a sinus wash be performed at the time of adenoidectomy, and children should be treated with intravenous antibiotics for several weeks postoperatively. No studies have been done, though, on sinus wash independent of antibiotic treatment. Therefore, Hassan H. Ramadan, MD, MSc, and Jamey L. Cost, MD, performed a prospective study comparing children who had adenoidectomy alone with children who underwent adenoidectomy with a maxillary sinus wash but no intravenous antibiotics.
All patients in the study were referred to the tertiary hospital because of refractory CRS that had been treated for at least six months, and had continuous symptoms despite allergy evaluation and CT documentation of rhinosinusitis. After evaluation of the CT scans, either an adenoidectomy or an adenoidectomy with maxillary sinus wash of the opacified sinuses was performed. Allocation of the patients was not random, but rather was based on the surgeon’s and parents’ preferences. All children were followed up after surgery at one, three, six, nine, and 12 months.
Sixty children satisfied the inclusion criteria. Thirty-two had maxillary sinus wash at the time of adenoidectomy (wash/A) and 28 had adenoidectomy only (A). The two groups were comparable with regard to age, sex, presence of allergies, asthma, and smoking in the household. The wash/A group had more severe disease, however-the mean CT score of this group was 7.9, compared with 3.0 for the A group.
Of the 32 children who underwent wash/A, 28 (87.5%) showed improvement of their symptoms at 12-month follow-up, compared with 17 (60.7%) of the patients in the A group. The investigators analyzed the data using CT score as a predictor of which children would do better with A alone and which with wash/A. They found that children with a high CT score had a 93% success rate with wash/A, versus 60% for those who had A only. There was no statistically significant difference between wash/A and A alone for children with a low CT score, however, although there was a trend for better outcome in the wash/A group. Multivariable analysis using logistic regression analysis with age, sex, asthma, allergy, and CT score as covariables showed that the success of wash/A compared with A alone remained significant; none of the other variables demonstrated statistical significance.
The researchers conclude that a sinus wash at the time of adenoidectomy for children with a high CT score led to an improved outcome compared with adenoidectomy alone, independent of oral or parenteral antibiotic management.
Efficacy of Nodal Dissection for Recurrent Papillary Thyroid Cancer
Although papillary thyroid cancer (PTC) generally has an excellent prognosis with regard to mortality, eventual recurrence in the thyroid bed or neck has been reported in up to 30% of patients. These locoregional recurrences may be associated with significant morbidity as well as long-term mortality in higher-risk patients. For patients with locoregional recurrences, both adjuvant radioiodine therapy and lymph node dissection (LND) have been advocated; however, the relative safety and efficacy of these two treatment modalities are unclear. Recent American Thyroid Association guidelines recommend surgery for bulky disease or disease that is amenable to a surgical approach, but also report that radioiodine is often used in place of surgery. Furthermore, if surgery is chosen as the treatment modality, the optimal extent of surgical dissection remains undefined. Kathryn G. Schuff, MD, and associates report on a retrospective analysis of the safety and efficacy of surgical management of persistent/recurrent PTC in a group of patients who underwent selective central or lateral LND by one surgeon, who used a systematic approach to treatment planning.
The study population included all patients with persistent/recurrent PTC who underwent central compartment or cervical LND during a 26-month period. Seventy-five patients met the inclusion criteria; a total of 79 resections were performed on these 75 patients. All patients had previously undergone total thyroidectomy, and most had also received radioiodine ablation. Previous LND had been performed in 57 patients, although the extent of the dissections varied widely. Of the 79 dissections, all were included in the safety analysis, and 41 met the criteria for efficacy analysis.
Nodal involvement with PTC in the central or lateral compartments was found in 91% of the resections. There were 25 minor complications among the 79 resections, and seven major complications, including permanent hypoparathyroidism, significant abscess, and pulmonary embolism after deep venous thrombosis. Neither prior nodal dissection, extent of nodal dissection, nor extent of disease were predictive of surgical complications.
The authors used a systematic, individualized approach to LND based on initial tumor site, prior surgical therapy, known pathways of nodal spread, and higher efficacy of formal nodal dissection over berry picking. This approach led to a cure rate of 41% of classifiable resections, using the criterion of postoperative stimulated thyroglobulin (Tg) of 2 ng/dL or less. In addition, 72% of resections had either cure or postoperative reductions of more than 50% in Tg levels, the primary serum marker of well-differentiated thyroid cancer persistence/recurrence.
The investigators conclude that, in experienced hands, systematic and individualized compartment-based nodal dissection is a safe and efficacious treatment for persistent/recurrent PTC, at least in the short term. They state that larger, longer-term studies will be necessary to further define efficacy and safety rates for this type of surgical approach.
©2008 The Triological Society