ABSTRACT
INTRODUCTION: The COVID-19 pandemic has caused unprecedented disruptions to medical education. Education in medical specialties, such as otolaryngology faces multiple challenges, including reduced bedside and "hands-on" training opportunities at all levels. Educators are turning to technological advancements to deliver effective remote medical education. This study investigated the value of enhancing traditional remote case-based teaching with the HoloLens2™. METHODS: We present a randomized educational design study. All educational content, media, and learning outcomes were identical. Primary outcome measures included student performance as measured with pre- and post-intervention quizzes and student engagement as measured by a tally-mark system. Secondary outcome measures, collected using feedback questionnaires, included perceived enjoyment, engagement, and opinions regarding the educational role of this technology. RESULTS: The undergraduate medical students were randomized to either conventional or HoloLens2™ enhanced remote case-based teaching (n = 56). HoloLens2™ enhanced teaching improved student performance by an average of 3 marks of 15% (p < 0.001). It was engaging and encouraged questions 4-fold per session (p < 0.05) when compared to conventional remote case-based teaching. There was no significant difference in overall objective measurements of engagement. Students taught using HoloLens2™ agreed that the teaching was enjoyable, effective in concept demonstration, and encouraged engagement. CONCLUSIONS: Remote teaching has allowed for the continuation of medical education in uncertain times. Beyond COVID-19, we predict that there will be a paradigm shift toward remote learning as new technological advancements emerges. These novel technologies may prove invaluable in the future potentially enabling education to be delivered between different hospitals, universities, and even overseas. LEVEL OF EVIDENCE: NA Laryngoscope, 2022.
ABSTRACT
OBJECTIVE: To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy. STUDY DESIGN: Prospective observational study. SETTING: Single institution across 3 hospital sites during the first wave of the COVID-19 pandemic. METHODS: Patients who were intubated for respiratory wean tracheotomy underwent SARS-CoV-2 PCR nasal, throat, and endotracheal tube swabs at the time of the procedure. These were assessed via quantitative real-time reverse transcription PCR. The tracheal tissue excised during the tracheotomy was cultured for SARS-CoV-2 with Vero E6 and Caco2 cells. Serum was assessed for antibody titers against SARS-CoV-2 via neutralization assays. RESULTS: Thirty-seven patients were included in this study. The mean number of days intubated prior to undergoing surgical tracheotomy was 27.8. At the time of the surgical tracheotomy, PCR swab testing yielded 8 positive results, but none of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patients who had serum sampling demonstrated neutralization antibodies, with a minimum titer of 1:80. CONCLUSION: In our series, irrespective of positive PCR swab, the likelihood of infectivity during tracheotomy remains low given negative tracheal tissue cultures. While our results do not undermine national and international guidance on tracheotomy after day 10 of intubation, given the length of time to procedure in our data, infectivity at 10 days cannot be excluded. We do however suggest that a preoperative negative PCR swab not be a prerequisite and that antibody titer levels may serve as a useful adjunct for assessment of infectivity.