Distribution of inadvertently excised parathyroid glands during thyroid surgery and the link with post-surgical hypoparathyroidism.

OBJECTIVES: To evaluate the incidence of inadvertent parathyroidectomy, identify risk factors, determine the location of inadvertently excised glands, review pathology reporting in inadvertent parathyroidectomy, and explore relationships between inadvertent parathyroidectomy and post-surgical hypoparathyroidism or hypocalcaemia. METHODS: A retrospective cohort study of 899 thyroidectomies between 2015 and 2020 was performed. Histopathology slides of patients who had an inadvertent parathyroidectomy and a random sample of patients without a reported inadvertent parathyroidectomy were reviewed. RESULTS: Inadvertent parathyroidectomy occurred in 18.5 per cent of thyroidectomy patients. Central neck dissection was an independent risk factor (inadvertent parathyroidectomy = 49.4 per cent with central neck dissection, 12.0 per cent without central neck dissection, p < 0.001). Most excised parathyroid glands were extracapsular (53.3 per cent), followed by subcapsular (29.1 per cent) and intrathyroidal (10.9 per cent). Parathyroid tissue was found in 10.2 per cent of specimens where no inadvertent parathyroidectomy was reported. Inadvertent parathyroidectomy was associated with a higher incidence of six-month post-surgical hypoparathyroidism or hypocalcaemia (19.8 per cent who had an inadvertent parathyroidectomy, 7.7 per cent without inadvertent parathyroidectomy). CONCLUSION: Inadvertent parathyroidectomy increases the risk of post-surgical hypoparathyroidism or hypocalcaemia. The proportion of extracapsular glands contributing to inadvertent parathyroidectomy highlights the need for preventative measures.

A survey of ENT undergraduate teaching in the UK.

BACKGROUND: ENT presentations are prevalent in clinical practice but feature little in undergraduate curricula. Consequently, most medical graduates are not confident managing common ENT conditions. In 2014, the first evidence-based ENT undergraduate curriculum was published to guide medical schools. OBJECTIVE: To assess the extent that current UK medical school learning outcomes correlate with the syllabus of the ENT undergraduate curriculum. METHOD: Two students from each participating medical school independently reviewed all ENT-related curriculum documents to determine whether learning outcomes from the suggested curriculum were met. RESULTS: Sixteen of 34 curricula were reviewed. Only a minority of medical schools delivered teaching on laryngectomy or tracheostomy, nasal packing or cautery, and ENT medications or surgical procedures. CONCLUSION: There is wide variability in ENT undergraduate education in UK medical schools. Careful consideration of which topics are prioritised, and the teaching modalities utilised, is essential. In addition, ENT learning opportunities for undergraduates outside of the medical school curriculum should be augmented.

Improving clinical undergraduate experience in otolaryngology: an audit of practice.

BACKGROUND: Otolaryngology is under-represented in UK medical schools. This presents challenges in terms of exposing students to the diversity of otolaryngology, as well as 'showcasing' the specialty as a career option. This study aimed to audit the impact of a change in the delivery of final year tuition on student satisfaction. METHOD: Participants were final year medical students completing a 2-day otolaryngology placement. A novel teaching programme was developed in response to feedback from students who completed a baseline teaching programme. The novel programme was evaluated over a 10-week period using questionnaires. RESULTS: Fifty-eight participants completed the novel programme questionnaire. Overall, there was a positive impact on student satisfaction. Students completing the novel programme expressed a desire for increased otolaryngology placement. CONCLUSION: This approach is an effective means of teaching otolaryngology to undergraduates. A mutual desire for greater exposure to otolaryngology in the undergraduate curriculum is held by medical students and otolaryngologists.

A systematic review of factors affecting choice of otolaryngology as a career in medical students and junior doctors.

BACKGROUND: There is growing concern over a future shortfall in provision of UK otolaryngology consultants. There is a declining rate of applications to otolaryngology specialty training in the UK. OBJECTIVE: This study aimed to systematically review the literature to establish what factors influence medical students' and junior doctors' decision to pursue a career in otolaryngology. METHOD: Medline, Embase and PubMed databases were searched in January 2019. Additional manual reference checks of identified literature were performed. RESULTS: Eleven articles were included in the review. Common factors that positively influenced the decision to pursue a career in otolaryngology were exposure to the specialty, positive role models and a good work-life balance. Lack of exposure was a consistent deterrent from pursuing a career in otolaryngology. CONCLUSION: This review reiterates the need for greater exposure to otolaryngology in the undergraduate curriculum. In addition, mentorship for students with an interest in otolaryngology should be a priority.