Poor Online Patient Ratings of Otolaryngologists in the United States: What are Patients Saying?

OBJECTIVES: Online patient forums have become a platform for patient education and advocacy in many areas of medicine. The anonymity provided by such forums may encourage honest, candid responses. Using patient online reviews, this study sought to explore themes that arose from negatively perceived care interactions with American otolaryngologists using the Accreditation Council for Graduate Medical Education (ACGME) competency framework. STUDY DESIGN: Qualitative thematic analysis. METHODS: Through an iterative multistep process, a qualitative thematic analysis was conducted on negative reviews (defined as ratings of two or less out of five) of all American otolaryngologists found on a popular online physician-rating website (RateMDs.com). RESULTS: A systematic search through the RateMDs website revealed 2950 separate comments of negative reviews. Of these negative reviews, 350 were randomly selected for thematic analysis. The predominant themes that emerged aligned closely with the Accreditation Council for Graduate Medical Education (ACGME) competencies, in particularly with professionalism and interprofessional skills and communication. CONCLUSIONS: The negative reviews of American otolaryngologists revealed a number of areas where improvements could be made to quality of care. Patients value evidence-based medicine delivered by compassionate and respectful physicians. Isolating and aligning predominant themes within the ACGME framework proved a productive method to collect and organize pertinent patient feedback and integrate teaching into the post-graduate training and continuing professional development in order to avoid such negatively perceived interactions in the future.

Long-Term Results of a Pedicled and Innervated Sternocleidomastoid Muscle Flap to Immediately Reconstruct Superficial Parotidectomy Defects.

Importance: Conventional reconstruction techniques for superficial parotidectomy have been criticized for their ability to provide long-term volumetric correction and to prevent Frey's syndrome. Objective: To demonstrate the long-term effectiveness of a pedicled and innervated sternocleidomastoid muscle flap (PISCMMF) to reconstruct superficial parotidectomy defects. Design, Setting, and Participants: This is a retrospective cohort study of patients treated by a single surgeon in a tertiary care center from July 2012 to March 2018. Seventeen of a possible 34 eligible adults having undergone reconstruction with a PISCMMF for benign parotid disease with at least 1 year of follow-up were included through convenience sampling. Patients with revision parotid surgery, malignant parotid tumors, neck dissections, or prior spinal accessory nerve dysfunction were excluded. Intervention: A PISCMMF was used to immediately reconstruct superficial parotidectomy defects. Main Outcomes and Measures: Participants underwent three-dimensional facial imaging, starch-iodine testing for Frey's syndrome, and completed a validated satisfaction questionnaire. The surface area of the positive starch-iodine tests was calculated. An average model was generated from participant images, allowing the calculation of surface millimeter differences comparing the operative with nonoperative sides. Results: Seventeen patients [7 male (41.2%), mean age 50.82 ± 12.37 years] underwent a PISCMMF to reconstruct excision (mean specimen weight = 21.45 ± 12.22 g) of benign lesions [9 pleomorphic adenomas (52.9%), 5 Warthin's tumors (29.4%), 2 cysts (11.8%), 1 chronic parotitis (5.9%)], with a mean follow-up time of 35.41 ± 12.30 months. Rates of objective and subjective Frey's syndrome were 29.4% and 11.8%, respectively. The average surface area affected was 2.32 cm2 [standard deviation (SD) = 1.95 cm2] compared with the average surface area of 16.35 cm2 (SD = 9.20 cm2) of the excised specimens. Facial symmetry analysis revealed an average millimeter difference of -1.57 ± 2.55 mm that was not significant at a threshold of 2 mm [t(16) = 0.69, p = 0.50]. No participants had postoperative shoulder or neck dysfunction. Overall satisfaction was 95.4%. Age (ß = -0.51, p = 0.02) and case number (ß = 0.44, p = 0.04) were significant predictors of smaller millimeter difference (R2 = 0.48, F(2,14) = 6.41, p = 0.01). The specimen mass (ß = -0.05, p = 0.35) did not predict millimeter difference (R2 = 0.11, F(1,8) = 0.10, p = 0.35). Conclusions and Relevance: A PISCMMF immediately reconstructing parotidectomy defects successfully restores facial symmetry, prevents clinically significant Frey's syndrome, and results in high patient satisfaction in the long term without significant morbidity.

Effectiveness of e-Learning in a Medical School 2.0 Model: Comparison of Item Analysis for Student-Generated vs. Faculty-Generated Multiple-Choice Questions.

BACKGROUND: Early reports in the literature describe using student-generated questions as a method of student learning as well as augmenting question exam banks. Reports on the performance of student-generated questions versus faculty-generated questions, however, remain limited. This study aims to compare the question performance of student-generated versus faculty-generated multiple-choice questions (MCQ). OBJECTIVES: To determine if student-generated questions using mobile audience response systems and online discussion boards have similar item discrimination scores as faculty-generated questions. METHODS: A team-based learning session was used to create 113 student-generated multiple-choice questions (SGQs). A 20 question MCQ quiz was presented to a second year medical school class made of 10 randomly selected SGQs and 10 randomly selected faculty-generated multiple-choice questions (FGQs). Item analysis was performed on the test results. RESULTS: The data showed no statistical difference in the point-biserial scores between the two groups (average point-biserial 0.31 students vs 0.36 faculty, p=0.14), with 90% of student-generated and 100% of faculty-generated questions meeting a cut-off of point-biserial score >0.2. Interestingly, student-generated questions were statistically more difficult than the faculty-generated questions (Item Difficulty score 0.46 students vs 0.69 faculty, p=0.003). CONCLUSIONS: This study suggests that student-generated compared to faculty-generated MCQs have similar item discrimination scores, but are perhaps more difficult questions.

Using Simulation Technology to Improve Patient Safety in Airway Management by Practicing Otolaryngologists.

OBJECTIVE: Simulation technology provides a safe environment to learn crisis resource management in stressful clinical scenarios, such as the acute airway. While a number of surgical simulation studies have assessed trainees, there remains a paucity of data on simulation benefits for practicing physicians. The objective of this study was to investigate the impact of a simulation symposium on airway management for practicing otolaryngologists. METHODS: Questionnaires (5-point Likert and open-answer questions) and interviews were distributed and conducted at a simulation symposium on airway management held at an annual meeting. RESULTS: The majority of participants had no prior experience in simulation (62.5%). The data suggested a strong increase in comfort with airway management scenarios (2.93 to 4.09 (p<0.001)). Participants reported the symposium as relevant (4.68) and useful (4.67), with increased confidence about their knowledge of crisis resource management and team training (4.53). Qualitative data suggested great educational value for technical skills and communication strategies. CONCLUSION: Simulation with feedback may provide an opportunity for the practicing otolaryngologist to fulfill Continuing Medical Education and Professional Development requirements. This symposium allowed practicing otolaryngologists, including those in the community, to learn, develop, and refresh technical and communication skills while fulfilling certification requirements.

Mobile Audience Response Systems at a Continuing Medical Education Conference.

BACKGROUND: Mobile audience response systems (mARS) are electronic systems allowing speakers to ask questions and audience members to respond anonymously and immediately on a screen which enables learners to view their peers' responses as well as their own. mARS encourages increased interaction and active learning. OBJECTIVES: This study aims to examine the perceptions of audience members and speakers towards the implementation of mARS at a national medical conference. METHODS: mARS was implemented at the CSO Annual Meeting in Winnipeg 2015. Eleven presenters agreed to participate in the mARS trial. Both audience and presenters received instructions. Five-point Likert questions and short answer questions were emailed to all conference attendees and the data was evaluated. RESULTS: Twenty-seven participants responded, 23 audience members and 4 instructors. Overall, responders indicated improved attention, involvement, engagement and recognition of audience's understanding of topics with the use of mARS. mARS was perceived as easy to use, with clear instructions, and the majority of respondents expressed an interest in using mARS in more presentations and in future national medical conferences. Most respondents preferred lectures with mARS over lectures without mARS. Some negative feedback on mARS involved dissatisfaction with how some presenters implemented mARS into the workshops. CONCLUSION: Overall mARS was perceived positively with the majority of respondents wanting mARS implemented in more national medical conferences. Future studies should look at how mARS can be used as an educational tool to help improve patient outcomes.

Tips for using mobile audience response systems in medical education.

BACKGROUND: With growing evidence on the benefits of active learning, audience response systems (ARSs) have been increasingly used in conferences, business, and education. With the introduction of mobile ARS as an alternative to physical clickers, there are increasing opportunities to use this tool to improve interactivity in medical education. AIM: The aim of this study is to provide strategies on using mobile ARS in medical education by discussing steps for implementation and pitfalls to avoid. METHOD: The tips presented reflect our commentary of the literature and our experiences using mobile ARS in medical education. RESULTS: This article offers specific strategies for the preparation, implementation, and assessment of medical education teaching sessions using mobile ARS. CONCLUSION: We hope these tips will help instructors use mobile ARS as a tool to improve student interaction, teaching effectiveness, and participant enjoyment in medical education.

Medical school 2.0: How we developed a student-generated question bank using small group learning.

BACKGROUND: The multiple-choice question (MCQ) is one of the most common methods for formative and summative assessment in medical school. Common challenges with this format include (1) creating vetted questions and (2) involving students in higher-order learning activities. Involving medical students in the creation of MCQs may ameliorate both of these challenges. What we did: We used a small group learning structure to develop a student-generated question bank. Students created their own MCQ based on self-study materials, and then reviewed each other's questions within small groups. Selected questions were reviewed with the class as a whole. All questions were later vetted by the instructor and incorporated into a question bank that students could access for formative learning. Post-session survey indicated that 91% of the students felt that the class-created MCQ question bank was a valuable resource, and 86% of students would be interested in collaborating with the class for creating practice questions in future sessions. CONCLUSIONS: Developing a student-generated question bank can improve the depth and interactivity of student learning, increase session enjoyment and provide a potential resource for student assessment.