Ear Disease Knowledge and Otoscopy Skills Transfer to Real Patients: A Randomized Controlled Trial

OBJECTIVE: To determine which teaching method otoscopy simulation (OS), web-based module (WM), or standard classroom instruction (SI) produced greater translation of knowledge and otoscopy examination skills to real patients. DESIGN: In a prospective randomized controlled nonclinical trial, medical students were randomized to 1 of 3 interventional arms: (1) OS, (2) WM, or (3) SI. Students were assessed at baseline for diagnostic accuracy and otoscopy skills on 5 volunteer patients (total of 10 ears), followed by the intervention. Testing was repeated immediately after intervention on the same patients. Student reported confidence in diagnostic accuracy and otoscopy examination were also captured. Assessors were blinded to the intervention group, and whether students were pre- or post-intervention. SETTING: Clinical Teaching Centre, Queen's University. PARTICIPANTS: Twenty-nine participants were initially randomized. Two students were unable to attend their specific intervention sessions and withdrew. Final group sizes were: OS-10, WM-9, SI-8. Five patients with external/middle ear pathologies were voluntarily recruited to participate as testing subjects. RESULTS: Baseline diagnostic accuracy and otoscopy clinical skills did not differ across the groups. Post-intervention, there were improvements in diagnostic accuracy from all groups: OS (127.78%, 2.30 +/- 1.42, p = 0.0006), WM (76.40%, 1.44 +/- 1.88, p = 0.0499), and SI (100.00%, 1.50 +/- 1.20, p = 0.0093). For otoscopy skills, post intervention improvements were noted from OS (77.00%, 3.85 +/- 2.55, p < 0.0001) and SI (22.20%, 1.25 +/- 1.20, p = 0.0011), with no significant improvement from WM (13.46%, 0.78 +/- 1.92, p = 0.1050). Students across all groups reported significantly improved confidence in diagnostic accuracy (p < 0.0001) and otoscopy skill (p < 0.0001) after the intervention. CONCLUSION: All 3 teaching modalities showed an improvement in diagnostic accuracy immediately post intervention. Otoscopy clinical skills were found to have increased only in OS and SI, with the OS group demonstrating the largest improvement. Simulation-based medical education in Otolaryngology may provide the greatest transfer of medical knowledge and technical skills when evaluated with real patients. (C) 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.