Challenges of Practical Training in Otorhinolaryngology : Contribution of Health Simulation in a University Hospital

Abstract

(EN) Ear, nose and throat (ENT) is a discipline that requires both theoretical knowledge and technical and procedural skills. The anatomy of the head and neck region is complex and requires visualization and orientation skills in a restricted three-dimensional space. These anatomical regions are accessible through specific instruments: microscopes, angled endoscopes, .... In Belgium, the specialisation master's degree lasts five years after the end of medical school and varies from four to five years in other European countries. Moreover, the training is only a small part of the life of young doctors, who also deal with the daily clinical responsibilities of hospital work.

The idea for this project arose from a reality on the ground, contrasting two facts:

On the one hand, the training methods for assistants have undergone reorganization with an overall trend towards standardisation at European level (1) with the formation of the European Examination Board and the establishment of a training convention. On the other hand, there is a trend towards a shorter theoretical training period for new candidates (medical studies in 6 years). There has also been an increase in the number of clinical assistants and trainees in universities, with the particular case of the double cohort in 2018. These facts are associated with an overall stable number of senior operating theatre supervisors, who are subject to hospital profit and safety constraints.

This situation therefore seems to limit the possibilities for practical learning during specialisation, since they are mainly based on the principle of companionship (see dedicated section). This may therefore lead to disappointment at the end of the training with gaps and a limitation of the efficiency of the training as it is currently proposed. When trying to reconcile increased training requirements with limited training time, the current literature offers an increasing number of teaching tools, some of which are simulation-based, at different stages of validation, accessible and available.

It was therefore important to define the notion of "simulation". The simulation techniques specific to ENT will then be described via a review of the literature which retains the essential points with an evaluation of their interest for initial and continuing education. We will also compare international practices, also through the literature. A visit to a reference centre in this field (Nancy School of Surgery, Professor Cécile Parietti) enabled us to clarify the reality of these practices in the field. Some notions of educational psychology applied to hospital environment and to surgery will be discussed in order to broaden our vision and understand how the operating theatre remains a very specific learning environment.

We will then present three studies conducted in our institution. The first was a survey to establish a national overview of the quality assessment of practical ENT training from the point of view of trainee in Belgium, in the different language communities. This survey also assessed the potential role of simulation in this respect. The other two studies aimed to clarify the interest and the place of simulation tools available in our department such as the Voxel-Man tempo° for middle ear surgery based on virtual reality and the evaluation of the psychometric scale of visualization capacity in space ("Vandenberg and Kuse mental rotation test") in the learning of sinus endoscopic surgery.

The objectives of our work evolve in stages : firstly, to take stock of learning, particularly surgical learning, during ENT specialisation from the point of view of the learners. Secondly, to highlight the factors that have a significant impact on surgical procedural skills using a validated scale, and to study the possible impact of the use of simulation on these factors.

At the end of this work, we wish to propose a concrete training project exploiting and articulating the different simulation tools in a structured way and based on objective scientific data.