Simulator approaches in otorhinolaryngology ‐ Looking beyond the ophthalmological horizon

Purpose: To improve medical students' learning of handheld otoscopy technique and findings based on a standardized simulator‐based procedure.Methods: A group of 120 medical students received a questionnaire containing 10 multiple choice questions (four theory questions, six pathological eardrum findings) prior to simulator‐based training (Earsi otoscope, Haag‐Streit Simulation, Germany) and classic otolaryngology internship without separate otoscopy training. Simulator‐based practical training was performed in groups of four students for 90 min with 40 students (“simulator group”) in addition to the classic otolaryngology internship (“control group”). After training, the students in the simulator‐group underwent an objective standardized clinical examination. Items assessed were (1) use of the correct hand, (2) correct handling of the otoscope, (3) stabilization of the otoscope with a finger, (4) pulling pinna upwards and backwards, (5) correct insertion depth, (6) atraumatic performance, (7) time required for task completion and (8) percentage of the assessed eardrum surface (cut‐off <85%). In addition, students were asked to draw the pathology shown during the examination (myringosclerosis, a whitish scar on the tympanic membrane) on a provided tympanic membrane sketch. The drawing was classified as “correct” or “incorrect” by a person uninvolved in the course. A maximum of eight points could be achieved. Students evaluated the simulator‐based otoscopy training afterwards. At the end of the otolaryngology internship, the questionnaire was repeated 4 weeks after the simulator‐based otoscopy training.Results: All participating students improved from an average of 4.5 ± 1.7/10 before otolaryngology internship to 6.4 ± 1.7/10 correctly answered questions after training. Looking at the two subgroups, it is noticeable that the students in the simulator group (7.1 ± 1.6/10) performed better than those without simulator‐based otoscopy training (6 ± 1.6/10). All students in the simulator group achieved good results in the objective standardized clinical examination (5.1 ± 1.4/8).The participating students rated the simulator‐based training mostly as “very good“. The students wished for more simulator‐based training and indicated higher interest in otolaryngology after training. Furthermore, they stated an improvement of their otoscopy skills and understanding of eardrum findings.Conclusion: A standardized simulator‐based approach improves medical students' skills in handheld otoscopy and arouses professional interest in otolaryngology.