Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
Am J Otolaryngol. 2023 Jan-Feb;44(1):103682. doi: 10.1016/j.amjoto.2022.103682. Epub 2022 Oct 22.
Musculoskeletal disorders are prevalent among otolaryngologists and otologists with symptoms starting during residency. Prior data suggested that high-risk joint angles were often adopted at procedure onset, suggesting a detrimental "natural" operating position. Despite its importance, dedicated ergonomic teaching is not systematically introduced into residency training. The objective of this study was to compare initial ergonomic positioning during microscopic temporal bone surgery between those who receive "Just in Time" ergonomic teaching prior to starting dissection with those who did not.
This was a pilot, prospective trial in which otolaryngology residents at an urban, multicenter tertiary care academic institution (n = 14) wore ergonomic sensors (inertial measurement units) during microscopic temporal bone lab drilling. Prior to recording, participants were randomized to receive an instructional presentation on ergonomic principles (n = 8, intervention group) or not (n = 6, control group). The inertial measurement units analyzed neck and back angles for the initial 5 min of drilling.
Of 14 trainees, 78.6 % had prior experience with otologic microscopic cases and 14.3 % reported prior surgical ergonomic training or instruction. The groups were matched in trainee height (P = 0.54), handedness (P = 0.83), stage of otolaryngology training (P = 0.64), prior otologic microscopic surgery experience (P = 0.35), prior temporal bone drilling experience (P = 0.35), and prior teaching in ergonomic principles (P = 0.47). Junior trainees (PGY 1-3) who did not receive "Just in Time" teaching adopted a posture with significantly higher risk back flexion compared to junior trainees who received the training (25.3° vs. 5.7°, P = 0.04). There was no difference in back positioning among senior trainees (12.6° vs. -5.7°, P = 0.13). While there was a trend towards those in the intervention group adopting safer procedural posture, there was no significant difference in the overall cohort between the intervention and control groups in both neck positioning (-11.0° vs. -19.1°, P = 0.17) and back positioning (8.6° vs. 19.1°, P = 0.18).
Musculoskeletal related pain is prevalent among otolaryngologists and otologists with data suggesting that symptoms begin during residency. Targeted "Just in Time" teaching of ergonomic principles is feasible and may be effective for development of healthy postural habits, especially among junior trainees.
耳鼻喉科医生和耳科医生中普遍存在肌肉骨骼疾病，其症状始于住院医师阶段。先前的数据表明，在手术开始时，高风险的关节角度经常被采用，这表明存在不利的“自然”手术体位。尽管这一点很重要，但专门的工效学教学并没有系统地引入住院医师培训。本研究的目的是比较在显微镜下进行颞骨手术时，那些在开始解剖前接受“及时”工效学教学的人与那些没有接受教学的人的初始手术时的工效学定位。
这是一项在城市多中心三级学术医疗机构进行的前瞻性试点研究，其中 14 名耳鼻喉科住院医师在显微镜下颞骨实验室钻孔时佩戴工效学传感器（惯性测量单元）。在记录之前，参与者被随机分为接受工效学原则指导讲座（n=8，干预组）或不接受（n=6，对照组）。惯性测量单元分析了钻孔前 5 分钟内的颈部和背部角度。
14 名受训者中，78.6%有过耳科显微镜手术经验，14.3%报告接受过手术工效学培训或指导。受训者的身高（P=0.54）、利手（P=0.83）、耳鼻喉科培训阶段（P=0.64）、耳科显微镜手术经验（P=0.35）、颞骨钻孔经验（P=0.35）和接受工效学原则教学（P=0.47）无差异。未接受“及时”教学的初级受训者（PGY1-3）与接受培训的初级受训者相比，背部弯曲的姿势风险明显更高（25.3° vs. 5.7°，P=0.04）。高级受训者（12.6° vs. -5.7°，P=0.13）之间的背部姿势没有差异。虽然干预组的受训者倾向于采用更安全的手术姿势，但在总队列中，干预组和对照组在颈部位置（-11.0° vs. -19.1°，P=0.17）和背部位置（8.6° vs. 19.1°，P=0.18）方面没有显著差异。
肌肉骨骼相关疼痛在耳鼻喉科医生和耳科医生中很常见，有数据表明症状始于住院医师阶段。有针对性的“及时”工效学原则教学是可行的，可能有助于养成健康的姿势习惯，尤其是对初级受训者。
