Donnelly M J, Walsh M A, Hone S, O'Sullivan P
Department of Otolaryngology, Beaumont Hospital, Dublin, Ireland.
Med Educ. 1996 Jul;30(4):299-302. doi: 10.1111/j.1365-2923.1996.tb00833.x.
Although otolaryngology represents up to 20% of the workload of general practitioners, the time allocated in the undergraduate medical curriculum to clinical teaching of ENT disorders is disproportionately small. Many GPs have indicated a desire for further training in ENT, particularly in small groups. This study was carried out on a group of 27 GPs who wished to revise their diagnostic skills in otoscopy by attending a 2-hour teaching session on basic examination of the ear and the recognition and management of common otological conditions. The GPs skill in otoscopy before and after the course was assessed subjectively by means of a self-administered questionnaire and scored objectively by ENT surgeons. Aspects of otoscopy chosen for assessment were technique of examination of the external ear, choosing correct speculum size, techniques of holding the otoscope and pinna, tympanic membrane description and diagnostic ability. An improvement between the objective pre- and post-workshop scores was found for assessment of the external ear, choice of speculum size, description of the tympanic membrane and diagnostic ability. No significant differences in the pre- and post-workshop scores was found for the techniques of holding the otoscope or holding the pinna. The majority of the GPs found the workshop beneficial. Postgraduate teaching of specialist diagnostic skills such as otoscopy to GPs is useful. An improvement in such skills should enable the GPs to manage ENT problems more confidently and refer patients appropriately to the ENT outpatients.
虽然耳鼻喉科的工作量在全科医生的工作总量中占比高达20%，但本科医学课程中分配给耳鼻喉疾病临床教学的时间却少得不成比例。许多全科医生表示希望接受耳鼻喉科方面的进一步培训，尤其是小组培训。本研究针对一组27名全科医生开展，他们希望通过参加一场为期2小时的关于耳部基本检查以及常见耳科病症的识别与管理的教学课程，来复习耳镜检查的诊断技能。课程前后，通过一份自我评估问卷对全科医生的耳镜检查技能进行主观评估，并由耳鼻喉外科医生进行客观评分。评估所选的耳镜检查方面包括外耳道检查技术、选择正确的窥镜尺寸、手持耳镜和耳廓的技术、鼓膜描述以及诊断能力。在对外耳道评估、窥镜尺寸选择、鼓膜描述和诊断能力方面，发现工作坊前后的客观评分有所提高。在手持耳镜或手持耳廓的技术方面，工作坊前后的评分没有显著差异。大多数全科医生认为该工作坊有益。对全科医生进行诸如耳镜检查等专科诊断技能的研究生教学是有用的。此类技能的提高应能使全科医生更自信地处理耳鼻喉问题，并将患者适当地转诊至耳鼻喉门诊。
