Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure

Advances in Medical Education and Practice, Jun 2018

Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure Susan L Brady,1 Noel Rao,2 Patricia J Gibbons,3 Letha Williams,4 Mark Hakel,5 Theresa Pape6 1Quality and Research Department, Marianjoy Rehabilitation Hospital, Wheaton, IL, USA; 2Medical Residency Department, Marianjoy Rehabilitation Hospital, Wheaton, IL, USA; 3Department of Speech Language Pathology, Midwestern University, Downers Grove, IL, USA; 4Health Administration, College of Graduate Health Studies, A.T. Still Medical University, Kirksville, MO, USA; 5Education and Staff Development, Madonna Rehabilitation Hospital, Lincoln, NE, USA; 6Hines Veterans Administration Hospital, Hines, IL, USA Objective: The aim of this study was to evaluate the comparative effectiveness of an online, interdisciplinary, interactive course designed to increase the ability to accurately interpret the fiberoptic endoscopic exam of the swallow (FEES) procedure to traditional, face-to-face (F2F) lectures for both graduate medical education (GME) and graduate speech language pathology (GSLP) programs.Design: This was a prospective, quantitative, nonrandomized study. Participants were medical residents in physical medicine and rehabilitation from two affiliated programs and graduate students in speech language pathology from two instructional cohorts at a single institution. Group 1, traditional group (n=51), participated in F2F lectures using an audience response system, whereas Group 2, online group (n=57), participated in an online, interactive course. The main outcome measure was pre- and post-course FEES knowledge test scores.Results: For Group 1, the mean pre-course score was 26.94 (SD=3.24) and the post-course score was 34.96 (SD=2.51). Differences between pre- and post-course scores for Group 1 were significant (t=−16.38, P≤0.0001). For Group 2, the mean pre-course score was 27.05 (SD=2.74) and the post-course score was 34.05 (SD=2.84). Differences between pre- and post-course scores for Group 2 were significant (t=−13.5, P≤0.0001). The mean knowledge change score for Group 1 and Group 2 was 8.01 (SD=3.50) and 7.04 (SD=3.91), respectively (nonsignificant, t=1.372, P=0.173), suggesting groups made similar gains.Conclusion: Incorporating technology into GME and GSLP programs yielded comparable gains to traditional lectures. Findings support the use of online education as a viable alternative to the traditional F2F classroom format for the instruction of the cognitive component of the FEES procedure. Keywords: deglutition, dysphagia, endoscopy, swallowing, training, medical education

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Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure

Advances in Medical Education and Practice Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure Quality 1 research Department 1 Marianjoy Rehabilitation Hospital 1 Wheaton 1 Medical residency 1 0 Department of speech language Pathology, Midwestern University , Downers grove, il, UsA 1 Department, Marianjoy Rehabilitation hospital , Wheaton, il, UsA 2 hines Veterans Administration hospital , hines, il, UsA 3 Education and staff Development, Madonna Rehabilitation Hospital , lincoln, n E, UsA 4 health Administration, college of graduate health studies, A.T. still Medical University , Kirksville, MO, UsA , USA 8 1 0 2 - l u J - 3 1 n o 7 1 1 . 2 2 . 8 3 . 4 5 y b / m o c . s s e r p e v o d . deglutition; dysphagia; endoscopy; swallowing; training; medical education - open access to scientific and medical research susan l Brady 1 n oel rao 2 Patricia J Gibbons 3 letha Williams 4 Mark hakel 5 Theresa Pape6 Introduction Swallowing disorders are a significant health care concern as these disorders may result in further debilitating or life-threatening conditions. An undiagnosed or misdiagnosed swallowing disorder may also result in prolonged hospitalization following a stroke or other related illness subsequently increasing health care costs. To effectively treat swallowing disorders, a health care team first needs to correctly diagnose the underlying cause of a disorder through the appropriate use and interpretation of diagnostic procedures. Swallowing disorders frequently occur in patients undergoing physical rehabilitation following a stroke, brain injury, or other complex medical conditions.17 Clinicians Advances in Medical Education and Practice 2018:9 433–441 433 © 2018 Brady et al. This work is published and licensed by Dove Medical Press Limited. The ful terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). providing direct treatment for dysphagia in the medical rehabilitation setting typically work under the guidance of physical medicine and rehabilitation (PMR) physicians. PMR physicians require a strong working knowledge of all rehabilitation modalities, and upon completion of the PMR medical 8 residency program, they are expected to lead and guide allied -102 health professionals in a variety of areas including clinicians l-Ju working with patients with swallowing disorders.7 n13 The current standard of care for the evaluation of swal17o low function includes the videofluoroscopic swallow study .212 (VFSS) and the fiberoptic endoscopic exam of the swallow ..83 (FEES) procedure.5 The VFSS is more popular as it has been y45 available since the 1950s,17 and incorporates the use of an /bm X-ray along with barium to evaluate the physiology of the .cso swallow function. The FEES procedure is newer and was rsep first reported by Langmore et al.15 The FEES procedure is an veo instrumental assessment of the swallowing function that uses .d nasal endoscopy to provide a real-time view of both the struc//www l.yno tures of the pharynx and the swallowing mechanism. Both : ttsph lseu the VFSS and FEES are valuable procedures for evaluating om ona dysphagia and demonstrate good agreement with diagnostic frd rse findings as related to aspiration, laryngeal penetration, phae p lado roF ryngeal residue, and diet recommendations.21 Even though eodnw itnhecFliEniEcSalhparsacbteiceen davuaeitloablliemsiitnecdetr1a9in8i8n,gitoipspleosrstuonfitteinesuasnedd itcca cost of the equipment to perform the procedure.3 r P d n a n o it a c u d E l a c i d e M n i s e c n a v d A Physician training The Accreditation Council for Graduate Medical Education (ACGME) requires all medical residents to demonstrate competency in system-based practice. One of the core expectations of the system-based practice is the ability to work in interprofessional teams and to demonstrate team collaboration.11 The care of patients with dysphagia offers a medical resident the opportunity to work in a collaborative manner to promote the patient’s swallowing safety and maximize treatment outcomes. Therefore, it is important for new PMR physicians to receive appropriate training on a variety of swallowing diagnostic procedures such as the FEES during a residency program. To address the educational needs to promote the systembased practice, the ACGME of the American Medical Association has introduced six domains of clinical competency for residency physician training. One of the d (...truncated)


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Susan L Brady, Noel Rao, Patricia J Gibbons, Letha Williams, Mark Hakel, Theresa Pape. Face-to-face versus online training for the interpretation of findings in the fiberoptic endoscopic exam of the swallow procedure, Advances in Medical Education and Practice, 2018, pp. 433-441, DOI: 10.2147/AMEP.S142947