Abstract
Introduction Otolaryngology, Head and Neck Surgery (ORLHNS) makes up a significant proportion of non-ORLHNS specialist practice. There is limited time allocated to this specialty in pre-registration education, leading to concern about inadequate preparation for practice. It is important to understand how students and teachers experience the ORLHNS curriculum as students may not receive further education in ORLHNS later in their careers. A scoping review informed the understanding of the current state of ORLHNS education. It provided insight into the primary concerns of students and teachers, as well as how educational theory has been used when developing teaching strategies. Therefore, the aim of this study was to better understand how students and teachers experience the ORLHNS curriculum. The research questions are as follows. 1. What are students’ attitudes to learning ORLHNS? 2. What are teacher’s attitudes to teaching ORLHNS? 3. What is student self-efficacy before and after an ORLHNS module? 4. How do student and teacher perceptions of an undergraduate ORLHNS module relate to one another? Methods An interpretive perspective informed this mixed-methods study. Social Cognitive Theory was used to investigate the perceived self-efficacy of students to manage ORLHNS conditions, student attitudes toward ORLHNS, and the experiences of medical students and their teachers with the ORLHNS curriculum in the MB ChB programme at the Dunedin School of Medicine, University of Otago. A questionnaire was designed and used to measure self- 12 efficacy and attitudes to ORLHNS of fourth-year medical students. Two clinical vignettes were included to assess students’ ability to apply their ORLHNS knowledge and teachers’ expectations about student learning. Questionnaire items were also used to construct a semi-structured, one-to-one interview protocol for teachers. Student data were collected before and after their ORLHNS module. Teacher data were collected after students completed the pre-module questionnaire. Self-efficacy and attitude data from students were analysed with descriptive and inferential statistics. A factor analysis was performed to ensure the self-efficacy items formed a self-efficacy scale. Free text responses about student attitudes to ORLHNS were analysed inductively with a reflexive thematic approach. Data from teachers were analysed descriptively and compared to student responses. Following project design and initiation of data collection, the COVID-19 pandemic caused significant disruption of student teaching and data collection. The responses provided by both students and teachers included commentary about the effect of the pandemic, and this has been incorporated into the study findings. Results Eighty students completed the pre-module questionnaire (response rate 100%). Self-efficacy statements were found to be highly reliable. A factor analysis indicated that a one-factor solution was optimal. Forty-seven students completed the post-module questionnaires (58% response rate). The average self-efficacy score was significantly higher (M = 58.31, SD = 14.27) after the ORLHNS module than before (M= 33.10, SD = 14.80) t(46) = -12.419, p < .001, d = -1.812. The teaching methods that students preferred changed after the module, with outpatient clinic ranked first pre-module and simulation ranked first post-module. Student interest in ORLHNS and likelihood to pursue ORLHNS as a career did not change following an ORLHNS module. Twenty-four students responded to the post-module clinical vignettes. Responses to the clinical vignettes were analysed using a paired Wilcoxon signed- 13 rank test, which found that there was no statistically significant change in score before and after the module. Twenty teachers took part in semi-structured interviews about undergraduate ORLHNS. Teachers were concerned that students did not have enough experience in ORLHNS. They felt that it was important to use learning strategies such as simulation to better engage students during the limited learning opportunities. Teachers predicted that students would rate clinic attendance highly due to the opportunity for real patient contact but expressed concern that students did not appear interested when attending clinics. Students and teachers prioritised learning general rather than specialist ORLHNS conditions such as otitis media and tonsillitis. Both groups prioritised active learning opportunities to achieve these learning goals, such as clinic attendance and simulation. Students and teachers also noted the impact of the COVID-19 pandemic on learning. Teachers described disruption to undergraduate education, opportunities to re-evaluate which topics provided core learning for students, and expressed concern regarding student mental health. Students reported reduced patient contact and fewer in-person learning opportunities, whereas teachers noted positive impacts that included opportunities to evaluate priorities for the curriculum, an impetus to develop online resources, and increased downtime for students to independently fill gaps in their knowledge. Discussion In this study, insights were gained about how students are prepared for future practice in the area of ORLHNS. Other educators can use the insights generated by the students and teachers to consider how ORLHNS is taught and learned at their institution. Aspects to consider are student interest and confidence in ORLHNS and ways to provide opportunities to support students to learn generalist ORLHNS knowledge and skills. Introducing simulation into the 14 ORLHNS learning activities helped focus on core ORLHNS presentations and conditions that students would likely see in general practice settings. Simulation engaged both student and teacher interest and provided a level of consistency throughout the module. The COVID-19 pandemic reinforced the benefit of flexible use of learning resources and highlighted the need to plan for unanticipated disruptions to teaching. Conclusion This study increased the understanding of how students and teachers experience the undergraduate ORLHNS curriculum. Take home messages are as follows: Student self-efficacy but not interest in ORLHNS increased after an ORLHNS module; Students and teachers prioritise general rather than specialist knowledge; Students prefer active learning opportunities such as clinic attendance and simulation; The COVID-19 pandemic had both positive and negative impacts on undergraduate ORLHNS education.