ENT symptoms and conditions are commonly encountered in primary care, yet the awareness and importance of ENT is underemphasized and misinterpreted. The aim of this comparative study was to describe the scope, importance and perceived needs of ENT training in General Practice (GP). The research assessed the frequency, importance of ENT conditions and pathology and awareness of management or whether a referral process had been initiated.
It is interesting to note that the experience did not match the referral pattern that reiterates the need for ENT training and awareness. The purpose of the study was to highlight the purpose of ENT and the need for further ENT training and exposure. It is a Surgical Subspecialty and internationally the third largest surgical specialty with associated problems frequently encountered in a number of other disciplines, including general practice and emergency medicine (along with General Surgery-Trauma and Orthopaedics) 2.
Traditionally, there are three ports of exposure to ENT – undergraduate, physician in ENT programs, and CME. Current international literature emphasizes the importance of ENT not only in general practice, but also in postgraduate training in neo-otolaryngology disciplines.
Research Question
A submission ready manuscript
An assessment of ENT scope and training perceptions among general practitioners and primary care physicians in Kwa-Zulu Natal. 96% of doctors felt that there is a need for additional emphasis on ENT training for GPs. Conclusion: This study emphasizes the breadth of ENT expertise needed for independent practice and will contribute to the development of a relevant curriculum for undergraduate as well as postgraduate CPD courses.
As an ENT Registrar you will encounter a significant number of ENT pathologies within KZN due to referrals that are often delayed or poorly managed. A descriptive analysis of perceived ENT training needs and suitability for general practice was obtained. The scope of ENT pathology and emergencies was collected and doctors were asked how often they occur within a month.
Of the participants, 44.4% Doctors admitted that they received between 2 weeks and 1 month of ENT education at Medical School. Most South African universities had an average period of 2 weeks to 1 month of ENT exposure (Figure 1 Undergraduate ENT training) and universities abroad (Other) were the only ones with more than 2 months of ENT training and had exposure.
Undergraduate ENT training
Approximately what percentage of patients have you referred to the following medical facilities in the past 3 months. When asked which areas Doctors feel they receive adequate training, Rhinology appears to be the most underrepresented in ENT training with 56.7%, followed by Throat 45.8% and then Otology 40.8%. The availability of an ENT ensured easier and more frequent referral, however justified or genuine the referral was, could not be assessed.
In private, the most common symptom is a sore throat, but for the public, rhinitis. Regarding referrals (Figure 4 Referrals: private vs. public), private physicians mostly referred to a pediatrician, followed by an ENT surgeon. Private sector doctors with more than ten years of practice referred mainly to ENT surgeons.
Public sector doctors with more than ten years of practice referred mainly to pediatricians, and those with less than ten years mostly to the local hospital. (Figure 6 Years of practice of public doctors). Doctors with more than ten years of practice mostly referred to the local hospital, while those with less than ten years of practice mostly referred to a pediatrician. Less than 25% of patients with ENT pathology are referred from the private and public sector.
As one moved closer to the Ethekwini district or tertiary institution, more referrals were made.
The Public and Private Sectors play an equal role in contributing to the scope and management of ENT conditions and emergencies. The training requirements for general practitioners are very different compared to the UK and America. There is a general perception that postgraduate trainees in disciplines such as General Practice will receive formal training in ENT.
Opinions about ENT by primary care physicians in America are formed in medical school and a formulation of ENT knowledge and understanding does not differ from internship to senior residency, thus stating that there is a lack of exposure among primary care residencies (internal medicine, paediatrics and family) is Medicine) 12. In summary there is agreement with the opinion among Private and Public Health Physicians when it comes to the importance and emphasis of ENT in GP practice. It was clear that 85.9% of our doctors would welcome further exposure in ENT in the form of workshops and postgraduate training programmes.
Based on the above research, a curriculum needs analysis can be designed, highlighting the shortcomings of the three main areas of otolaryngology: rhinology, otology and throat diseases. Offering workshops or refresher courses on ENT conditions would be beneficial to our GPs and public sector doctors. Referrals by doctors with more than ten years of experience are mainly made to local hospitals (public/private).
Integrated approach to teaching and learning of ENT, including the use of simulation training and online virtual learning, along with clinical rotations. In particular to emphasize to the Department of Health that it is essential to bring specialist care to the communities, but training in ENT does not reduce referral rates to hospitals for further management. The focus should be on Hospital-based and or Primary Care level training of Primary Care Physicians (Medical Officers, Interns or CSOs) in ENT and training of nursing staff in ENT (able to recognize symptoms, basic examination, effectively treat minor conditions and or refer emergencies accordingly).
The aim of the study was not to provide objective validation or to denigrate the good value of practitioner training nor to discredit the HPCSA guidelines for independent practice, but to provide an insight into perceptions of training and exposure in ENT and to highlight the wide range it faces. Prevalence of ear, nose and throat diseases and adequacy of ENT training among general practitioners. Identifying the Determinants of and Solutions to South Arika's Physician Shortage: Is There a Role for the Private Sector in Medical Education.
Appendices
The final Study Protocol
- Aims
- Outcome
- Type of research
- Research Methodology 1 Study setting
- Target Population
- Study population 1. Inclusion
- List of variables
- Plan for data collection
- Plan for data handling/processing
- List of Limitations
- List of associations to be measured
- Ethical considerations
- References
The survey will be deployed among GPs and primary care providers in the government sector within rural and urban areas across KZN. ENT specialists working within KZN will be used to cross-administer the questionnaire formulated from the survey and serve as a control group. Then the questionnaire will be given to the survey participants and a basic ENT knowledge will be formulated.
A pilot study of the survey will be sent electronically to 5 GPs and 5 public primary care providers to evaluate the research tool for relevance and content and clarity. It will be distributed via electronic mail or paper to ENT specialists who will act as a control group for the questionnaire. Once completed, the questionnaire will be a reference for ENT knowledge based on the current ENT specialists practicing in KZN.
Again, distribution will take place in the form of electronic mail or paper edition if necessary. Physicians working within the centralized and decentralized hospital training sites will be asked by e-mail to participate in the study. Testing of the study will be carried out in a pilot study given to 5 general practitioners and 5 primary care providers in the public sector (of which will be excluded from the actual study and questionnaire).
Government primary care providers working in central and decentralized hospital areas will be randomly selected to participate in the study. The questionnaire is provided electronically via email or on paper if the electronic response rate is poor. The survey will be used to collect information (university graduate; years in practice; practice area/district; local referral hospital; local ENT physician; ENT work experience or training; perceptions of ENT training needs for primary care practice; List of ENT -symptoms, conditions Treatment of emergencies and referrals to specific disciplines or personnel listings) that provide a scope of ENT exposure and reflect a need for ENT expertise.
The approved questionnaire will be distributed to ENT specialists by email or hard copy and they will be asked to participate in the questionnaire. A level of ENT knowledge will be established and identified gaps in knowledge and training will be used to establish the need for further ENT training among primary care providers in Government and the private sector. Primary care providers within the Government will be randomly selected from their respective Provincial Hospitals and Community Health Clinics within their districts.
Focus group discussions about the survey content will be conducted after participation in the survey. The questionnaire will be administered to ENT specialists who may practice outside of KZN to externally validate the research instrument.
The Guidelines for Authorship for the Journal selected for submission of the manuscript
Use only those figures that added value to the paper beyond what is stated in the text. Background: why the study is being done and how it relates to other published work. Results: first sentence should be a brief population and sample description; outline the results according to the methods described.
Primary outcomes should be described first, even if they are not the main findings of the study. Ensure that the structured summary is complete, accurate, clear and approved by all authors. All articles should contain the following main sections: Introduction/Background, Methods, Results, Discussion, Conclusions.
Objectives (in introduction/background): A clear statement of the main aim of the study and the main hypothesis tested or research question posed. Participants (rather than patients or subjects; within methods): numbers entering and completing the study, sex, age, and any other biological, behavioral, social, or cultural factors (e.g., smoking status, socioeconomic group, educational attainment, indicators of concomitant diseases, etc.) that may affect the results of the study. Main outcome measures (within methods): those as planned in the protocol and those ultimately measured.
Ethical approvals 1.Change of Supervisor
Data collection tools
Raw data
