ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Designing self-assessment tools for learning five instrumental clinical procedures in ENT: A modified Delphi consensus approach.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeIn otorhinolaryngology head and neck surgery (OHNS), ensuring surgeon competency depends on reliable assessment of ear, nose, and throat (ENT) examination skills, yet standardized methods for evaluating these instrumental examinations are lacking. This study aimed to develop and validate self-assessment checklists with an emphasis on defining success and failure criteria to provide a basis for studying the learning curve of procedures.
methodsA two-round modified Delphi study involving OHNS experts and experienced residents was conducted to develop five consensus-based checklists for ENT instrumental examinations: adult and pediatric flexible pharyngolaryngoscopy, rigid nasal endoscopy, otomicroscopy, and otoendoscopy. Participants rated the items on a nine-point Likert Scale for relevance and applicability. The panel also estimated the minimum number of supervised procedures and acceptable failure rates for transitioning from supervised to autonomous practices for each procedure.
resultsFifty-four items reached expert consensus to define five self-assessment checklists: 8 anatomical structures and 3 technical points for adult flexible laryngoscopy; 5 anatomical structures and 5 technical points for pediatric flexible laryngoscopy; 6 anatomical structures and 3 technical points for rigid nasal endoscopy; 6 anatomical structures and 5 technical points for otoendoscopy; and 5 anatomical structures and 8 technical points for otomicroscopy. A procedure was considered failed if at least one required item was not correctly performed. The expected failure rates for each studied instrumental examination procedure ranged from 5 to 10% at resident level whereas expected failure rates for experts was estimated to be around 2%.
conclusionThese results provide a foundation for structured self-assessment of technical skills for five common procedures. This has the potential for harmonizing training assessment worldwide.
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