No abstract

Introduction The COVID‐19 pandemic has caused unprecedented disruptions to medical education. Education in medical specialties, such as otolaryngology faces multiple challenges, including reduced bedside and “hands‐on” training opportunities at all levels. Educators are turning to technological advancements to deliver effective remote medical education. This study investigated the value of enhancing traditional remote case‐based teaching with the HoloLens2™. Methods We present a randomized educational design study. All educational content, media, and learning outcomes were identical. Primary outcome measures included student performance as measured with pre‐ and post‐intervention quizzes and student engagement as measured by a tally‐mark system. Secondary outcome measures, collected using feedback questionnaires, included perceived enjoyment, engagement, and opinions regarding the educational role of this technology. Results The undergraduate medical students were randomized to either conventional or HoloLens2™ enhanced remote case‐based teaching (n = 56). HoloLens2™ enhanced teaching improved student performance by an average of 3 marks of 15% (p < 0.001). It was engaging and encouraged questions 4‐fold per session (p < 0.05) when compared to conventional remote case‐based teaching. There was no significant difference in overall objective measurements of engagement. Students taught using HoloLens2™ agreed that the teaching was enjoyable, effective in concept demonstration, and encouraged engagement. Conclusions Remote teaching has allowed for the continuation of medical education in uncertain times. Beyond COVID‐19, we predict that there will be a paradigm shift toward remote learning as new technological advancements emerges. These novel technologies may prove invaluable in the future potentially enabling education to be delivered between different hospitals, universities, and even overseas. Level of Evidence NA Laryngoscope, 133:1606–1613, 2023

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: which is the best tissue valve for use in the pulmonary position, late after previous repair of tetralogy of Fallot? Altogether 141 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. In addition to this, 1 paper was found by searching the reference lists of the relevant papers. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude from the best evidence available that homograft valves function well in the pulmonary position late after Tetralogy of Fallot (TOF) repair. This is particularly evident in the larger studies where the patients were only treated with homografts. It has been suggested that Homografts are better than xenografts and this has not been statistically shown. Two articles have suggested that xenografts outperform homografts however, in both studies these results were not statistically significant. Furthermore, early indications suggest that porcine valves may be better than bovine pericardial valves but a better longer term follow-up is certainly required to demonstrate this. It is important to realize also that when comparing the effectiveness of these valves in the pulmonary position, one cannot ignore confounding factors. The most important of these include timing of operation, age of patient, valve size, immunological factors, operative complexity and also postoperative valvular gradients. The timing of these operations has always been an area of great controversy illustrated by varied guidelines. There is no general consensus regarding whether there is even a role of pulmonary valve replacement late after TOF repair. Further weakening any conclusions that may be drawn based on current best evidence is the lack of strong follow-up data (transvalvular gradients and right ventricular (RV) volumetric data). New research is required with comparisons using objective clinical parameters in order to more effectively answer our clinical question.