ENT and general practice: A study of paediatric ENT problems seen in general practice and recommendations for general practitioner training in ENT in Ireland

Abstract

A questionnaire survey of 225 general practitioners was carried out to establish the proportion of their workload formed by paediatric ENT problems. Approximately 50% of children seeking medical care from their general practitioners had problems in this area. Infections of the upper respiratory tract and associated organs were the most commonly dealt with complaints. The monthly referral rate by GPs of paediatric patients in their practice to an ENT outpatient clinic was 4.3%. As ENT problems are seen so commonly in general practice it is important that teaching of otolaryngology at undergraduate and postgraduate levels is emphasised. We examined the present teaching structure of ENT in Irish universities and established that the appointment of a professorial unit dramatically improved the extent of the undergraduate curriculum. Non-specialist postgraduate ENT exposure was found to be inadequate and a number of mechanisms to improve postgraduate ENT training for GPs are suggested.

Prioritising topics for the undergraduate ENT curriculum

“…ENT problems account for 1.5% of Emergency Department attendances (overall commonest identified first diagnosis is dislocation/fracture/joint injury/amputation at 4.6%). 72% of GPs would see at least three children with ENT problems each day, and half of children that a GP sees will have ENT problems 1,2,4 .…”

“…However, the structure of postgraduate training is such that not all non-ENT doctors will rotate through ENT, therefore ENT in the undergraduate curriculum assumes a relatively greater importance compared to other specialties 1,6 . However, a 2004 study in the UK found that only 78% of medical schools had a compulsory ENT attachment, and the average length of time spent in ENT was a week and a half 7 .…”

Survey of current undergraduate otolaryngology training in the United Kingdom

“…2,3 This rises to 50 per cent in paediatric consultations. 4 Clinical expertise of GPs must, therefore, be adequate to enable early assessment and appropriate treatment of the common ENT diseases. This expertise is also essential to minimize inappropriate referral of patients who should be managed in the community.…”

Tympanostomy Tubes: Indications for Referral Versus Indica-tions for Surgery

“…Half of the medical class will become family physicians (14), where 20-30% of their practice is likely to be otolaryngological (15)(16)(17). Very little curricular time is spent on common otolaryngological problems.…”