WSU News Archive

By Judith Van Dongen, WSU Spokane

 

 

 

SPOKANE - If you could take three minutes out of your day to help a student become a better health professional, would you? What if this involved having an inexperienced student pass a small video camera down your nose to assess your swallowing?

I didn't think so…

 

This is the dilemma the speech and hearing sciences program faces every year. As part of assistant professor Nancy Potter's dysphagia (swallowing disorders) class, graduate students need hands-on practice performing transnasal endoscopy to meet guidelines set by the American Speech-Language-Hearing Association.

 

Until last year, only a few students each year received this practice, typically scoping each other or Potter - a less than ideal situation for the person being scoped.

 

Thesis explores simulation training
So when first-year master's student Elise Benadom consulted with Potter in fall 2008 on a topic for her thesis, they decided to explore the use of simulation in training graduate students to perform transnasal endoscopy.

 

"We wanted to see whether we could train students without compromising people's noses, because it can be rather uncomfortable," Benadom laughed.

 

The study design used by Benadom, who graduated in May, compared the effect of two forms of training - using a human patient simulator versus using a non-lifelike simulator. Identifying a human patient simulator led Benadom and Potter on an extensive search that started at the College of Nursing simulation lab.

 

"They kindly let us scope all of their manikins, but none had realistic nasal passages with nasal turbinates (thin scroll-shaped bones on the walls of the nasal passages)," Potter said. "What's challenging in this procedure is passing the scope along the nasal floor below the nasal turbinates without touching them, so it’s crucial that a manikin has realistic nasal anatomy."

 

Frankencrafting a nose
Benadom and Potter eventually decided to rebuild an aging manikin found in a closet on the Pullman campus. They separated the manikin into halves, gutted his nose and used $10 worth of craft supplies to create a nasal structure that would look realistic as seen through the endoscope.

 

The non-lifelike simulator was more quickly identified. They used a glove box - much like a tissue box - and students passed the endoscope through the plastic slit in the middle of the box.

 

Results a surprise
Benadom's study, which was published recently in the journal Dysphagia, took place over two days in September 2009. Eighteen graduate student clinicians from the speech and hearing sciences program were randomly assigned to groups that either used the manikin or the glovebox to complete seven training passes with the flexible nasal endoscope on day one.

 

On the second day, each clinician performed one pass on two different volunteers. Each volunteer was scoped twice: once by a clinician who trained on the manikin and once by a clinician who used the glovebox for training.

Surprisingly, study results showed no difference in pass times on human volunteers between clinicians trained on the manikin and those trained on the glovebox. Both groups were faster and more confident on the second endoscopy on a volunteer than on the first.

 

Studies continue for national model
For Benadom, the research project solidified her interest in research. She is completing her clinical fellowship year at a skilled nursing and rehabilitation facility in Dallas, Texas, while considering going back to school for a PhD.

 

Meanwhile, Potter is working with another student on a follow-up study. She said this study and the one conducted by Benadom are part of a series aimed at determining what would be optimal simulation training prior to performing endoscopy on a human. The intended outcome is a training protocol that could be used by speech-language pathology programs across the nation.

 

Using simulation for endoscopy training is common sense, Potter said.

 

"Students should know how to use the equipment prior to scoping a volunteer or real patient, just as pilots should know how to use their equipment before flying a plane."

 

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