Purpose: Acute otitis media (AOM) is one of the most common diagnoses in childhood and one of the most frequent causes for patient encounters in the ambulatory setting. Teaching otoscopic exams is difficult due to limitation of visibility of the tympanic membrane (TM) by both teacher and student simultaneously. A device, Oto, has been developed that turns an iPhone into an otoscope and allows for visualization of the TM by more than one person at a time and for recording pictures. The purpose of this study was to evaluate the utility of this device in teaching otoscopic exams to residents in real time. Methods: Pediatric and Medicine-Pediatric residents used the Oto device with an iPhone in our Pediatric Emergency Department from January to March of 2017. A survey was given to residents to obtain their level of training, if they had used Oto or similar device, and comfort level with ear exams (1 to 5, 1 being uncomfortable and 5 being very comfortable). Residents then used Oto for patient encounters and took a picture of the TM. All patient encounters were included to help teach both normal and abnormal ear exams. After the exam, residents would record their diagnosis and basic demographics of the patient (age, gender, and chief complaint). Two board certified pediatricians reviewed the images to see if their diagnoses matched the resident diagnosis. The reviewers classified the photos as TM visualized or not. Results: 26 residents (8 PGY1, 11 PGY2, 6 PGY3, 0 PGY4) have completed our survey and used Oto with 37 patient encounters recorded. Seven residents had used Oto or a similar device prior to our study. Comfort level was most commonly recorded as 4. Chief complaint varied with about half of encounters presenting for an acute illness. AOM was diagnosed 2 times out of the 37 encounters by residents. The reviewers had 78% agreement in classifying the photos. TM was not visualized in 9 of the photos. Conclusion: Residents gave positive reviews regarding the device in immediate sharing of findings; however, there was a learning curve to obtaining clear pictures. This made the number of inconclusive photos for review high, but use did improve with time. This small pilot study revealed the challenges of using technology and user dependence upon results as noted by the inability to conclusively diagnose acute otitis media by our reviewers. Future aims of this project would include further education on technique of obtaining images and ultimately to feedback sessions to improve education and training of residents. We are continuing to use the device and collect data as residents are receiving immediate feedback which we hope will lead to improved diagnostic skills.

Figure 1

Tympanic Membrane from Oto Device

Figure 1

Tympanic Membrane from Oto Device

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