Validated self-assessment checklists for core ENT clinical procedures

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Created On: 17/07/2026

Reliable assessment of instrumental examination skills is fundamental for ensuring competency in otorhinolaryngology head and neck surgery (OHNS).

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Key take away

Consensus-based self-assessment checklists standardize competency evaluation for five core ENT instrumental procedures and support objective learning curve assessment.

Background

Reliable assessment of instrumental examination skills is fundamental for ensuring competency in otorhinolaryngology head and neck surgery (OHNS). However, standardized methods for exploring ear, nose, and throat (ENT) examination techniques remain limited. This study sought to develop and validate expert consensus-based self-assessment checklists with clearly defined success and failure criteria to support competency assessment and evaluation of procedural learning curves.

Method

Researchers executed a two-round modified Delphi consensus study involving OHNS experts and experienced residents. The panel developed self-assessment checklists for five commonly performed instrumental ENT procedures:

Flexible pharyngolaryngoscopy (Adults)
Flexible pharyngolaryngoscopy (Pediatrics)
Rigid nasal endoscopy
Otomicroscopy
Otoendoscopy

Volunteers rated checklist items for clinical utility using a nine-point Likert scale. The panel also checked the minimum number of supervised procedures and acceptable failure rates required before trainees could transition from supervised to independent practice.

Result

The Delphi process achieved consensus on 54 checklist items across the five procedures. The final validated checklists comprised the following components:

Adult flexible pharyngolaryngoscopy: 8 anatomical landmarks and 3 technical assessment items.
Pediatric flexible pharyngolaryngoscopy: 5 anatomical landmarks and 5 technical assessment items.
Rigid nasal endoscopy: 6 anatomical landmarks and 3 technical assessment items.
Otoendoscopy: 6 anatomical landmarks and 5 technical assessment items.
Otomicroscopy: 5 anatomical landmarks and 8 technical assessment items.

A procedure was classified as unsuccessful if any required checklist item was not completed correctly. The expert panel estimated acceptable failure rates of 5%–10% for residents and approximately 2% for experienced clinicians performing these procedures.

Conclusion

Consensus-based procedural benchmarks were successfully defined for five essential ENT examinations, offering a practical framework for objective skills assessment and trainee development. The resulting methodology provided an important foundation for future validation studies exploring procedural learning curves and performance outcomes.