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Background and objectives: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. Materials and methods: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. Results: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. Conclusions: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.

Objectives To perform a radio‐anatomical evaluation of the nasal cavity floor free mucosal graft (endonasal extended mucoplasty, EEM) to repair mucosal defects after an extended ethmoid‐sphenoidotomy. Methods A human cadaveric study (radiological and anatomical dissection) and an in vivo study in surgical patients with CRSwNP were performed. The EEM areas were compared between 3D reconstruction from CT scans and anatomical/surgical dissections, both in cadaver specimens and in patients. Feasibility was assessed by correlation between the EEM area on CT scans and when harvested in cadavers and when grafted in patients. Usefulness was assessed by the degree of coverage of the EEM in the surface exposed after an extended ethmoid‐sphenoidotomy. Both feasibility and usefulness were assessed in cadaveric specimens (n = 15) and patients (n = 4). Results Fifteen cadaveric specimens and 4 patients with bilateral CRSwNP were included. The mean (SD) areas obtained in the cadaveric radiological and anatomical studies were 9.44 (2.07) cm2 and 8.03 (1.36) cm2, respectively (intraclass correlation coefficient 0.59, moderate correlation), and in 3D reconstruction for operated patients were 10.32 (0.98) cm2 and 11.27 (2.44) cm2, respectively. The coverage of the ethmoidal roof in the cadaveric dissection study was 100%, from the anterior ethmoidal artery to the posterior ethmoidal artery, covering the planun sphenoidale up to 75% in the case series. In 87.5% of the cases, up to 50% of the papiracea lamina was covered. Conclusion The EEM have shown to be a feasible and useful grafting technique to repair skull base defects after performing an extended ethmoid‐sphenoidotomy during surgery for CRSwNP. Level of Evidence NA.

Resumen Antecedentes y objetivos La pandemia de la COVID-19 ha obligado a completar los estudios universitarios online. La Conferencia Nacional de Decanos de Facultades de Medicina coordina una prueba de evaluacion de competencias clinicas objetiva y estructurada (ECOE) de 20 estaciones presenciales a los estudiantes de sexto del grado. Como consecuencia de la pandemia se ha disenado una ECOE sustitutoria con casos-clinicos computarizados simulados (ECOE-CCS). El objetivo del articulo es describir la elaboracion, la ejecucion y el desarrollo de la prueba. Materiales y metodos Estudio descriptivo de la ECOE-CCS conjunta desde su gestacion en abril 2020 hasta su ejecucion en junio 2020. Resultados La ECOE-CCS evaluo las competencias de anamnesis, exploracion, juicio clinico, aspectos eticos, relaciones interprofesionales, prevencion y promocion de la salud. No se evaluaron habilidades tecnicas ni de comunicacion. La ECOE-CCS consistio en 10 estaciones de 12 minutos de duracion, con un numero de preguntas de seis a 21 (media: 1,1 minutos/pregunta). En la ECOE-CCS se utilizo la plataforma virtual del campus de cada una de las 16 facultades de Medicina que participaron, con un total de 2.829 estudiantes de sexto curso. Se realizo de una forma conjunta en dos fechas de junio del 2020. Conclusiones La experiencia de la ECOE-CCS permitio llevar a cabo una integracion y el trabajo interdisciplinar de las diferentes facultades de Medicina. La ECOE-CCS realizada podria asemejarse al Step 3 CCS de la United States Medical Licensing Examination.

Background: Endoscopic sinus surgery (ESS) is performed on endonasal landmarks that have great anatomical variability, therefore a detailed preoperative study of these structures is necessary. Objective: To develop a checklist for the systematic identification of the paranasal sinuses and the skull base, based on 3D images that guide the planning and implementation of ESS to minimize complications and improve surgical outcomes. Methods: This study evaluates the usefulness of the “ABCDEF Checklist”, in a randomized study involving 30 otolaryngologists with more than 2 years of practical experience in ESS evaluating preoperative radiological examination and subsequent surgical performance in the sinus of 30 cadavers. Results: Differences between groups in identifying the essential anatomical references were significant in 9 of the 11 essential anatomical references for the Checklist Group Surgical procedures and surgical mistakes were performed systematically less often in the Checklist group but the differences did not reach significance after Bonferroni correction. Conclusions: The use of "ABCDEF Checklist" prior to ESS facilitates the identification of the essential anatomical references for the preoperative and systematized planning of the surgical procedures. However, in this small sample of 15 participants per group the differences found in the performance of the surgical procedures did not reach significance.

Background and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents. Methods A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website. Results A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009 and 2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format. Conclusions The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.

Resumen Introduccion y objetivos Evaluar la capacidad formativa del libro del residente espanol como portafolio electronico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringologia (ORL). Metodos Se realizo una investigacion cualitativa multimetodo de caracteristicas tranversal, temporal y de orientacion retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicacion informatica web FORMIR. Resultados Participaron el 56,5% de los MIR de ORL de alguno de los 63 hospitales espanoles acreditados para impartir formacion en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electronico eran capaces de autoguiar mejor su aprendizaje, conocian mejor sus objetivos de aprendizaje, cumplian mas eficientemente el programa de formacion, identificaban mas claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electronico constituia una herramienta formativa idonea para sustituir al libro del residente en formato papel. Conclusiones Los MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electronico, especialmente su interfaz, el feedback numerico y automatico sobre la adquisicion de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como logbook de la Union Europea de Medicos Especialistas o como un curriculum vitae estandar. Este feedback automatico facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptacion de instrumentos similares puestos a disposicion de los residentes, que no dudan en proponerlo como el libro del residente mas idoneo para facilitar su formacion especializada.

Resumen Introduccion y objetivos La elevada variabilidad anatomica de los senos paranasales requiere disponer del mejor conocimiento de su conformacion tridimensional para afrontar la cirugia con mayor seguridad y eficiencia. El objetivo del estudio fue validar la utilidad de Osirix ® y la estereolitografia en la mejora de la planificacion de las cirugias endoscopicas nasosinusales. Metodos Se utilizo Osirix ® como visor y gestor de imagenes DICOM en 3 dimensiones (3D) en la planificacion de 114 cirugias endoscopicas nasosinusales por poliposis (86) y rinosinusitis cronica (28) junto con prototipos rapidos estereolitograficos en 7 mucoceles frontoetmoidales. Resultados Se identificaron mayor numero de estructuras anatomicas, mas rapidamente y con una correlacion clinico-radiologica estadisticamente significativa (p Conclusiones La utilizacion sistematica de Osirix ® para visualizacion y tratamiento autonomo de imagenes nasosinusales en 3D desde archivos DICOM permite a los cirujanos efectuar las cirugias endoscopicas nasosinusales con mayor confianza y seguridad y en menos tiempo que utilizando imagenes en 2D. Los residentes tambien alcanzan la competencia quirurgica mas rapidamente, con mayor seguridad y con menos complicaciones. La mejora en la planificacion se incrementa cuando el equipo quirurgico dispone de prototipos rapidos estereolitograficos en los casos de mayor complejidad.

Nowadays, endoscopic endonasal expanded approach targeting for the clival lower third is well described in literature. Nonetheless, great variations can be found among surgical groups, specially during the earlier stages of this procedure. We present a step by step description of the clival lower third approach until entering the dural space, setting its bony limits. We describe the basipharyngeal flap tailoring as a helpful option for latter reconstruction. The study of cadaveric specimens adds clarifying dissections. The expansion in the coronal plane is providential in most of the intradural lesions of the inferior clivus. Basipharyngeal flap may help seal the surgical defects in this area.

Don Juan de Mata Carriazo entregó dos lotes de huesos humanos procedentes de su excavación del Dolmen de Cañada Real: uno fue depositado en el Museo Arqueológico de Sevilla, mientras que el otro fue llevado a la Facultad de Medicina de la Universidad. Una vez publicados los resultados de los restos óseos del museo, nos detenemos aquí en la descripción de este segundo depósito. Mr. Juan de Mata Carriazo handed over two sets of human bones from his excavation of the ‘Dolmen de Cañada Real’: one was deposited at the Archaeological Museum of Seville, while another was taken to the Medicine Faculty of the University. Once the bone remains housed at the museum have been published, we study the second ones.

The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning.Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles.Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38±12.3min in CRS and 42±27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19).The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases.

El presente trabajo analiza la morfología del endotelio corneal en el embrión de pollo con la ayuda de la microscopía electrónica de barrido. Nuestro fin descriptivo se ha centrado tanto en las relaciones que las células endoteliales mantienen entre sí y con sus sustratos, como en los cambios morfológicos que sufren durante su desarrollo y diferenciación.