Objectives/Hypothesis The objective of this project was to develop a virtual temporal bone dissection system that would provide an enhanced educational experience for the training of otologic surgeons. Study Design A randomized, controlled, multi-institutional single blinded validation study. Methods The project encompassed 4 areas of emphasis: structural data acquisition, integration of the system, dissemination of the system, and validation. Results Structural acquisition was performed on multiple imaging platforms. Integration achieved a cost effective system. Dissemination was achieved on different levels including casual interest, downloading of software, and full involvement in development and validation studies. A validation study was performed at 8 different training institutions across the country using a two arm, randomized trial where study subjects were randomized to a two-week practice session using either the virtual temporal bone or standard cadaveric temporal bones. Eighty subjects were enrolled and randomized to one of the two treatment arms, 65 completed the study. There was no difference between the two groups using a blinded rating tool to assess performance after training. Conclusions 1. A virtual temporal bone dissection system has been developed and compared to cadaveric temporal bones for practice using a multi-center trial. 2. There is no statistical difference seen between practice on the current simulator when compared to practice on human cadaveric temporal bones. 3. Further refinements in structural acquisition and interface design have been identified which can be implemented prior to full incorporation into training programs and use for objective skills assessment.

The system provides an environment to learn temporal bone surgery in a way similar to the experience with cadaver material where the subject is able to interact with the data without constraints (nondeterministic). Eventually, it may provide the "front end" to a large repository of various temporal bone pathologies that can be accessed through the Internet.

The number of personnel providing in-home health care services is increasing substantially. The unique configuration of environmental hazards in individual client homes has a significant impact on the safety and health of home health care providers (HHPs). This mixed-methods study used data from a standardized questionnaire, focus groups, and individual interviews to explore environmental health and safety hazards encountered by HHPs in client homes. The participant sample (N = 68) included nurses, aides, therapists, and owners/managers from a variety of geographic locations. The most often-reported hazards were trip/slip/lift hazards, biohazards, and hazards from poor air quality, allergens, pests and rodents, and fire and burns. Frequency of identified key hazards varied by room, that is, kitchen (e.g., throw rugs, water on floor), bathroom (e.g., tight spaces for client handling), bedroom (e.g., bed too low), living room (e.g., animal waste), and hallway (e.g., clutter). Findings indicate the need for broader training to enable HHPs to identify and address hazards they encounter in client homes.

Objectives/Hypothesis There is increasing interest in objective assessment of surgeon competence. In the field of otolaryngology, several surgical training programs, including The Ohio State University, the University of Toronto, and Stanford University, have pursued standardized criteria to rate their trainees’ performance in the initial steps of temporal bone dissection (complete mastoidectomy with facial recess approach). Although these assessment metrics require the completion of similar basic components integral to successful temporal bone dissection, certain listed criteria are unique to each institution. Our aim was to establish a more standardized set of criteria that can be used across different institutions to objectively assess temporal bone dissection. We translated these new criteria into automated metrics in our temporal bone dissection simulator to achieve even more objective grading of temporal bone dissections. Study Design Cross-sectional study/survey. Methods The temporal bone assessment criteria developed by each of the three aforementioned institutions were compiled into an all-encompassing scale. This compilation was sent out as an online survey to members of the American Neurotology Society and American Otological Society with instructions to rate the importance of each criterion. Results Criteria that were ranked by >70% of respondents as either “very important” or “important” were used to create the new, cross-institutional scale for the objective assessment of temporal bone dissection. Conclusions The new assessment scale and its eventual incorporation into the temporal bone surgical simulator will enhance the objectivity of currently existing methods to evaluate surgical performance across different institutions.