Comparative validity of three simulation platforms for objective assessment of otoscopy skills

Abstract

Main Outcome Measures: Face and Content validity based on expert assessor ranking on each model and their feedback from semi-structured interviews. Construct validity based on Objective Structured Clinical Examination scores.Results: Each platform differed in face, construct and content validity scores, with no one platform consistently outperforming others. Three main themes were identified during thematic analysis of expert assessor interviews: ability to assess what is seen, anatomical reality, and ease of use. The low-cost model showed greatest potential, where modification to include a silicone ear could lead to high validity with marginal increase in cost. Conclusion:Several modalities for assessing otoscopy skills exist, each with advantages and disadvantages. Modifications to a low-cost model, for use with either a traditional or digital otoscope, could prove to be the best model. K E Y W O R D S digital otoscope, medical education, OSCE, Otoscopy, training methods 1 | BACKGROUND Otoscopy (visual examination of the external auditory canal and tympanic membrane [TM]) is a key clinical skill for medical students and healthcare professionals. 1 Otological complaints comprise 1%-2% of all consultations in general practice 2 (15% in children aged under two 3 ), and 2% of all Accident and Emergency department attendances. 4 Previous studies have found medical students report low confidence in performing otoscopy 5,6 (often linked to a lack of exposure), and have assessed interventions to improve teaching and learning of this skill. 7,8 The Medical Licensing Assessment (MLA) is an objective test of core knowledge, skills and behaviours to be introduced in the United Kingdom (UK) from 2024 to standardise the curriculum and assessment for joining the UK medical register. 9 Skills assessed within the MLA include an expectation that a qualified doctor should be able to perform otoscopy and recognise 'common abnormalities' including otitis media with effusion, TM perforation and acute otitis media. 9Current approaches to assessing otoscopy skills are imperfect.Competent otoscopy includes visualising the TM, but objectively assessing this outcome can be difficult because traditional otoscopes do not allow simultaneous viewing by candidate and assessor. Published checklists for otoscopy skills do not include objective measures of visualisation, making assessing