Evaluation of a low-fidelity ear surgery simulator in a low-resource setting

Luu, Kimberly; Straatman, L; Nakku, Doreen; Westerberg, Brian D.; Carter, N; Clark, Matthew

doi:10.1017/s002221511700216x

Cited by 13 publications

(22 citation statements)

References 12 publications

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“…Because the middle ear is hidden inside the temporal bone and has limited accessibility, several strategies have been developed to visualize its anatomy (Tschabitscher and Klug, ). Due to these difficulties, to date, simulations have gained increasing popularity in otolaryngology, especially for teaching the surgical anatomy of the middle ear and procedures used to treat it (Javia and Deutsch, ; Javia and Sardesai, ), including computer‐based simulations (Abou‐Elhamd et al, ; Clifton et al, ; Francis et al, ), problem‐based learning (Abou‐Elhamd et al, ), simulations using three‐dimensional synthetic models (Mills and Lee, ; Bakhos et al, ; Rose et al, ; Barber et al, ; Luu et al, ; VanKoevering and Malloy, ) and even animal models (Anschuetz et al, ). Similar results have been described between virtual and cadaveric temporal bone dissections regarding the acquisition of surgical skills in the middle ear region (Wiet et al, ; Andersen, Foghsgaard et al, ).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study

Anschuetz

Huwendiek

Stricker

et al. 2018

Anatomical Sciences Ed

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Teaching methodologies for the anatomy of the middle ear have not been investigated greatly due to the middle ear's highly complex structure and hidden location inside of the temporal bone. The aim of this randomized study was to quantitatively compare the suitability of using microscope-and endoscope-based methods for teaching the anatomy of the middle ear. We hypothesize that the endoscopic approach will be more efficient compared to the microscopic approach. To answer the study questions, 33 sixth-year medical students, residents and otorhinolaryngology specialists were randomized either into the endoscopy or the microscopy group. Their anatomical knowledge was assessed using a structured anatomical knowledge test before and after each session. Each participant received tutoring on a human cadaveric specimen using one of the two methods. They then performed a hands-on dissection. After 2-4 weeks, the same educational curriculum was repeated using the other technique. The mean gains in anatomical knowledge for the specialists, residents, and medical students were +19.0%, +34.6%, and +23.4%, respectively. Multivariate analyses identified a statistically significant increase in performance for the endoscopic method compared to the microscopic technique (P < 0.001). For the recall of anatomical structures during dissection, the endoscopic method outperformed the microscopic technique independently of the randomization or the prior training level of the attendees (P < 0.001). In conclusion, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge as compared to the microscopic approach. The participants subjectively preferred the endoscope for educational purposes. Anat Sci Educ 12: 507-517.

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Section: Introductionmentioning

confidence: 99%

Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study

Anschuetz

Huwendiek

Stricker

et al. 2018

Anatomical Sciences Ed

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“…When tasks were performed and assessed on the Ear Trainer, one was able to differentiate between novices and experts. This initial assessment of the Ear Trainer was made on participants in the UK and the findings were then confirmed in the low-resource setting 3 …”

Section: Introductionmentioning

confidence: 97%

An endoscopic Ear Trainer for the low-resource setting

2019

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BackgroundEndoscopic ear surgery is a technique that is growing in popularity. It has potential advantages in the low-resource setting for teaching and training, for the relative ease of transporting and storing the surgical equipment and for telemedicine roles. There may also be advantages to the patient, with reduced post-operative pain, facilitating the ability to complete procedures as out-patients.MethodsOur Ear Trainer has previously been validated for headlight and microscope otology skills, including foreign body removal and ventilation tube insertion, in both the high- and low-resource setting. This study aimed to assess the Ear Trainer for similar training and assessment of endoscopic ear surgery skills in the low-resource setting. The study was conducted in Uganda on ENT trainees.ResultsDespite a lack of prior experience with endoscopes, with limited practice time most participants showed improvements in: efficiency of instrument movement, steadiness of the camera view obtained, overall global rating of the task and performance time (faster task performance).ConclusionThese results indicate that the Ear Trainer is a useful tool in the training and assessment of endoscopic ear surgery skills.

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“…Low-fidelity surgical simulation appears to be an interesting alternative for practical residency training because residents can access the simulator directly in keeping with infection control practices, even during lockdowns [ 10 ]. A number of simulators have been evaluated for basic microsurgical procedures carried out in consultations, such as the treatment of external ear canal disorders and tympanostomy tube insertion [ 11 – 13 ]. The simulator investigated in this study has previously been evaluated for endoscopic surgery of the middle ear without a microscope [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Otoskills training during covid-19 pandemic: a before-after study

et al. 2021

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Background The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. Methods In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. Results Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents. Conclusions This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

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Evaluation of a low-fidelity ear surgery simulator in a low-resource setting

Abstract: This study validates the Ear Trainer as a useful training tool for otological microsurgical skills in developing world settings.

Cited by 13 publications

References 12 publications

Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study

Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study

An endoscopic Ear Trainer for the low-resource setting

Otoskills training during covid-19 pandemic: a before-after study

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