Face and content validity of a virtual-reality simulator for myringotomy with tube placement

Abstract

BackgroundMyringotomy with tube insertion can be challenging for junior Otolaryngology residents as it is one of the first microscopic procedures they encounter. The Western myringotomy simulator was developed to allow trainees to practice microscope positioning, myringotomy, and tube placement. This virtual-reality simulator is viewed in stereoscopic 3D, and a haptic device is used to manipulate the digital ear model and surgical tools.ObjectiveTo assess the face and content validity of the Western myringotomy simulator.MethodsThe myringotomy simulator was integrated with new modules to allow speculum placement, manipulation of an operative microscope, and insertion of the ventilation tube through a deformable tympanic membrane. A questionnaire was developed in consultation with instructing surgeons. Fourteen face validity questions focused on the anatomy of the ear, simulation of the operative microscope, appearance and movement of the surgical instruments, deformation and cutting of the eardrum, and myringotomy tube insertion. Six content validity questions focused on training potential on surgical tasks such as speculum placement, microscope positioning, tool navigation, ear anatomy, myringotomy creation and tube insertion. A total of 12 participants from the Department of Otolaryngology—Head and Neck Surgery were recruited for the study. Prior to completing the questionnaire, participants were oriented to the simulator and given unlimited time to practice until they were comfortable with all of its aspects.ResultsResponses to 12 of the 14 questions on face validity were predominantly positive. One issue of concern was with contact modeling related to tube insertion into the eardrum, and the second was with the movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64 % of the responses were positive, 21 % were neutral, and 15 % were negative.ConclusionsThe Western myringotomy simulator appears to have sufficient face and content validity. Further development with automated metrics and skills transference testing is planned.

Assessment of a virtual reality temporal bone surgical simulator: A national face and content validity study

“…Thirty-two simulators were specific to ear and temporal bone surgery, with six being VR simulators [16]. Although the majority of otologic simulators focus on temporal bone surgery, other platforms exist including a VR myringotomy simulator that recently achieved face, content, and construct validity [17,18]. Virtual reality simulators for temporal bone surgery are well documented and various groups have shown promising benefits for residency education [7,11,15,[19][20][21][22].…”

Validation of a model of feline ureteral obstruction as a tool for teaching microsurgery to veterinary surgeons

“…A questionnaire (Appendix B) designed to assess face validity of the model was derived from previous studies . Specifically, experts were asked how much the model physically resembled a feline ureter and if the chosen tasks closely resembled those routinely performed during a routine ureterotomy.…”

“…Studies in human medicine have shown, however, that well‐trained novice surgeons are capable of delivering outcomes similar to expert microsurgeons . To provide consistent and reliable instruction, microsurgery training programs for veterinary surgeons would benefit from a nonliving, affordable, reusable, and validated model of ureteral obstruction …”

“…Several methods have been described to validate surgical models . The most commonly assessed types of validity include subjective methods such as content and face validity and objective measures such as construct, concurrent, and predictive validity . Subjective validation is an initial step in planning substantiated, prospective studies incorporating objective measures of validity …”

Otologic Skills Training

“…Numerous models have been described ranging from DIY models based on readily available materials 12 to more complex physical models 13,14 . In addition, a VR simulation model for myringotomy and tube insertion with supporting haptic feedback has been developed 15–18 . Although global rating scales and task-based checklists have been developed and validated 12,19 to assess for myringotomy with tube insertion competency, evidence to support the efficacy of myringotomy simulation training is limited and high quality studies examining the transfer of skills to improved patient outcomes are needed (see SimTube project below).…”