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

Abstract

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.

Health Care Simulation as a Training Tool for Epidemic Management

“…The study characteristics are presented in the Table 1. Most of the studies on simulation-based training were developed in response to SARS-CoV-2 (n = 117, 79.1%) 6–8,16–128 . Eighteen were motivated by Ebola outbreaks (12.2%), 129–146 7 by influenza (4.7%), 147–153 3 by MERS (2%), 154–156 and 3 by pandemics in general (2%) 157–159 …”

Use of a Caprine Model for Simulation and Training of Endoscopic Ear surgery

“…While there are some impressive examples within the literature of assessment tools, they are either unvalidated or were developed for use in microscope-guided ear surgery. 5 , 11 , 12 , 18 Development of expert consensus on key steps or a tool such as an objective structured assessment tool would allow for a more objective assessment of the goat head model and offer a means of tracking learner progression through the course of a surgical skills curriculum. 19 A benefit of endoscopic surgery in a simulation or operating room is the ability to easily record video of the procedure for subsequent analysis.…”

“…Multiple synthetic, virtual reality, and 3D-printed models are currently in existence. 5 , 6 Many of these were developed for use in teaching temporal bone drilling with a focus on the fidelity of drilling the hard bone. These are poorly adapted to endoscopic ear surgery training as it requires more emphasis on soft tissue dissection and handling.…”

Thinking Beyond the Temporal Bone Lab: A Systematic Process for Expanding Surgical Simulation in Otolaryngology Training

“…Simulation in neuro-otology was captured in 20 models (Supplemental Table 1). 10-30 Eight were intended for myringotomy +/− pressure equalization tube (PET) insertion, 7 for mastoidectomy, 2 for temporal bone dissection, one each for otoplasty, ossiculoplasty, and endoscopic transcanal tympanoplasty. Of the bench-top models, the myringotomy and PET insertion model described by Malekzadeh et al is notable for its low cost and low fidelity approach that incorporated readily available clinical supplies to enhance time to completion and global rating scores when compared to didactic training alone.…”