A model for training and evaluation of myringotomy and tube placement skills

Gathering validity evidence for a 3D-printed simulator for training of myringotomy and ventilation tube insertion

Objectives

This study aimed to gather validity evidence according to Messick's framework for a novel 3D-printed simulator for myringotomy with ventilation tube insertion for use in technical skills training of otorhinolaryngology (ORL) residents.

Methods

The study included 15 junior ORL residents (trainees) and 13 experienced teaching otolaryngologists (experts). Experts and trainees first received an identically structured introduction to the procedure, simulator, and simulation setup. Five procedures performed by each participant were video-recorded and ordered randomly for blinded rating by two independent raters. The rating tools used were a global rating scale (GBRS) and a task-specific checklist. Validity evidence was collected according to Messick's framework. Differences in time consumption and performance scores were analyzed. Finally, a pass/fail standard was established using the contrasting groups' method.

Results

Trainees used significantly more time per procedure (109 s, 95% CI: 99-120) than experts (82 s, 95% CI: 71-93; p < .001). Adjusted for repetition and rater leniency, experts achieved an average GBRS score of 18.8 (95% CI: 18.3-19.2) out of 20 points, whereas trainees achieved an average of 17.1 points (95% CI: 16.6-17.5; p < .001). In contrast to the task-specific checklist, the GBRS score discriminated between repetition number and participant experience. The pass/fail standard for the GBRS was established at 18.4 points.

Conclusion

We established educational validity evidence for a novel 3D-printed model for simulation-based training of ventilation tube insertion and established a reliable pass/fail standard.

Level of Evidence

1b.

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

The COVID-19 pandemic led to a temporary lapse in the development of otolaryngology trainee operative skills due to the cancellation of elective procedures and redeployment of trainees and attendings to COVID-19 units. Although transient, this disruption provided an opportunity for otolaryngology programs to develop contingency plans and formalize nascent simulation training curricula. Integration of formal simulation training alongside current didactic and surgical education may offset lost exposure during surgically lean times while providing the framework and resources for enhanced baseline training. Here, we provide an up-to-date overview of surgical simulation models in otolaryngology and identify easily implementable, low-cost, low fidelity models for junior trainees. By taking advantage of rapid advancements in technology and a paradigm shift to a more hands-on approach in medical education, formal simulation training may prove to be a beneficial tool at all stages of residency training, allowing for expanded peer-mentored skill development and providing a safe haven during unforeseen disruptions in surgical case volume.

A novel approach to myringotomy simulation

Objective

In the wake of the 2019 coronavirus disease pandemic, elective cases and opportunities for clinical application have decreased, and the need for useful simulation models has become more apparent for developing surgical skills. A novel myringotomy with ventilatory tube insertion simulation model was created.

Methods

Residents across all levels at our institution participated in the simulation. Participants were evaluated in terms of: time of procedure, microscope positioning, cerumen removal, identification of middle ear effusion type, canal wall trauma, tympanic membrane damage and tube placement.

Results

Eleven residents participated. Scores ranged from 14 to 34, out of a maximum of 40. The average score among junior and senior residents was 24 and 31, respectively. The simulation was felt to be representative of the operating theatre experience.

Conclusion

This study demonstrates a low-cost simulation model that captures several important, nuanced aspects of myringotomy with tube insertion, often overlooked in previously reported simulations.

Current Evidence for Simulation-Based Training and Assessment of Myringotomy and Ventilation Tube Insertion: A Systematic Review

OBJECTIVE

Myringotomy and ventilation tube insertion (MT) is a key procedure in otorhinolaryngology and can be trained using simulation models. We aimed to systematically review the literature on models for simulation-based training and assessment of MT and supporting educational evidence.

DATABASES REVIEWED

PubMed, Embase, Cochrane Library, Web of Science, Directory of Open Access Journals.

METHODS

Inclusion criteria were MT training and/or skills assessment using all types of training modalities and learners. Studies were divided into 1) descriptive and 2) educational interventional/observational in the analysis. For descriptive studies, we provide an overview of available models including materials and cost. Educational studies were appraised using Kirkpatrick's level of educational outcomes, Messick's framework of validity, and a structured quality assessment tool.

RESULTS

Forty-six studies were included consisting of 21 descriptive studies and 25 educational studies. Thirty-one unique physical and three virtual reality simulation models were identified. The studies report moderate to high realism of the different simulators and trainees and educators perceive them beneficial in training MT skills. Overall, simulation-based training is found to reduce procedure time and errors, and increase performance as measured using different assessment tools. None of the studies used a contemporary validity framework and the current educational evidence is limited.

CONCLUSION

Numerous simulation models and assessment tools have been described in the literature but educational evidence and systematic implementation into training curricula is scarce. There is especially a need to establish the effect of simulation-based training of MT in transfer to the operating room and on patient outcomes.

A systematic review of low-cost simulators in ENT surgery

BACKGROUND

Simulation training has become a key part of the surgical curriculum over recent years. Current trainees face significantly reduced operating time as a result of the coronavirus disease 2019 pandemic, alongside increased costs to surgical training, thus creating a need for low-cost simulation models.

METHODS

A systematic review of the literature was performed using multiple databases. Each model included was assessed for the ease and expense of its construction, as well as its validity and educational value.

RESULTS

A total of 18 low-cost simulation models were identified, relating to otology, head and neck surgery, laryngeal surgery, rhinology, and tonsil surgery. In only four of these models (22.2 per cent) was an attempt made to demonstrate the educational impact of the model. Validation was rarely formally assessed.

CONCLUSION

More efforts are required to standardise validation methods and demonstrate the educational value of the available low-cost simulation models in otorhinolaryngology.

Validated specialty-specific models for multi-disciplinary microsurgery training laboratories: a systematic review

BACKGROUND

Laboratory simulation is increasingly important for teaching microsurgical skills. Training microsurgeons of different specialties within the same simulation laboratory increases efficiency of resource use. For maximal benefit, simulations should be available for trainees to practice specialty-specific, higher-order skills. Selection of appropriate simulations requires knowledge of the efficacy and validity of the numerous described laboratory models. Here we present a systematic review of validated training models that may serve as useful adjuncts to achieving competency in specialty elements of microsurgery, and appraise the evidence behind them.

METHODS

In setting up a multi-disciplinary microsurgery training course, we performed a systematic review according to preferred reporting items for systematic reviews and meta-analyses guidelines. EMBASE, MEDLINE, Cochrane and PubMed databases were searched for studies describing validated, microscope-based, specialty-specific simulations, and awarded a level of evidence and level of recommendation based on a modified Oxford Centre for Evidence-Based Medicine classification.

RESULTS

A total of 141 papers describing specialty-specific microsimulation models were identified, 49 of which included evidence of validation. Eleven were in the field of neurosurgery, 21 in otolaryngology/head and neck surgery, two in urology/gynaecology and 15 plastic and reconstructive surgery. These papers described synthetic models in 19 cases, cadaveric animals in 10 cases, live animals in 12 cases and human cadaveric material in 10 cases.

CONCLUSION

Numerous specialty-specific models for use in the microscope laboratory are available, but the quality of evidence for them is poor. Provision of models that span numerous specialties may encourage use of a microscope lab whilst still enabling more specific skills training over a 'one-size-fits-all' approach.

Combined web and haptic simulation system: A pilot study

OBJECTIVES

Simulation education is increasingly used in otolaryngology training. The objective of this pilot study is to describe a mixed web-based and haptic modular platform for pediatric airway conditions.

METHODS

A web-based modular case presentation and evaluation system were developed to correspond to a pediatric laryngeal condition represented on the haptic models created using 3D printing and silicone elastomer. The haptic microlaryngoscopy simulation training and web module were evaluated by participants using a Likert scale. The mixed modular apparatus systematized the open web platform and haptic simulator, videos, text, questions, and evaluation to provide a more comprehensive simulation experience.

RESULTS

Seventeen otolaryngology trainees participated, each completing a post-simulation survey. All participants responded 4 or higher (agree or strongly agree) on the Likert scale that the virtual training and case presentations improved their understanding of the pediatric laryngeal conditions presented.

CONCLUSION

A modular system constitutes a variety of web-based cases for evaluating, diagnosing, and performing procedures on a haptic surgical simulator taking the physician in training from diagnosis to treatment thereby expanding our current use of haptic simulators in surgical education to include case based learning and decision making.

SimTube: A National Simulation Training and Research Project

OBJECTIVE

To test the feasibility and impact of a simulation training program for myringotomy and tube (M&T) placement.

STUDY DESIGN

Prospective randomized controlled.

SETTING

Multi-institutional.

SUBJECTS AND METHODS

An M&T simulator was used to assess the impact of simulation training vs no simulation training on the rate of achieving competency. Novice trainees were assessed using posttest simulator Objective Structured Assessment of Technical Skills (OSATS) scores, OSATS score for initial intraoperative tube insertion, and number of procedures to obtain competency. The effect of simulation training was analyzed using χ² tests, Wilcoxon-Mann-Whitney tests, and Cox proportional hazards regression.

RESULTS

A total of 101 residents and 105 raters from 65 institutions were enrolled; however, just 63 residents had sufficient data to be analyzed due to substantial breaches in protocol. There was no difference in simulator pretest scores between intervention and control groups; however, the intervention group had better OSATS global scores on the simulator (17.4 vs 13.7, P = .0003) and OSATS task scores on the simulator (4.5 vs 3.6, P = .02). No difference in OSATS scores was observed during initial live surgery rating (P = .73 and P = .41). OSATS scores were predictive of the rate at which residents achieved competence in performing myringotomy; however, the intervention was not associated with subsequent OSATS scores during live surgeries (P = .44 and P = .91) or the rate of achieving competence (P = .16).

CONCLUSIONS

A multi-institutional simulation study is feasible. Novices trained using the M&T simulator achieved higher scores on simulator but not initial intraoperative OSATS, and they did not reach competency sooner than those not trained on the simulator.

Low cost, easy-to-replicate myringotomy tube insertion simulation model

INTRODUCTION

Simulation is an established part of modern surgical education. Several training centers have proposed different simulation models for myringotomy tube (MT) placement and validated their effectiveness in medical student and resident training. None is widely used. Early models were simple tubes that lacked important microsurgical elements. Newer simulators are more comprehensive, but are difficult and expensive to build. We present a MT placement simulator that is low cost, easy to construct with basic power tools and allows for acquisition of the most necessary MT placement skills.

METHODS

The model incudes a rotating spherical "head", a 4 mm oval speculum, a drilled-out working shaft similar in size to the external auditory canal, and a realistic paper tympanic membrane target, set at an anatomically correct angle. To evaluate the model's efficacy, we assessed the performance of 10 surgically naïve medical student volunteers before training and after 30 min of instruction with the model. Their speed was recorded and operative performance was assessed using a validated Global Rating Scale.

RESULTS

After 30 min of practice on the model, there was significant improvement in MT placement skill scores and significant decrease in time for tube placement (p < 0.05).

CONCLUSION

This MT placement simulation model is inexpensive and easy to build. Unlike existing planar models, it simulates patient head orientation, and requires realistic hand positioning on a 4 mm speculum. Practice with the model for 30 min resulted in statistically significant improvement in MT placement skill scores for inexperienced student surgeons.

Creating a Validated Simulation Training Curriculum in Otolaryngology

Purpose of Review

Simulation-based training is an integral component of surgical training. It allows practice of technical skills within a safe environment without compromising patient safety. This article seeks to review current virtual and non-virtual reality simulation models within the literature and review their validation status.

Recent Findings

Many simulation models exist within otolaryngology and are currently being used for education. New models are also continuously being developed; however, validity should be proven for the models before incorporating their use for educational purposes. Validity should be determined by experts and trainees themselves.

Summary

A validated simulation curriculum should be incorporated within the otolaryngology training programme. A curriculum based on the current training programme at our institution serves as an exemplar for local adoption.

3D printed myringotomy and tube simulation as an introduction to otolaryngology for medical students

OBJECTIVES

Surgical simulation models have been shown to improve surgical skill and confidence for surgical residents before real life procedures. Surgical simulators can be similarly applied in undergraduate medical education as a tool to introduce students to the field of otolaryngology.

METHODS

Ear models were created using 3D printing and high-performance silicone. Twenty medical students participated in a slide presentation and a myringotomy tube simulation station, each completing a pre- and post-survey using a 5-point Likert scale.

RESULTS

A previously validated 3D myringotomy simulator was used. Twenty medical student volunteers participated in the simulation including 14 first-year and 6 s-year medical students. None of the participating students reported observing myringotomy and placement of tympanostomy tubes before the session. Medical student participants rated their knowledge of the steps of the procedure and where to insert the tympanostomy tube at 2 (2 = disagree) or below with a mean of 1.35 SD = 0.47 and 1.2 SD = 0.41 respectively. At the completion of the educational session, the medical students rated their knowledge of the steps of the procedure as significantly improved at 4.45 SD = 0.6 (p = 0.00001).

DISCUSSION

We found that medical students with no prior exposure to ear anatomy or surgical training were able to use the simulator as an introduction to the specialty. There was a perceived improvement in their medical knowledge and basics of a procedural skill.

CONCLUSION

Medical schools can provide an inexpensive, safe, procedural practice tool using 3D printing as an introduction for students interested in surgical procedures.

Otologic Skills Training

This article presents a summary of the current simulation training for otologic skills. There is a wide variety of educational approaches, assessment tools, and simulators in use, including simple low-cost task trainers to complex computer-based virtual reality systems. A systematic approach to otologic skills training using adult learning theory concepts, such as repeated and distributed practice, self-directed learning, and mastery learning, is necessary for these educational interventions to be effective. Future directions include development of measures of performance to assess efficacy of simulation training interventions and, for complex procedures, improvement in fidelity based on educational goals.

Patient Safety and Quality Improvement in Otolaryngology Education: A Systematic Review

Objective

The breadth and depth of patient safety/quality improvement (PS/QI) research dedicated to otolaryngology–head and neck surgery (OHNS) education remains unknown. This systematic review aims to define this scope and to identify knowledge gaps as well as potential areas of future study to improved PS/QI education and training in OHNS.

Data Sources

A computerized Ovid/Medline database search was conducted (January 1, 1965, to May 15, 2015). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar.

Review Methods

The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were classified by year, subspecialty, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass.

Results

Computerized searches yielded 8743 eligible articles, 267 (3.4%) of which met otolaryngology PS/QI inclusion criteria; 51 (19%) were dedicated to resident/fellow education and training. Simulation studies (39%) and performance/competency evaluation (23.5%) were the most common focus. Most projects involved general otolaryngology (47%), rhinology (18%), and otology (16%). Classification by the IOM included effective care (45%), safety/effective care (41%), and effective and efficient care (7.8%). Most research fell into the WHO category of “identifying solutions” (61%).

Conclusion

Nineteen percent of OHNS PS/QI articles are dedicated to education, the majority of which are simulation and focus on effective care. Knowledges gaps for future research include facial plastics PS/QI and the WHO category of “studies translating evidence into safer care.”

Current Status of Simulation in Otolaryngology: A Systematic Review

OBJECTIVE

Otolaryngology is a highly technical and demanding specialty and the requirements for surgical trainees to acquire proficiency remains challenging. Simulation has been purported to be an effective tool in assisting with this. The aim of this systematic review is to identify the available otolaryngology simulators, their status of validation, and evaluation the level of evidence behind each training model and thereby establish a level of recommendation.

DESIGN

PubMed, ERIC, and Google Scholar databases were searched for articles that described otolaryngology simulators or training models between 1980 and April 2016. Any validation studies for simulators were also retrieved. Titles and abstracts were screened for relevance using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Level of evidence (LoE) and Level of recommendation (LoR) was awarded to each study and model, respectively.

RESULTS

A total of 70 studies were identified describing 64 simulators. Out of these, at least 54 simulators had 1 validation study. Simulators for the ear and temporal bone surgery were the most common (n = 32), followed by laryngeal and throat (n = 20) and endoscopic sinus surgery (n = 12). Face validity was evaluated by 29 studies, 20 attempted to show construct, 20 assessed content, 20 transfer, and only 2 assessed concurrent validity. Of the validation assessments, 2 were classified as Level 1b, 10 Level 2a, and 48 Level 2b. No simulators received the highest LoR, but 8 simulators received a LoR of 2.

CONCLUSIONS

Despite the lack of evidence in outcome studies and limited number of high-validity otolaryngology simulators, the role of simulation continues to grow across surgical specialties Hence, it is imperative that the simulators are of high validity and construct for trainees to practice and rehearse surgical skills to develop confidence.

Otolaryngology Education: Recent Trends in Publication

Objectives

(1) Evaluate peer-reviewed publications regarding education in otolaryngology since 2000. (2) Analyze publication trends as compared with overall otolaryngology publications.

Study Design

Bibliometric analysis.

Setting

Academic medical center.

Subjects and Methods

A search for articles regarding education in otolaryngology from 2000 to 2015 was performed with MEDLINE and EMBASE databases, yielding 1220 articles; 362 relevant publications were categorized by topic, subspecialty, subject, article type, and funding source. Impact factors for each journal by year were obtained, and trends of each category over time were analyzed. These were then compared with publication numbers and impact factors for all otolaryngology journals.

Results

From 2000 to 2015, publications in otolaryngology education increased more rapidly than the field of otolaryngology overall. The most published topics included operative skills training, surgical simulation, and professionalism/career development. Recently there has been a decline in publications related to residency administration and duty hours relative to other topics. Only 12.2% of publications reported a funding source, and only 12.2% of studies were controlled.

Conclusion

Recent trends in otolaryngology literature reflect an increasing focus on education; however, this work is underfunded and often lacks high-quality evidence.

Ventilation tube insertion simulation: a literature review and validity assessment of five training models

OBJECTIVE

The objective of this study was to identify and investigate the face and content validity of ventilation tube insertion (VTI) training models described in the literature.

DESIGN

A review of literature was carried out to identify articles describing VTI simulators. Feasible models were replicated and assessed by a group of experts.

SETTING

Postgraduate simulation centre.

PARTICIPANTS

Experts were defined as surgeons who had performed at least 100 VTI on patients. Seventeen experts were participated ensuring sufficient statistical power for analysis.

MAIN OUTCOME MEASURES

A standardised 18-item Likert-scale questionnaire was used. This addressed face validity (realism), global and task-specific content (suitability of the model for teaching) and curriculum recommendation.

RESULTS

The search revealed eleven models, of which only five had associated validity data. Five models were found to be feasible to replicate. None of the tested models achieved face or global content validity. Only one model achieved task-specific validity, and hence, there was no agreement on curriculum recommendation.

CONCLUSIONS

The quality of simulation models is moderate and there is room for improvement. There is a need for new models to be developed or existing ones to be refined in order to construct a more realistic training platform for VTI simulation.

Simulation Activity in Otolaryngology Residencies

OBJECTIVES

Simulation has become a valuable tool in medical education, and several specialties accept or require simulation as a resource for resident training or assessment as well as for board certification or maintenance of certification. This study investigates current simulation resources and activities in US otolaryngology residency programs and examines interest in advancing simulation training and assessment within the specialty.

STUDY DESIGN

Web-based survey.

SETTING

US otolaryngology residency training programs.

SUBJECTS AND METHODS

An electronic web-based survey was disseminated to all US otolaryngology program directors to determine their respective institutional and departmental simulation resources, existing simulation activities, and interest in further simulation initiatives. Descriptive results are reported.

RESULTS

Responses were received from 43 of 104 (43%) residency programs. Simulation capabilities and resources are available in most respondents' institutions (78.6% report onsite resources; 73.8% report availability of models, manikins, and devices). Most respondents (61%) report limited simulation activity within otolaryngology. Areas of simulation are broad, addressing technical and nontechnical skills related to clinical training (94%). Simulation is infrequently used for research, credentialing, or systems improvement. The majority of respondents (83.8%) expressed interest in participating in multicenter trials of simulation initiatives.

CONCLUSION

Most respondents from otolaryngology residency programs have incorporated some simulation into their curriculum. Interest among program directors to participate in future multicenter trials appears high. Future research efforts in this area should aim to determine optimal simulators and simulation activities for training and assessment as well as how to best incorporate simulation into otolaryngology residency training programs.

Trauma training course: innovative teaching models and methods for training health workers in active conflict zones of Eastern Myanmar

Background

Myanmar has struggled through decades of internal conflict, which has negatively impacted the country’s health outcomes. Recent government changes have brought hope and reduced conflict. The ethnic minority groups have suffered the brunt of the health consequences and reside in regions that lack health infrastructure, resources, and providers. Due to the chronic lack of healthcare providers within conflict areas, health workers (HWs) have been trained in an effort to fill the void. Research has shown that these non-physician clinicians positively impact health outcomes in developing countries. These HWs are supported by community-based organizations in collaboration with foreign non-governmental organizations. Started in 2000, the trauma training course was developed to meet the educational needs of these HWs.

Methods

Essential procedures for HWs in conflict zones were identified, and teaching methods were adapted to develop models that were simple, reproducible, cost effective, and able to facilitate effective learning within the limitations of these challenging environments. This paper presents simulation models developed to teach trauma injury evaluation and management in resource-limited settings to HWs.

Results

Material and construction of the models described include breathing, chest, cricothyroidotomy, circulation, wound repair, fracture/dislocation, splinting, fasciotomy/amputation, and an animal model. In 2013, a pre/post test and post-training evaluation were completed, which demonstrated an increase in understanding of the material and satisfaction with the training.

Conclusions

The simulation models described engage the HWs in clinical skills practice specific to injury management, which builds upon the HWs existing knowledge and facilitates an increased understanding of life-saving procedures. Through observation of the HW performance and HW feedback, these simulation models have increased the understanding of trauma management. Limitations include lack of a graduated learning system for the HWs, logistics, and time constraints. Despite the barriers faced, we feel that this is a necessary program that has reduced morbidity and mortality due to traumatic injury in the geographic areas that the HWs serve. With the changing political environment in Myanmar and the development of peace agreements between the government and the ethnic minority groups, these HWs can be integrated into Myanmar’s evolving health system.

An anatomically sound surgical simulation model for myringotomy and tympanostomy tube insertion

OBJECTIVE

Myringotomy and tympanostomy tube insertion (MT) is a common surgical procedure. Although surgical simulation has proven to be an effective training tool, an anatomically sound simulation model for MT is lacking. We developed such a model and assessed its impact on the operating room performance of senior medical students.

STUDY DESIGN

Prospective randomized trial.

METHODS

A randomized single-blind controlled study of simulation training with the MT model versus no simulation training. Each participant was randomized to either the simulation model group or control group, after performing an initial MT procedure. Within two weeks of the first procedure, the students performed a second MT. All procedures were performed on real patients and rated with a Global Rating Scale by two attending otolaryngologists. Time to complete the MT was also recorded.

RESULTS

Twenty-four senior medical students were enrolled. Control and intervention groups did not differ at baseline on their Global Rating Scale score or time to complete the MT procedure. Following simulation training, the study group received significantly higher scores (P=.005) and performed the MT procedure in significantly less time (P=.034). The control group did not improve their performance scores (P>.05) or the time to complete the procedure (P>.05).

CONCLUSION

Our surgical simulation model shows promise for being a valuable teaching tool for MT for senior medical students. Such anatomically appropriate physical simulators may benefit teaching of junior trainees.

Interval vs Massed Training

Objective

To compare 2 different training paradigms, massed vs interval training, when novice students learn a surgical procedure, myringotomy with ventilation tube insertion, on a validated surgical simulator.

Study Design

Medical students were randomized into 2 training groups: the interval group (n = 19) was trained to perform the procedure in 5 trials/d over 3 days, and the massed group (n = 21) was trained to perform the procedure in 15 trials all in 1 session. One week later, all students were tested in 5 additional final trials. Pre- and posttest surveys were administered.

Setting

Academic medical center.

Subjects and Methods

Forty medical students: 19 students in the interval group were compared with 21 students in the massed group. Time to complete the procedure and number and type of error made were recorded and compared between groups. Pre- and poststudy surveys examined confidence levels working under a microscope and with the procedure.

Results

Students in both groups had a significant decrease in time between practice and final trials. In the final 5 trials, there was no difference in average time to complete the procedure between the massed and interval training groups. No difference was observed in the number of errors committed per trial between initial and final trials (both groups) or between massed and interval training groups. The students’ confidence levels significantly increased across the trials, regardless of group.

Conclusion

Surgical training improves proficiency, but method of training had little impact on proficiency in performing a simulated surgical procedure in this setting.

Face, Content, and Construct Validity of a Low-Cost Sinus Surgery Task Trainer

Objective. To assess the face, content, and construct validities of a low-cost sinus surgery task trainer in acquisition of skills for endoscopic sinus surgery.

Study Design. Prospective validation study.

Setting. Tertiary academic center.

Subjects and Methods. Attending otolaryngologists, otolaryngology residents at various levels of training, and medical students performed nasal endoscopy and 5 specific tasks using this model. Face and content validities were assessed based on the attendings’ responses to a questionnaire evaluating the task trainer. Construct validity was determined by comparing novice to experienced performance using a validated checklist and globalized rating scale.

Results. A total of 77 subjects participated in the study. Attending otolaryngologists responded to a survey after completing the tasks. Eighty percent of evaluators rated the trainer as realistic and agreed that this model correlates with the essential skills needed for endoscopic sinus surgery, 90% felt this model provided adequate training and would increase resident competency, and 90% were interested in using the model to train residents. On the task trainer, experienced otolaryngologists and senior residents scored significantly higher than junior residents and medical students using the objective measures of the globalized rating scale and checklist.

Conclusion. This study demonstrates face, content, and construct validity of the low-cost sinus surgery task trainer. This model has the potential to be a valuable tool in endoscopic sinus surgery training for otolaryngology residents.