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Santander MJ, Sepúlveda V, Iribarren J, Rosenbaum A, Albrich D, Varas J, Lagos A, Napolitano C. Development and Validation of a Laryngeal Microsurgery Simulation Training System for Otolaryngology Residents. Otolaryngol Head Neck Surg 2023; 169:971-987. [PMID: 37232508 DOI: 10.1002/ohn.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/28/2023] [Accepted: 04/29/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study aims to create a synthetic laryngeal microsurgery simulation model and training program; to assess its face, content, and construct validity; and to review the available phonomicrosurgery simulation models in the literature. STUDY DESIGN Nonrandomly assigned control study. SETTING Simulation training course for the otolaryngology residency program at Pontificia Universidad Católica de Chile. METHODS Resident (postgraduate year 1 [PGY1]/PGY2) and expert groups were recruited. A laryngeal microsurgery synthetic model was developed. Nine tasks were designed and assessed through a set of programmed exercises with increasing difficulty, to fulfill 5 surgical competencies. Imperial College Surgical Assessment Device sensors applied to the participants' hands measured time and movements. The activities were video-recorded and blindly assessed by 2 laryngologists using a specific and global rating scale (SRS and GRS). A 5-point Likert survey assessing validity was completed by experts. RESULTS Eighteen participants were recruited (14 residents and 4 experts). Experts performed significantly better than residents in the SRS (p = .003), and GRS (p = .004). Internal consistency was demonstrated for the SRS (α = .972, p < .001). Experts had a shorter execution time (p = .007), and path length with the right hand (p = .04). The left hand did not show significant differences. The survey assessing validity resulted in a median 36 out of 40 points score for face validity; and 43 out of 45 points score, for global content validity. The literature review revealed 20 available phonomicrosurgery simulation models, only 6 with construct validity. CONCLUSION The face, content, and construct validity of the laryngeal microsurgery simulation training program were established. It could be replicated and incorporated into residents' curricula.
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Affiliation(s)
- María Jesús Santander
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Sepúlveda
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Iribarren
- Faculty of Medicine, Division of Undergraduate Education-School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Rosenbaum
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diego Albrich
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julian Varas
- Department of Digestive Surgery, Experimental Surgery and Simulation Center, Clinic Hospital, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonia Lagos
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carla Napolitano
- Department of Otolaryngology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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James J, Irace AL, A Drusin M, Kim AH, Gudis DA, Overdevest JB. Thinking Beyond the Temporal Bone Lab: A Systematic Process for Expanding Surgical Simulation in Otolaryngology Training. Ann Otol Rhinol Laryngol 2022:34894221115753. [PMID: 35915918 DOI: 10.1177/00034894221115753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Joel James
- City University of New York School of Medicine, New York, NY, USA
| | - Alexandria L Irace
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Madeleine A Drusin
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ana H Kim
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Saliba TV, Barros RSMD. Development and validation of a 3D laryngeal model in surgical skills training. Braz J Otorhinolaryngol 2021; 89:128-135. [PMID: 34896037 PMCID: PMC9874342 DOI: 10.1016/j.bjorl.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/05/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To present and validate a new simulation model for endoscopic phonomicrosurgery training as an improved teaching method. METHODS A low-cost artificial model was assembled using 3D printing, silicone, and gelatin. The study was designed to test the model's ability to carry out training and teaching of endoscopic phonomicrosurgery. The synthetic model was built to simulate normal and pathological vocal folds such as polyps, intracordal cysts and keratoses, made of silicone and gelatin and embedded in a larynx framework made by 3D printing. Simulations of endoscopic surgical procedures were performed and documented through photographs and videos and the images were submitted to the evaluation of a group of 17 otorhinolaryngologists who used a Likert scale questionnaire. The responses were submitted to an agreement analysis using the sum of the scores obtained for the responses as an appropriate level of validation. Cronbach's alpha index was calculated to measure the degree of the questionnaire internal consistency. RESULT The evaluations indicated maximum approval for the model adequacy for use in practical classes and for the teaching of the procedures, as well as in the overall satisfaction with the model in the use of surgical training. CONCLUSION The present proposal for training laryngeal endoscopic surgery in a 3D synthetic model is a viable option according to the validation methodology used in the present study.
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Salazar J, Gras JR, Sanchez-Guillen L, Sánchez-Del-Campo F, Arroyo A. Phonosurgery Training in Human Larynx Preserved with Thiel's Embalming Method. ORL J Otorhinolaryngol Relat Spec 2021; 83:412-419. [PMID: 34530430 DOI: 10.1159/000512725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 10/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND To describe the suitability of larynges preserved with Thiel's embalming method for phonosurgery training. METHODS A training model for phonosurgery techniques simulating vocal pathology and glottal insufficiency is developed to compare and evaluate the perception of embalmed vocal cords through a voluntary and anonymous survey rated on a scale of 1-5. A total of 10 residents and young otolaryngologists participated in the surgical training in phonosurgery. RESULTS Ten larynges preserved in formalin and 10 Thiel's embalmed larynges were used for the investigation. Phonosurgery procedures were performed following microflap and injection laryngoplasty techniques. The larynges preserved with Thiel's method demonstrated vocal cords that maintain their pliability and good tissue quality allowing a sensation of realism compared to the living body and providing suitable conditions for realistic laryngeal training. Participants held a positive experience, believed them to be useful and that these models of embalmed larynges were similar to the clinical setting and improved skills and confidence in performing phonosurgery. CONCLUSIONS The human larynges embalmed with Thiel's method maintain the pliability of the vocal cords, thus representing a unique model to practice and reproduce training for endolaryngeal procedures without the risks of contamination, anatomical variation, or rigidity of other models.
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Affiliation(s)
- Jhonder Salazar
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Vall d`Hebron, Barcelona, Spain.,Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain
| | - Juan-Ramón Gras
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain
| | - Luis Sanchez-Guillen
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain.,Department of Surgery, University General Hospital of Elche, Elche, Spain
| | - Francisco Sánchez-Del-Campo
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain
| | - Antonio Arroyo
- Program in Public Health, Medical and Surgical Sciences, Miguel Hernández University of Elche, Alicante, Alicante, Spain.,Department of Surgery, University General Hospital of Elche, Elche, Spain
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Crouch G, Wong G, Hong J, Varey A, Haddad R, Wang ZZ, Wykes J, Koutalistras N, Clark JR, Solomon M, Bannon P, McBride KE, Ch'ng S. Validated specialty-specific models for multi-disciplinary microsurgery training laboratories: a systematic review. ANZ J Surg 2021; 91:1110-1116. [PMID: 33719142 DOI: 10.1111/ans.16721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Gareth Crouch
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Gerald Wong
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan Hong
- Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Alex Varey
- Department of Plastic and Reconstructive Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Roger Haddad
- Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Plastic and Reconstructive Surgery, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Zane Zhanxiang Wang
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head & Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Centre, Sydney, New South Wales, Australia
| | - Nick Koutalistras
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Transplantation Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Sydney Head & Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Centre, Sydney, New South Wales, Australia
| | - Michael Solomon
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul Bannon
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kate E McBride
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Head & Neck Cancer Institute, Chris O'Brien Lifehouse Cancer Centre, Sydney, New South Wales, Australia
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Enver N, Ramaswamy A, Sulica L, Pitman MJ. Office-Based Procedure Training in Laryngology Fellowship Programs. Laryngoscope 2020; 131:2054-2058. [PMID: 33043999 DOI: 10.1002/lary.29170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/18/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the current practices and challenges of training office-based procedures to laryngology fellows in the United States. METHODS An anonymous web-based survey study was distributed to laryngology fellowship program directors, as listed by the American Laryngological Association. The survey was a 19-item questionnaire with free-text, Likert scale, and multiple-choice answers. RESULTS Twenty-two of 27 program directors (81.4%) replied to the survey. Many programs (8/16) have three or more laryngologists and do more than 10 procedures each week (10/16). Sixty-nine percent (11/16) of directors had not been trained for office procedures in their fellowship. The fellows are allowed to be primary surgeon on 68.75% and 75% of vocal fold augmentation and laser procedures, respectively. The expected competencies for these procedures on graduation are average-moderate and moderate. When program directors asked about the methods used for training, a minority of them use simulators (2/16), procedural checklists (2/16), or structured debriefing (2/16). The most commonly used methods were case-based troubleshooting (13/16) and unstructured debriefing (13/16). Patients being awake and patients' expectations are seen as the most important obstacles. Most of the directors thought office-based procedure training could be improved (14/16). The most common suggestions were using step-wise checklists, simulator-labs, and formal debriefings. CONCLUSION This is the first study evaluating the training of office-based laryngeal procedures during laryngology fellowship. Given the increasing importance of these procedures in practice and the herein identified barriers and need for improvement, fellowships should investigate the use of systematic training tools to improve fellow competency with office-based procedures. Laryngoscope, 131:2054-2058, 2021.
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Affiliation(s)
- Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A.,Department of Otolaryngology - Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Apoorva Ramaswamy
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
| | - Lucian Sulica
- Department of Otolaryngology - Head & Neck Surgery, Sean Parker Institute for the Voice, Weill Cornell Medical College, New York, New York, U.S.A
| | - Michael J Pitman
- Department of Otolaryngology-Head and Neck Surgery, The Center for Voice and Swallowing, Columbia University Irvine Medical Center, New York-Presbyterian Hospital, New York, New York, U.S.A
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Ex Vivo Porcine Larynx Model for Microlaryngoscopy Laryngeal Surgery: Proposal for a Structured Surgical Training. J Voice 2020; 34:629-635. [DOI: 10.1016/j.jvoice.2019.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/22/2022]
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Aragón-Benedí C, Visiedo-Sánchez S, Pascual-Bellosta A, Ortega-Lucea S, Fernández-Liesa R, Martínez-Ubieto J. Study of Rocuronium-Sugammadex as an Alternative to Succinylcholine-Cisatracurium in Microlaryngeal Surgery. Laryngoscope 2020; 131:E212-E218. [PMID: 32324308 DOI: 10.1002/lary.28649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Abstract
Microlaryngeal surgery (ML) is a short procedure that requires a deep neuromuscular blockade to provide optimum surgical conditions. Succinylcholine is a relaxant widely used but involves numerous complications. One valid alternative is rocuronium, with a specific antagonist, sugammadex. The primary objective was to assess the surgical conditions in ML according to the relaxant. The secondary objectives were to assess intubation conditions and intraoperative and immediate postoperative adverse events. STUDY DESIGN Prospective randomized study. METHODS This was a prospective study of patients scheduled for ML randomized into two groups according to relaxant. Neuromuscular blockade was recorded after administration and during ML surgery. Surgical conditions were assessed using the ML Rating Scale, intubation conditions, remifentanil doses, intraoperative complications, surgery time, emergence time, and complications in the postanesthesia care unit. RESULTS Two hundred five patients were included (rocuronium = 103, succinylcholine = 102). Train-of-four values were higher for rocuronium, though the otorhinolaryngology surgical conditions were significantly better in that group (rocuronium = 5.54 ± 1.39 points; succinylcholine = 9.13 ± 1.99 points). Intubation conditions were similar in both groups. Remifentanil doses were higher for succinylcholine (P < .001) (rocuronium = 0.102 ± 0.05 μg/kg/min; succinylcholine = 0.201 ± 0.05 μg/kg/min). There were no differences in the duration of surgery, but the time to awakening was significantly longer for succinylcholine (rocuronium = 3.82 ± 1.38 minutes, succinylcholine = 9.18 ± 2.04 minutes, P < .001). CONCLUSIONS Rocuronium provides better surgical conditions and allows for the use of lower doses of remifentanil as compared to succinylcholine and cisatracurium in ML. This makes it possible to decrease the time to awakening and the complications associated with high doses of remifentanil. LEVEL OF EVIDENCE 1b Laryngoscope, 131:E212-E218, 2021.
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Affiliation(s)
- Cristian Aragón-Benedí
- Department of Anesthesia, Resuscitation and Pain Therapy, Móstoles General University Hospital, Móstoles, Spain
| | - Sara Visiedo-Sánchez
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Ana Pascual-Bellosta
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Sonia Ortega-Lucea
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
| | - Rafael Fernández-Liesa
- Head of Department of Otolaryngology-Head and Neck Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | - Javier Martínez-Ubieto
- Department of Anesthesia, Resuscitation and Pain Therapy, Miguel Servet University Hospital, Zaragoza, Spain
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Bhalla S, Tolley N, Awad Z. Creating a Validated Simulation Training Curriculum in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
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.
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Javid P, Aydın A, Mohanna P, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: A systematic review. Microsurgery 2019; 39:655-668. [DOI: 10.1002/micr.30513] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/25/2019] [Accepted: 08/30/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Pernia Javid
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Abdullatif Aydın
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Pari‐Naz Mohanna
- Department of Plastic SurgeryGuy's and St. Thomas' NHS Foundation Trust London UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's HospitalKing's College London London UK
- Department of UrologyKing's College Hospital NHS Foundation Trust London UK
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11
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Yu P, Luan J, Cui X, Li X, Hu X, Sun G. Development and Validation of a Low-Cost and Simple Simulator for Microlaryngeal Surgery. Clin Exp Otorhinolaryngol 2019; 13:58-63. [PMID: 31370389 PMCID: PMC7010492 DOI: 10.21053/ceo.2019.00556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives. The simulation of microlaryngeal skills is rarely seen in surgical training, but it is particularly important in phonomicrosurgery. This study described and validated the laryngeal surgical simulator through surgical training. Methods. A simple and low-cost simulator was developed for the fixation of the suspension laryngoscope and porcine larynges. Twenty participants with work skills and experience did preparation before training, and performed suture and carbon dioxide (CO2) laser cordectomy for simulator evaluation. The results were proposed by the aspects of time taken for each procedure, the global rating scale, a procedure-specific assessment, and a post-simulation questionnaire. Results. All participants completed the preparation within 9 minutes and reached the conclusion that the microlaryngeal surgical simulator was helpful in improving their surgical skills. The performance of experts was superior to that of novices in both suture and CO2 laser cordectomy. Conclusion. This simulator could be easily assembled and was successfully validated by microlaryngeal surgical training both subjectively and objectively. It may be helpful to clinicians in microlaryngeal skills.
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Affiliation(s)
- Pengcheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia Luan
- Outpatient Department, Huashan Worldwide Medical Center, Shanghai, China
| | - Xidong Cui
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xumao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinqi Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guangbin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Landry EC, Yong M, Pauwels J, Chadha NK. The use of video glasses improved learning of tonsillectomy and adenoidectomy surgery: A randomized controlled trial. Int J Pediatr Otorhinolaryngol 2019; 117:12-16. [PMID: 30579065 DOI: 10.1016/j.ijporl.2018.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE One of the most common challenges in surgical education for trainees is gaining practical experience through observing procedures in the operating room. Due to the nature of some procedures, a narrow surgical view severely limits the learning experience. Video glasses are new devices that offer the potential to project the primary surgeon's exact view to learners in real-time, allowing for an enhanced operative learning experience. STUDY DESIGN Single center randomized prospective trial. SETTING Tertiary care pediatric hospital. PARTICIPANTS Using block randomization, medical students and surgical residents observed either a tonsillectomy or adenoidectomy, either directly at table-side or by real-time video feed from the surgeon's video glasses projected to a screen in the operating room, in random order. Participants then completed a survey comparing aspects of their learning experience viewing the procedure through the video feed in comparison to direct observation. MAIN OUTCOME MEASURES Evaluating the hypothesis that video glasses provided an improved overall learning experience and a realistic simulation of the open surgical procedures tested. RESULTS 23 trainees participated in the study. Survey results demonstrated that the overall learning experience with the use of video glasses was significantly improved when compared to direct visualization (average Visual Analog Scale (VAS) score 82/100 vs. 64/100, p = 0.021). Video glasses were shown to be superior when comparing the view of the surgical field (83/100 vs. 54/100 on VAS, p < 0.001) and the ability to identify anatomical structures (79/100 vs. 56/100 on VAS, p = 0.001). The ease of following surgical steps with video glasses was also shown to be better than by direct visualization (81/100 vs. 69/100 on VAS, p = 0.039). All participants stated that video glasses closely simulated the learning environment of the real-life open procedure. CONCLUSION This study showed that the use of video glasses was beneficial for surgical education and a realistic tool for learners at varying levels of training. Video glasses may significantly improve the learning experience for procedures with a narrow field of view.
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Affiliation(s)
- Evie C Landry
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | - Michael Yong
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Julie Pauwels
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
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Soliman AMS, Ianacone DC, Isaacson GC. Ex vivo ovine model for teaching open laryngotracheal surgery. World J Otorhinolaryngol Head Neck Surg 2018; 4:140-144. [PMID: 30101225 PMCID: PMC6074011 DOI: 10.1016/j.wjorl.2018.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To develop an animal model for teaching open laryngotracheal surgical procedures. Methods The heads and necks from 5 pre-pubescent sheep were harvested after humane anesthesia. After 2–5 days to allow for rigor mortis to resolve, a specimen was supported with sandbags on an operating table. Operative procedures including tracheotomy, medialization laryngoplasty, anterior cartilage grafting, tracheal resection with primary anastomosis, and laryngectomy with closure of the pharynx were attempted. Results The ovine head and neck provided an accurate model for simulation of all attempted procedures. Ovine tissue resembled that of humans in mechanical properties and handling. Postsurgical endoscopy confirmed graft alignment. Conclusions The sheep head and neck provides an inexpensive, realistic, and safe model for surgical training for a variety of open laryngotracheal procedures. This is particularly relevant given the recent emphasis on surgical simulation and the relative rarity of some of these procedures in residency training.
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Affiliation(s)
- Ahmed M S Soliman
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA
| | - David C Ianacone
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA
| | - Glenn C Isaacson
- Department of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA.,Department of Pediatrics, Lewis Katz School of Medicine Temple University, Philadelphia, PA, 19140, USA
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Javia L, Sardesai MG. Physical Models and Virtual Reality Simulators in Otolaryngology. Otolaryngol Clin North Am 2017; 50:875-891. [DOI: 10.1016/j.otc.2017.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Burns JA, Adkins LK, Dailey S, Klein AM. Simulators for Laryngeal and Airway Surgery. Otolaryngol Clin North Am 2017; 50:903-922. [DOI: 10.1016/j.otc.2017.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Musbahi O, Aydin A, Al Omran Y, Skilbeck CJ, Ahmed K. Current Status of Simulation in Otolaryngology: A Systematic Review. JOURNAL OF SURGICAL EDUCATION 2017; 74:203-215. [PMID: 27839694 DOI: 10.1016/j.jsurg.2016.09.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/06/2016] [Accepted: 09/27/2016] [Indexed: 06/06/2023]
Abstract
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.
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Affiliation(s)
- Omar Musbahi
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Abdullatif Aydin
- MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom
| | - Yasser Al Omran
- Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - Christopher James Skilbeck
- Department of ENT and Head and Neck Surgery, Guy's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kamran Ahmed
- MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
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Simulation in Otolaryngology: A Teaching and Training Tool. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017. [DOI: 10.1016/j.otoeng.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Simulación en Otorrinolaringología: una herramienta de enseñanza y entrenamiento. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:115-120. [DOI: 10.1016/j.otorri.2016.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 12/20/2022]
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Klein AM, Gross J. Development and validation of a high-fidelity phonomicrosurgical trainer. Laryngoscope 2016; 127:888-893. [DOI: 10.1002/lary.26230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/30/2016] [Accepted: 07/18/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Adam M. Klein
- Emory Voice Center; Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine; Atlanta Georgia U.S.A
| | - Jennifer Gross
- Washington University School of Medicine; St. Louis Missouri U.S.A
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Zambricki EA, Bergeron JL, DiRenzo EE, Sung CK. Phonomicrosurgery simulation: A low-cost teaching model using easily accessible materials. Laryngoscope 2016; 126:2528-2533. [PMID: 27107403 DOI: 10.1002/lary.25940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/01/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVES/HYPOTHESIS To introduce the use of a new phonomicrosurgical trainer using easily accessible materials, and to establish the effectiveness of the model. STUDY DESIGN The model uses a grape imbedded in gelatin, a microscope, and microlaryngeal instruments. The study was designed to test baseline differences in training levels, as well as improvement in performance after training with the simulation model. METHODS Thirty subjects enrolled in the Stanford University School of Medicine otolaryngology training program performed microlaryngeal surgery tasks on a grape. Tasks were designed to model both excision of a vocal fold lesion and vocal fold injection. Anonymized video recordings comparing presimulation and postsimulation training were collected and graded by an expert laryngologist. Both objective comparison of skills and subjective participant surveys were analyzed. RESULTS Objectively, trainees in all groups made statistically significant improvements across all tested variables, including microscope positioning, creation of a linear incision, elevation of epithelial flaps, excision of a crescent of tissue, vocal fold injection, preservation of remaining tissue, and time to complete all tasks. Subjectively, 100% of participants felt that they had increased comfort with microlaryngeal instruments and decreased intimidation of microlaryngeal surgery after completing the simulation training. This appreciation of skills was most notable and statistically significant in the intern trainees. CONCLUSION Microlaryngeal surgical simulation is a tool that can be used to train residents to prepare them for phonomicrosurgical procedures at all levels of training. Our low-cost model with accessible materials can be easily duplicated and used to introduce trainees to microlaryngeal surgery or improve skills of more senior trainees. LEVEL OF EVIDENCE NA Laryngoscope, 126:2528-2533, 2016.
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Affiliation(s)
- Elizabeth A Zambricki
- Department of Otolaryngology, Stanford University, School of Medicine, Stanford, California, U.S.A..
| | - Jennifer L Bergeron
- Department of Otolaryngology, Stanford University, School of Medicine, Stanford, California, U.S.A
| | - Elizabeth E DiRenzo
- Department of Otolaryngology, Stanford University, School of Medicine, Stanford, California, U.S.A
| | - C Kwang Sung
- Department of Otolaryngology, Stanford University, School of Medicine, Stanford, California, U.S.A
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Pywell MJ, Evgeniou E, Highway K, Pitt E, Estela CM. High fidelity, low cost moulage as a valid simulation tool to improve burns education. Burns 2016; 42:844-52. [PMID: 26810642 DOI: 10.1016/j.burns.2015.12.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 12/23/2015] [Accepted: 12/27/2015] [Indexed: 11/15/2022]
Abstract
Simulation allows the opportunity for repeated practice in controlled, safe conditions. Moulage uses materials such as makeup to simulate clinical presentations. Moulage fidelity can be assessed by face validity (realism) and content validity (appropriateness). The aim of this project is to compare the fidelity of professional moulage to non-professional moulage in the context of a burns management course. Four actors were randomly assigned to a professional make-up artist or a course faculty member for moulage preparation such that two actors were in each group. Participants completed the actor-based burn management scenarios and answered a ten-question Likert-scale questionnaire on face and content validity. Mean scores and a linear mixed effects model were used to compare professional and non-professional moulage. Cronbach's alpha assessed internal consistency. Twenty participants experienced three out of four scenarios and at the end of the course completed a total of 60 questionnaires. Professional moulage had higher average ratings for face (4.30 v 3.80; p=0.11) and content (4.30 v 4.00; p=0.06) validity. Internal consistency of face (α=0.91) and content (α=0.85) validity questions was very good. The fidelity of professionally prepared moulage, as assessed by content validity, was higher than non-professionally prepared moulage. We have shown that using professional techniques and low cost materials we can prepare quality high fidelity moulage simulations.
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Affiliation(s)
- M J Pywell
- North Bristol NHS Trust, Trust Headquarters, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB.
| | - E Evgeniou
- Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH
| | - K Highway
- North Bristol NHS Trust, Trust Headquarters, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB
| | - E Pitt
- North Bristol NHS Trust, Trust Headquarters, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB
| | - C M Estela
- North Bristol NHS Trust, Trust Headquarters, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB
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Dedmon MM, Paddle PM, Phillips J, Kobayashi L, Franco RA, Song PC. Development and Validation of a High-Fidelity Porcine Laryngeal Surgical Simulator. Otolaryngol Head Neck Surg 2015; 153:420-6. [DOI: 10.1177/0194599815590118] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/15/2015] [Indexed: 11/16/2022]
Abstract
Objective Design and validate a laryngeal surgical simulator to teach phonomicrosurgical techniques. Study Design Device development and prospective validation. Setting Tertiary medical center. Subjects and Methods A novel laryngeal fixation device and custom laryngoscope were produced for use with ex vivo porcine larynx specimens. Vocal fold lesions such as nodules and keratotic lesions were simulated with silicone injections and epithelial markings. A prospective validation using postsimulation surveys, global rating scales, and procedure-specific checklists was performed with a group of 15 medical students, otolaryngology residents, fellows, and attending laryngologists. Three procedures were performed: vocal fold augmentation, excision of a simulated vocal fold nodule, and excision of a simulated vocal fold keratosis. Results Participants overwhelmingly agreed that the simulator provided a realistic dissection experience that taught skills that would transfer to real operating scenarios. Expert performance was statistically superior to novice performance for excision of simulated vocal fold nodules and keratotic lesions, while no difference was observed for injection laryngoplasty. Conclusion The ability to learn and rehearse surgical procedures in a safe environment is invaluable, particularly for delicate and highly technical phonomicrosurgical operations. We have developed a high-fidelity laryngeal surgical simulator complete with pathological lesions such as nodules and keratoses to teach these procedures. A prospective study demonstrated validity of our global rating scale and checklist assessments for vocal fold nodule and keratosis excision procedures, allowing them to be confidently incorporated into phonomicrosurgical training programs for surgeons of all levels of expertise.
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Affiliation(s)
- Matthew M. Dedmon
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Paul M. Paddle
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Jeananne Phillips
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Leo Kobayashi
- Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ramon A. Franco
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Phillip C. Song
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology–Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
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Szasz P, Louridas M, Harris KA, Aggarwal R, Grantcharov TP. Assessing Technical Competence in Surgical Trainees. Ann Surg 2015; 261:1046-55. [DOI: 10.1097/sla.0000000000000866] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Awad Z, Patel B, Hayden L, Sandhu G, Tolley N. Simulation in laryngology training; what should we invest in? Our experience with 64 porcine larynges and a literature review. Clin Otolaryngol 2015; 40:269-73. [DOI: 10.1111/coa.12360] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Z. Awad
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology, Head and Neck Surgery; St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
| | - B. Patel
- Department of Surgery and Cancer; Imperial College; London UK
| | - L. Hayden
- School of Medicine; Imperial College; London UK
| | - G.S. Sandhu
- Department of Otolaryngology, Head and Neck Surgery; Charing Cross Hospital; Imperial College Healthcare NHS Trust; London UK
| | - N.S. Tolley
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology, Head and Neck Surgery; St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
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Ilgen JS, Ma IWY, Hatala R, Cook DA. A systematic review of validity evidence for checklists versus global rating scales in simulation-based assessment. MEDICAL EDUCATION 2015; 49:161-73. [PMID: 25626747 DOI: 10.1111/medu.12621] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/01/2014] [Accepted: 09/09/2014] [Indexed: 05/14/2023]
Abstract
CONTEXT The relative advantages and disadvantages of checklists and global rating scales (GRSs) have long been debated. To compare the merits of these scale types, we conducted a systematic review of the validity evidence for checklists and GRSs in the context of simulation-based assessment of health professionals. METHODS We conducted a systematic review of multiple databases including MEDLINE, EMBASE and Scopus to February 2013. We selected studies that used both a GRS and checklist in the simulation-based assessment of health professionals. Reviewers working in duplicate evaluated five domains of validity evidence, including correlation between scales and reliability. We collected information about raters, instrument characteristics, assessment context, and task. We pooled reliability and correlation coefficients using random-effects meta-analysis. RESULTS We found 45 studies that used a checklist and GRS in simulation-based assessment. All studies included physicians or physicians in training; one study also included nurse anaesthetists. Topics of assessment included open and laparoscopic surgery (n = 22), endoscopy (n = 8), resuscitation (n = 7) and anaesthesiology (n = 4). The pooled GRS-checklist correlation was 0.76 (95% confidence interval [CI] 0.69-0.81, n = 16 studies). Inter-rater reliability was similar between scales (GRS 0.78, 95% CI 0.71-0.83, n = 23; checklist 0.81, 95% CI 0.75-0.85, n = 21), whereas GRS inter-item reliabilities (0.92, 95% CI 0.84-0.95, n = 6) and inter-station reliabilities (0.80, 95% CI 0.73-0.85, n = 10) were higher than those for checklists (0.66, 95% CI 0-0.84, n = 4 and 0.69, 95% CI 0.56-0.77, n = 10, respectively). Content evidence for GRSs usually referenced previously reported instruments (n = 33), whereas content evidence for checklists usually described expert consensus (n = 26). Checklists and GRSs usually had similar evidence for relations to other variables. CONCLUSIONS Checklist inter-rater reliability and trainee discrimination were more favourable than suggested in earlier work, but each task requires a separate checklist. Compared with the checklist, the GRS has higher average inter-item and inter-station reliability, can be used across multiple tasks, and may better capture nuanced elements of expertise.
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Affiliation(s)
- Jonathan S Ilgen
- Division of Emergency Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Ainsworth TA, Kobler JB, Loan GJ, Burns JA. Simulation Model for Transcervical Laryngeal Injection Providing Real-time Feedback. Ann Otol Rhinol Laryngol 2014; 123:881-6. [DOI: 10.1177/0003489414539922] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: This study aimed to develop and evaluate a model for teaching transcervical laryngeal injections. Methods: A 3-dimensional printer was used to create a laryngotracheal framework based on de-identified computed tomography images of a human larynx. The arytenoid cartilages and intrinsic laryngeal musculature were created in silicone from clay casts and thermoplastic molds. The thyroarytenoid (TA) muscle was created with electrically conductive silicone using metallic filaments embedded in silicone. Wires connected TA muscles to an electrical circuit incorporating a cell phone and speaker. A needle electrode completed the circuit when inserted in the TA during simulated injection, providing real-time feedback of successful needle placement by producing an audible sound. Face validation by the senior authorconfirmed appropriate tactile feedback and anatomical realism. Otolaryngologists pilot tested the model and completed presimulation and postsimulation questionnaires. Results: The high-fidelity simulation model provided tactile and audio feedback during needle placement, simulating transcervical vocal fold injections. Otolaryngology residents demonstrated higher comfort levels with transcervical thyroarytenoid injection on postsimulation questionnaires. Conclusion: This is the first study to describe a simulator for developing transcervical vocal fold injection skills. The model provides real-time tactile and auditory feedback that aids in skill acquisition. Otolaryngologists reported increased confidence with transcervical injection after using the simulator.
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Affiliation(s)
- Tiffiny A. Ainsworth
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James B. Kobler
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory J. Loan
- Department of Radiology–Harvard Medical School, The Simulation Group, Massachusetts General Hospital, Cambridge, Massachusetts, USA
| | - James A. Burns
- Department of Surgery–Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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Bowles P, Harries M, Young P, Das P, Saunders N, Fleming J. A validation study on the use of intra-operative video recording as an objective assessment tool for core ENT surgery. Clin Otolaryngol 2014; 39:102-7. [DOI: 10.1111/coa.12240] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- P.F.D. Bowles
- Department of Otorhinolaryngology, Head and Neck Surgery; Royal Sussex County Hospital; Brighton UK
| | - M. Harries
- Department of Otorhinolaryngology, Head and Neck Surgery; Royal Sussex County Hospital; Brighton UK
| | - P. Young
- Department of Otorhinolaryngology, Head and Neck Surgery; Royal Sussex County Hospital; Brighton UK
| | - P. Das
- Department of Otorhinolaryngology, Head and Neck Surgery; Royal Sussex County Hospital; Brighton UK
| | - N. Saunders
- Department of Otorhinolaryngology, Head and Neck Surgery; Royal Sussex County Hospital; Brighton UK
| | - J.C. Fleming
- Department of Otorhinolaryngology, Head and Neck Surgery; Royal Sussex County Hospital; Brighton UK
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Kesser BW, Hallman M, Murphy L, Tillar M, Keeley M, Peirce S. Interval vs Massed Training. Otolaryngol Head Neck Surg 2013; 150:61-7. [DOI: 10.1177/0194599813513712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Bradley W. Kesser
- Departments of Otolaryngology–Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Matthew Hallman
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Loren Murphy
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Maggie Tillar
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Meg Keeley
- Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Shayn Peirce
- Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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