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Brennan LJ, Balakumar R, Waite S, Bennett WO. An update on simulation training in rhinology: a systematic review of evidence. J Laryngol Otol 2024:1-7. [PMID: 38602176 DOI: 10.1017/s0022215124000495] [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: 04/12/2024]
Abstract
BACKGROUND Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training. METHODS Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis ('PRISMA') protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification. RESULTS Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development. CONCLUSION Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training.
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Affiliation(s)
- Laura J Brennan
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Ramkishan Balakumar
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Seren Waite
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
| | - Warren O Bennett
- Department of ENT, St Michaels Hospital, University Hospitals Bristol and Weston, Bristol, United Kingdom
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2
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Takagi T, Mitani S, Aoishi K, Nishida N, Hato N. Development of a proficiency-based training curriculum for beginners in endoscopic endonasal surgery. Auris Nasus Larynx 2023; 50:887-894. [PMID: 36964077 DOI: 10.1016/j.anl.2023.03.002] [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: 11/09/2022] [Revised: 02/24/2023] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Precise endoscopic skills are critical for endoscopic endonasal surgery (EES) to ensure patient safety, as well as to succeed as a surgeon. Among these skills, basic skills such as hand-eye coordination and bimanual dexterity are the most important skills for novice surgeons. However, there is no proficiency-based training for the basic skills in EES. In this study, we aimed to develop a proficiency-based training curriculum for beginners in EES using tractable tasks and to assess the curriculum's validity and educational benefits. METHODS Training tasks for basic surgical skills of EES were created by experts, using a low-cost and simple simulator. Subsequently, a proficiency-based training curriculum was developed through a preliminary study. The face and content validity of the curriculum was evaluated by expert surgeons. The construct validity was confirmed by comparing the scores of the medical students with those of the experts. In addition, the educational benefits of the curriculum were assessed by comparing the scores of the medical students before and after the implementation of the curriculum. RESULTS A proficiency-based training curriculum using six tractable tasks was developed in the preliminary study. Replication of real surgical situation, camera navigation, and instrument operability under endoscopy were all highly appreciated (4.6, 4.6, and 4.8 out of 5 points, respectively), which indicates face validity. The content validity of the curriculum was demonstrated by the results of the questionnaire (4.4 out of 5 points). The curriculum was implemented by 12 medical students. The initial student scores were significantly lower than the expert scores (mean score: 61.9 vs. 100.0, p < 0.001), and each coefficient of variation of the student scores was higher than that of the expert scores (p < 0.01), supporting the construct validity of the curriculum. The mean student composite scores were statistically improved after the training (61.9 vs. 93.3, p < 0.0001). In addition, improvement of five other medical students' EES skills through this training curriculum was confirmed in cadaver dissection (1.7 vs. 3.7, p < 0.0001). CONCLUSION The validity of the proficiency-based training curriculum developed through the preliminary study was established based on the questionnaire of experts and the difference between student and expert scores. In addition, the educational benefits were demonstrated by the students' learning curves. The low-cost and simple simulator seems appropriate as an entry model for beginners in EES, and this curriculum can provide rapid intervention and objective assessment of basic skills in EES.
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Affiliation(s)
- Taro Takagi
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Sohei Mitani
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.
| | - Kunihide Aoishi
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Naoya Nishida
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Naohito Hato
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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Gillanders SL, McHugh A, Lacy PD, Thornton M. Safe surgical training: evaluation of a national functional endoscopic sinus surgery model simulation course using the Kirkpatrick evaluation model. Ir J Med Sci 2023; 192:3039-3042. [PMID: 36800053 PMCID: PMC9936104 DOI: 10.1007/s11845-023-03309-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Simulation is a rapidly developing field in modern undergraduate skills education and postgraduate surgical training. AIM We aim to evaluate simulation training as a tool for higher surgical training in functional endoscopic sinus surgery (FESS) using the Kirkpatrick evaluation model. METHODS This was a prospective cohort study in which a qualitative survey and multiple-choice questionnaire were distributed to otolaryngology trainees pre- and post-FESS training course using simulation models. Participants' reactions and interpretations of the models were assessed. Pre- and post-simulation knowledge and subjective skills were assessed. RESULTS A total of 21 trainees completed the course. Trainees reported simulation models to be accurate representations of human anatomy 95% and easy to use 90%. There was an improvement in anatomical 54 to 62% (Z = 76, p0.03) and procedural 65 to 72% (Z = 87, p0.03) knowledge overall. CONCLUSION Simulation training is an effective method of postgraduate education. This has been particularly useful following reduced operative exposure in the COVID-19 era.
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Affiliation(s)
| | - Alison McHugh
- Royal College of Surgeons, Dublin, Ireland
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Peter D Lacy
- Royal College of Surgeons, Dublin, Ireland
- Beaumont Hospital Dublin, Dublin, Ireland
| | - Mona Thornton
- Royal College of Surgeons, Dublin, Ireland
- Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Stan C, Vesa D, Tănase MI, Bulmaci M, Pop S, Rădeanu DG, Cosgarea M, Maniu A. Can Non-Virtual Reality Simulation Improve Surgical Training in Endoscopic Sinus Surgery? A Literature Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:637-646. [PMID: 37360838 PMCID: PMC10290466 DOI: 10.2147/amep.s406537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Simulation in endoscopic sinus surgery allows residents to learn anatomy, to achieve the correct handling of various rhinological instruments, and to practice different surgical procedures. Physically or non-virtual reality models are the main items in endoscopic sinus surgery simulation. The objective of this review is to identify and make a descriptive analysis of non-virtual endoscopic sinus surgery simulators which have been proposed for training. As a new state of the art, surgical simulators are developed continuously, so they can be used to learn basic endoscopic surgery skills by repetitive maneuvers, permitting detection of surgical error and incidents without risk for the patient. Of all training physical models, the ovine model stands out because of the similarities of the sinonasal pathways, the wide availability, and the low costs. Considering the similar nature of the tissues involved, the techniques and surgical instruments can be used almost interchangeably with minimal differences. Every surgical technique studied until now has a degree of risk and the only aspects that consistently reduced the number of complications are training, repetition, and hands-on experience.
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Affiliation(s)
- Constantin Stan
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
- Department of Surgical Clinical, “Dunărea de Jos” University, Faculty of Medicine and Pharmacy, Galați, România
| | - Doiniţa Vesa
- Department of Surgical Clinical, “Dunărea de Jos” University, Faculty of Medicine and Pharmacy, Galați, România
| | - Mihai Ionuț Tănase
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Mara Bulmaci
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Sever Pop
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Doinel Gheorghe Rădeanu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Marcel Cosgarea
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Alma Maniu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
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de Souza MA, Bento RF, Lopes PT. A three-dimensionally printed otological model for cholesteatoma mastoidectomy training. Eur Arch Otorhinolaryngol 2023; 280:671-680. [PMID: 35789285 DOI: 10.1007/s00405-022-07536-y] [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: 03/04/2022] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To relate the creation and expert validation (face and content validity) of an affordable three-dimensional (3-D) printed model of temporal bones with chronic otitis media with cholesteatoma (COMC) as a simulator for mastoidectomy. METHODS We performed computed tomography (CT) of the temporal bones of a patient with COMC followed at the University of São Paulo (USP) Hospital with 3-D Slicer to create a 3-D model of the affected bone using light-curing resin and silicone (cholesteatoma). The final 3-D printed images were scored by 10 otologists using a customized version of the Michigan Standard Simulation Scale Experience (MiSSES). Internal consistency and inter-rater reliability were assessed using Cronbach's α and intraclass correlations. RESULTS Otologists consistently scored the model positively for fidelity, educational value, reactions, and the overall model quality. Nine otologists agreed that the model was a good educational device for surgical training of COMC. All experts deemed the model ready-or nearly ready-for use. The final cost of the model, including raw materials and manufacturing, was 120 USD. CONCLUSIONS Using 3-D printing technology, we created the first anatomically accurate, low-cost, disease-reproducing 3-D model of temporal bones for mastoidectomy training for cholesteatoma.
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Affiliation(s)
- Marcos Antonio de Souza
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil.
| | - Ricardo Ferreira Bento
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil
| | - Paula Tardim Lopes
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil
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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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7
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Properties and Characteristics of Three-Dimensional Printed Head Models Used in Simulation of Neurosurgical Procedures: A Scoping Review. World Neurosurg 2021; 156:133-146.e6. [PMID: 34571242 DOI: 10.1016/j.wneu.2021.09.079] [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: 06/20/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial surgery can be complex and high risk. Safety, ethical and financial factors make training in the area challenging. Head model 3-dimensional (3D) printing is a realistic training alternative to patient and traditional means of cadaver and animal model simulation. OBJECTIVE To describe important factors relating to the 3D printing of human head models and how such models perform as simulators. METHODS Searches were performed in PubMed, the Cochrane Library, Scopus, and Web of Science. Articles were screened independently by 3 reviewers using Covidence software. Data items were collected under 5 categories: study information; printers and processes; head model specifics; simulation and evaluations; and costs and production times. RESULTS Forty articles published over the last 10 years were included in the review. A range of printers, printing methods, and substrates were used to create head models and tissue types. Complexity of the models ranged from sections of single tissue type (e.g., bone) to high-fidelity integration of multiple tissue types. Some models incorporated disease (e.g., tumors and aneurysms) and artificial physiology (e.g., pulsatile circulation). Aneurysm clipping, bone drilling, craniotomy, endonasal surgery, and tumor resection were the most commonly practiced procedures. Evaluations completed by those using the models were generally favorable. CONCLUSIONS The findings of this review indicate that those who practice surgery and surgical techniques on 3D-printed head models deem them to be valuable assets in cranial surgery training. Understanding how surgical simulation on such models affects surgical performance and patient outcomes, and considering cost-effectiveness, are important future research endeavors.
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8
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de Souza MA, Bento RF, Lopes PT, de Pinto Rangel DM, Formighieri L. Three-dimensional printing in otolaryngology education: a systematic review. Eur Arch Otorhinolaryngol 2021; 279:1709-1719. [PMID: 34533591 DOI: 10.1007/s00405-021-07088-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE The progressive expansion of the technology that facilitates the development of three-dimensional (3D) printing within the field of otorhinolaryngology has opened up a new study front in medicine. The objective of this study is to systematically review scientific publications describing the development of 3D models having applications in otorhinolaryngology, with emphasis on subareas with a large number of publications, as well as the countries in which the publications are concentrated. METHODS In this literature review, specific criteria were used to search for publications on 3D models. The review considered articles published in English on the development of 3D models to teach otorhinolaryngology. The studies with presurgical purposes or without validation of the task by surgeons were excluded from this review. RESULTS This review considered 39 articles published in 10 countries between 2012 and 2021. The works published prior to 2012 were not considered as per the inclusion criteria for the research. Among the 39 simulators selected for review, otology models comprised a total of 15 publications (38%); they were followed by rhinology, with 12 (31%); laryngology, with 8 (21%); and head and neck surgery, with 4 publications (10%). CONCLUSION The use of 3D technology and printing is well established in the context of surgical education and simulation models. The importance of developing new technological tools to enhance 3D printing and the current limitations in obtaining appropriate animal and cadaver models signify the necessity of investing more in 3D models.
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Affiliation(s)
- Marcos Antonio de Souza
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil.
| | - Ricardo Ferreira Bento
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil
| | - Paula Tardim Lopes
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil
| | - Denis Melo de Pinto Rangel
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil
| | - Lucas Formighieri
- Radiology Department, Radiology at DAPI, Catholic Ladies League of Curitiba, Curitiba, Brazil
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Gallet P, Rebois J, Nguyen DT, Jankowski R, Perez M, Rumeau C. Simulation-based training in endoscopic endonasal surgery: Assessment of the cyrano simulator. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:29-34. [DOI: 10.1016/j.anorl.2020.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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10
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Baby B, Singh R, Singh R, Suri A. In Reply to the Letter to the Editor Regarding "A Review of Physical Simulators for Neuroendoscopy Skills Training". World Neurosurg 2020; 141:531-532. [PMID: 32871715 DOI: 10.1016/j.wneu.2020.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Britty Baby
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India; Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India
| | - Ramandeep Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajdeep Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India; Amar Nath and Shashi Khosla School of Information Technology, Indian Institute of Technology Delhi, New Delhi, India.
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Salmas M, Paraskevas G, Noussios G, Chytas D. Letter to the Editor Regarding "A Review of Physical Simulators for Neuroendoscopy Skills Training". World Neurosurg 2020; 141:529-530. [PMID: 32871714 DOI: 10.1016/j.wneu.2020.05.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Paraskevas
- Department of Anatomy and Surgical Anatomy, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Noussios
- Department of Physical Education and Sports Sciences in Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Chytas
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus.
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12
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Gallet P. WITHDRAWN: Simulation-based training in endoscopic endonasal surgery: Assessment of the cyrano simulator. Eur Ann Otorhinolaryngol Head Neck Dis 2020:S1879-7296(20)30148-4. [PMID: 32616393 DOI: 10.1016/j.anorl.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cet article a du être retiré conformément à la ligne de conduite d'Elsevier concernant le retrait d'articles. Vous pouvez consulter le site (https://www.elsevier.com/about/our-business/policies/article-withdrawal) pour de plus amples renseignements. L'éditeur vous prie d'accepter ses excuses pour ce désagrément.
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Affiliation(s)
- P Gallet
- Département d'ORL et chirurgie cervico-faciale, université de Lorraine, CHRU de Nancy, 54511 Vandoeuvre-les-Nancy, France.
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Chang B, Powell A, Ellsperman S, Wehrmann D, Landry A, Jabbour N, Goudy S, Zopf D. Multicenter Advanced Pediatric Otolaryngology Fellowship Prep Surgical Simulation Course with 3D Printed High-Fidelity Models. Otolaryngol Head Neck Surg 2020; 162:658-665. [PMID: 32286159 DOI: 10.1177/0194599820913003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/21/2020] [Indexed: 11/01/2023]
Abstract
OBJECTIVE To assess the effect of 3-dimensional (3D)-printed surgical simulators used in an advanced pediatric otolaryngology fellowship preparatory course on trainee education. STUDY DESIGN Quasi-experimental pre/postsurvey. SETTING Multicenter collaborative course conducted at a contract research organization prior to a national conference. SUBJECTS AND METHODS A 5-station, 7-simulator prep course was piloted for 9 pediatric otolaryngology fellows and 17 otolaryngology senior residents, with simulators for airway graft carving, microtia ear framework carving, and cleft lip/palate repair. Prior to the course, trainees were provided educational materials electronically along with presurveys rating confidence, expertise, and attitude around surgical simulators. In October 2018, surgeons engaged in simulation stations with direction from 2 attending faculty per station, then completed postsurveys for each simulator. RESULTS Statistically significant increases (P < .05) in self-reported confidence (average, 53%; range, 18%-80%) and expertise (average, 68%; range, 9%-95%) were seen across all simulators, corresponding to medium to large effect sizes as measured by Cohen's d statistic (0.41-1.71). Positive attitudes around 3D printing in surgical education also demonstrated statistically significant increases (average, 10%; range, 8%-13%). Trainees commented positively on gaining such broad exposure, although consistently indicated a preference for more practice time during the course. CONCLUSION We demonstrate the benefit of high-fidelity, 3D-printed simulators in exposing trainees to advanced procedures, allowing them hands-on practice in a zero-risk environment. In the future, we hope to refine this course design, develop standardized tools to assess their educational value, and explore opportunities for integration into use in milestone assessment and accreditation.
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Affiliation(s)
- Brian Chang
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Allison Powell
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Susan Ellsperman
- Department of Otolaryngology Head and Neck Surgery, Ann Arbor, Michigan, USA
| | - Daniel Wehrmann
- Department of Otolaryngology Head and Neck Surgery, Ann Arbor, Michigan, USA
| | - April Landry
- Department of Otolaryngology-Head and Neck Surgery, Emory Medicine, Atlanta, Georgia, USA
| | - Noel Jabbour
- University of Pittsburgh Department of Otolaryngology Eye and Ear Institute, Pittsburgh, Pennsylvania, USA
| | - Steven Goudy
- Department of Otolaryngology-Head and Neck Surgery, Emory Medicine, Atlanta, Georgia, USA
| | - David Zopf
- Department of Otolaryngology Head and Neck Surgery, Ann Arbor, Michigan, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Rhinology: Simulation Training (Part 2). CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00273-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
Recently, there has been an expansion of novel technologies in simulation training. The aim of this review was to examine existing evidence about training simulators in rhinology, their incorporation into real training programmes and translation of these skills into the operating room. The first part focuses on the virtual and augmented reality simulators. The second part describes the role of physical (i.e. non-computer-based) models of endoscopic sinus surgery.
Recent Findings
We learned that an ideal sinus surgery model would score highly in all standard measures of validity whilst maintaining an attainable cost. This is a challenging goal that is worthy of pursuit given that simulation training has been shown to be cost-effective option in other domains. Non-AR or VR models are attractive ways to fill gaps in simulation training whilst reducing compared with computer-based models.
Summary
In an era of improved computer technology and improved 3D printing, it will be increasingly important to focus on both the manufacture and validation process. One area that will benefit from further technological advancement is the realistic simulation of bleeding as this would obviate the need for animal models. Future studies on ESS simulation will also need to robustly demonstrate the validity of each model with the emphasis on the ability of a model to predict performance in operative environment.
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Three-dimensional printing as a tool in otolaryngology training: a systematic review. The Journal of Laryngology & Otology 2019; 134:14-19. [PMID: 31865920 DOI: 10.1017/s0022215119002585] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Three-dimensional printing is a revolutionary technology that is disrupting the status quo in surgery. It has been rapidly adopted by otolaryngology as a tool in surgical simulation for high-risk, low-frequency procedures. This systematic review comprehensively evaluates the contemporary usage of three-dimensional printed otolaryngology simulators. METHOD A systematic review of the literature was performed with narrative synthesis. RESULTS Twenty-two articles were identified for inclusion, describing models that span a range of surgical tasks (temporal bone dissection, airway procedures, functional endoscopic sinus surgery and endoscopic ear surgery). Thirty-six per cent of articles assessed construct validity (objective measures); the other 64 per cent only assessed face and content validity (subjective measures). Most studies demonstrated positive feedback and high confidence in the models' value as additions to the curriculum. CONCLUSION Whilst further studies supported with objective metrics are merited, the role of three-dimensional printed otolaryngology simulators is poised to expand in surgical training given the enthusiastic reception from trainees and experts alike.
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