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

Abstract Background The ongoing COVID-19 pandemic has disrupted the surgical training of residents. There is a real concern that trainees will not be able to meet their training requirements. Low-fidelity surgical simulation appears to be an alternative for surgical training. The educational benefits of repeating ossiculoplasty simulations under a microscope have never been evaluated. With this study we aimed to evaluate the differences in performance scores and on a global rating scale before and after training on an ossiculoplasty simulator. Methods In this quasi-experimental, prospective, single-centre, before-after study with blinded rater evaluation, residents performed five microscopic ossiculoplasty tasks with a difficulty gradient (sliding beads onto rods, the insertion of a partial prosthesis, the insertion of a total prosthesis, and the insertion of a stapedotomy piston under microscopic or endoscopic surgery) before and after training on the same simulator. Performance scores were defined for each task, and total performance scores (score/min) were calculated. All data were collected prospectively. Results Six out of seven intermediate residents and 8/9 novices strongly agreed that the simulator was an effective training device and should be included in the ENT residency program. The mean effect of training was a significant increase in the total performance score (+ 0.52 points/min, [95 % CI, 0.40–0.64], p < 0.001), without a significant difference between novice and intermediate residents. Conclusions This preliminary study shows that techniques for middle-ear surgery can be acquired using a simulator, avoiding any risk for patients, even under lockdown measures.

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Development and Validation of a Low-Cost and Simple Simulator for Microlaryngeal Surgery

Clinical and Experimental Otorhinolaryngology ◽

10.21053/ceo.2019.00556 ◽

2020 ◽

Vol 13 (1) ◽

pp. 58-63

Author(s):

Pengcheng Yu ◽

Jia Luan ◽

Xidong Cui ◽

Xumao Li ◽

Xinqi Hu ◽

...

Keyword(s):

Surgical Training ◽

Co2 Laser ◽

Rating Scale ◽

Low Cost ◽

Global Rating Scale ◽

Global Rating ◽

Surgical Simulator ◽

Work Skills ◽

Carbon Dioxide Co2 ◽

Microlaryngeal Surgery

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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Effect of Eccentric Exercise Program for Early Tibialis Posterior Tendinopathy

Foot & Ankle International ◽

10.3113/fai.2009.0877 ◽

2009 ◽

Vol 30 (9) ◽

pp. 877-885 ◽

Cited By ~ 38

Author(s):

Kornelia Kulig ◽

Eric S. Lederhaus ◽

Steve Reischl ◽

Shruti Arya ◽

Greg Bashford

Keyword(s):

Rating Scale ◽

Early Stage ◽

Case Series ◽

Exercise Program ◽

Global Rating Scale ◽

Tibialis Posterior ◽

Global Rating ◽

Level Of Evidence ◽

Time Points ◽

Significant Difference

Background: Morphology and vascularization of painful tibialis posterior (TP) tendons before and after an intervention targeting the degenerated tendon were examined. Functional status and pain level were also assessed. Materials and Methods: A10-week twice daily, progressive eccentric tendon loading, calf stretching program with orthoses was implemented with ten, early stage TP tendinopathy subjects. TP tendons were imaged by grayscale and Doppler ultrasound at INITIAL and POST evaluations to assess the tendon's morphology and signs of neovascularization. The Foot Functional Index (FFI), Physical Activity Scale (PAS), 5-Minute Walk Test, and single heel raise (SHR) test were completed at INITIAL and POST evaluations. The Global Rating Scale (GRS) was completed at 6 months followup. One-way ANOVA was used to compare the FFI at INITIAL, POST, and 6-MONTH time points. Paired t-tests were used to compare means between the remaining variables. The level of significance was p = 0.05. Results: There was a significant difference in FFI total, pain, and disability at the three time-points. Post-hoc paired t-tests revealed that the FFI scores were lower for the total score and pain and disability subcategories when comparing from INITIAL to POST and INITIAL to 6-MONTH evaluations ( p < 0.05 for all). The number of SHR increased significantly on the involved side from INITIAL to POST evaluation ( p = 0.041). The GRS demonstrated minimum clinically important differences for improvements in symptoms at 6-MONTH. Tendon morphology and vascularization remained abnormal following the intervention. Conclusion: A 10-week tendon specific eccentric program resulted in improvements in symptoms and function without changes in tendon morphology or neovascularization. Level of Evidence: IV, Case Series

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Development and incorporation of hybrid simulation OSCE into in-training examinations to assess multiple CanMEDS competencies in urologic trainees

Canadian Urological Association Journal ◽

10.5489/cuaj.2366 ◽

2015 ◽

Vol 9 (1-2) ◽

pp. 32 ◽

Cited By ~ 13

Author(s):

Laura Nguyen ◽

Kim Tardioli ◽

Matthew Roberts ◽

James Watterson

Keyword(s):

Rating Scale ◽

Hybrid Simulation ◽

Cost Effective ◽

Technical Skills ◽

Global Rating Scale ◽

Global Rating ◽

Training Requirements ◽

Objective Structured Clinical Exam ◽

Competency Based ◽

Multiple Domains

Introduction: As residency training requirements increasingly emphasize a competency-based approach, novel tools to directly evaluate Canadian Medical Education Directives for Specialists (CanMEDS) competencies must be developed. Incorporating simulation allows residents to demonstrate knowledge and skills in a safe, standardized environment. We describe a novel hybrid simulation station for use in a urology resident in-training Objective Structured Clinical Exam (OSCE) to assess multiple CanMEDS competencies.Methods: An OSCE station was developed to assess Communicator, Health Advocate, Manager, and Medical Expert (including technical skills) CanMEDS roles. Residents interviewed a standardized patient, interacted with a nurse, performed flexible cystoscopy and attempted stent removal using a novel bladder/stent model. Communication was assessed using the Calgary-Cambridge Observational Guide, knowledge was assessed using a checklist, and technical skills were assessed using a previously validated global rating scale. Video debriefing allowed residents to review their performance. Face and discriminative validity were assessed, and feasibility was determined through qualitative post-examination interviews and cost analysis.Results: All 9 residents (postgraduate years [PGY] 3, 4, 5) completed the OSCE in 15 minutes. Communicator and knowledge scores were similar among all PGYs. Scores in technical skills were higher in PGY-5 compared with PGY-3/4 reside nts (mean score 79% vs. 73%). Residents and exam personnel felt the OSCE station allowed for realistic demonstration of competencies. Equipment cost was $218 for the exam station.Conclusions: We developed and implemented a hybrid simulation- based OSCE station to assess multiple CanMEDS roles. This approach was feasible and cost-effective; it also provided a framework for future development of similar OSCE stations to assess resident competencies across multiple domains.

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Fiberoptic Oral Intubation

Anesthesiology ◽

10.1097/aln.0b013e31818d6c3c ◽

2008 ◽

Vol 109 (6) ◽

pp. 1007-1013 ◽

Cited By ~ 77

Author(s):

Deven B. Chandra ◽

Georges L. Savoldelli ◽

Hwan S. Joo ◽

Israel D. Weiss ◽

Viren N. Naik

Keyword(s):

Virtual Reality ◽

Operating Room ◽

Rating Scale ◽

Training Model ◽

Educational Interventions ◽

Global Rating Scale ◽

High Fidelity ◽

Global Rating ◽

Significant Difference ◽

Better Than

Background Previous studies have indicated that fiberoptic orotracheal intubation (FOI) skills can be learned outside the operating room. The purpose of this study was to determine which of two educational interventions allows learners to gain greater capacity for performing the procedure. Methods Respiratory therapists were randomly assigned to a low-fidelity or high-fidelity training model group. The low-fidelity group was guided by experts, on a nonanatomic model designed to refine fiberoptic manipulation skills. The high-fidelity group practiced their skills on a computerized virtual reality bronchoscopy simulator. After training, subjects performed two consecutive FOIs on healthy, anesthetized patients with predicted "easy" intubations. Each subject's FOI was evaluated by blinded examiners, using a validated global rating scale and checklist. Success and time were also measured. Results Data were analyzed using a two-way mixed design analysis of variance. There was no significant difference between the low-fidelity (n = 14) and high-fidelity (n = 14) model groups when compared with the global rating scale, checklist, time, and success at achieving tracheal intubation (all P = not significant). Second attempts in both groups were significantly better than first attempts (P < 0.001), and there was no interaction between "fidelity of training model" and "first versus second attempt" scores. Conclusions There was no added benefit from training on a costly virtual reality model with respect to transfer of FOI skills to intraoperative patient care. Second attempts in both groups were significantly better than first attempts. Low-fidelity models for FOI training outside the operating room are an alternative for programs with budgetary constraints.

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Shoulder Arthroscopy Simulator Training Improves Surgical Procedure Performance: A Controlled Laboratory Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211003873 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110038

Author(s):

Jordan Hauschild ◽

Jessica C. Rivera ◽

Anthony E. Johnson ◽

Travis C. Burns ◽

Christopher J. Roach

Keyword(s):

Surgical Procedures ◽

Laboratory Study ◽

Surgical Procedure ◽

Rating Scale ◽

Shoulder Arthroscopy ◽

Simulator Training ◽

Simulation Program ◽

Global Rating Scale ◽

Global Rating ◽

Significant Difference

Background: Previous simulation studies evaluated either dry lab (DL) or virtual reality (VR) simulation, correlating simulator training with the performance of arthroscopic tasks. However, these studies did not compare simulation training with specific surgical procedures. Purpose/Hypothesis: To determine the effectiveness of a shoulder arthroscopy simulator program in improving performance during arthroscopic anterior labral repair. It was hypothesized that both DL and VR simulation methods would improve procedure performance; however, VR simulation would be more effective based on the validated Arthroscopic Surgery Skill Evaluation Tool (ASSET) Global Rating Scale. Study Design: Controlled laboratory study. Methods: Enrolled in the study were 38 orthopaedic residents at a single institution, postgraduate years (PGYs) 1 to 5. Each resident completed a pretest shoulder stabilization procedure on a cadaveric model and was then randomized into 1 of 2 groups: VR or DL simulation. Participants then underwent a 4-week arthroscopy simulation program and completed a posttest. Sports medicine–trained orthopaedic surgeons graded the participants on completeness of the surgical repair at the time of the procedure, and a single, blinded orthopaedic surgeon, using the ASSET Global Rating Scale, graded participants’ arthroscopy skills. The procedure step and ASSET grades were compared between simulator groups and between PGYs using paired t tests. Results: There was no significant difference between the groups in pretest performance in either the procedural steps or ASSET scores. Overall procedural step scores improved after combining both types of simulator training ( P = .0424) but not in the individual simulation groups. The ASSET scores improved across both DL ( P = .0045) and VR ( P = .0003), with no significant difference between the groups. Conclusion: A 4-week simulation program can improve arthroscopic skills and performance during a specific surgical procedure. This study provides additional evidence regarding the benefits of simulator training in orthopaedic surgery for both novice and experienced arthroscopic surgeons. There was no statistically significant difference between the VR and DL models, which disproved the authors’ hypothesis that the VR simulator would be the more effective simulation tool. Clinical Relevance: There may be a role for simulator training in the teaching of arthroscopic skills and learning of specific surgical procedures.

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The ASSET Global Rating Scale is a Valid and Reliable Adjunct Measure of Performance on a Virtual Reality Simulator for Hip Arthroscopy.

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.01.046 ◽

2021 ◽

Author(s):

Meghan E. Bishop ◽

Gabriella E. Ode ◽

Daniel Hurwit ◽

Stephan Zmugg ◽

Ryan Rauck ◽

...

Keyword(s):

Virtual Reality ◽

Hip Arthroscopy ◽

Rating Scale ◽

Global Rating Scale ◽

Global Rating ◽

Virtual Reality Simulator ◽

Measure Of Performance

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Objective structured assessment of technical skill in temporal bone dissection: validation of a novel tool

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001201 ◽

2021 ◽

pp. 1-11

Author(s):

M Stavrakas ◽

G Menexes ◽

S Triaridis ◽

P Bamidis ◽

J Constantinidis ◽

...

Keyword(s):

Temporal Bone ◽

Rating Scale ◽

Assessment Tool ◽

Three Dimensional ◽

Technical Skills ◽

Technical Skill ◽

Global Rating Scale ◽

Global Rating ◽

Validity And Reliability ◽

Cortical Mastoidectomy

Abstract Objective This study developed an assessment tool that was based on the objective structured assessment for technical skills principles, to be used for evaluation of surgical skills in cortical mastoidectomy. The objective structured assessment of technical skill is a well-established tool for evaluation of surgical ability. This study also aimed to identify the best material and printing method to make a three-dimensional printed temporal bone model. Methods Twenty-four otolaryngologists in training were asked to perform a cortical mastoidectomy on a three-dimensional printed temporal bone (selective laser sintering resin). They were scored according to the objective structured assessment of technical skill in temporal bone dissection tool developed in this study and an already validated global rating scale. Results Two external assessors scored the candidates, and it was concluded that the objective structured assessment of technical skill in temporal bone dissection tool demonstrated some main aspects of validity and reliability that can be used in training and performance evaluation of technical skills in mastoid surgery. Conclusion Apart from validating the new tool for temporal bone dissection training, the study showed that evolving three-dimensional printing technologies is of high value in simulation training with several advantages over traditional teaching methods.

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