The CanadaWest scale was facile and delineated performance by experience level with strong intrarater reliability. Comparable to the validated Welling Scale, it distinguished junior from senior trainees but was challenged in differentiating intermediate and senior trainee performance.
Patient safety demands enhancements in training. Graduated cadaveric bone exposure is fundamental to otologic training. Printed bone models (PBM) provide a low-cost, anatomically consistent adjunct to cadaveric materials in trainee skill acquisition. The purpose of this study is to determine if resident training level can be distinguished on the basis of performance employing a printed temporal bone model, graded by a previous validated scale. Methods: Nineteen residents (11 male, 8 female) from 9 graduate programs, attending a National Otolaryngology Conference, completed a mastoidectomy with posterior tympanotomy on identic 3D PBMs and a Likert scale (1–7) survey on subjective appreciation of the simulation. Four experts graded participant performance using the previously validated Welling Scale. Results: ANOVA revealed significant performance differences between the junior/intermediate and junior/senior PGY cohorts. No difference was observed between intermediate/senior cohorts on the basis of PGY or subjective temporal bone dissection experience. Clustering aspects of the scale with specific focus on thinning tasks found a similar outcome to the composite scale scores. Subjective experience judged printed bone to be similar to cadaveric in drill–bone interaction. Participants believed the simulation would improve surgical performance, comfort with actual patients, and operative speed. Conclusion: Subjectively, printed bone compared favorably to cadaveric. The simulation demonstrated construct validity but was challenged in differentiating senior from intermediate trainee performance. This may be a function of the PBM inherent character, limitations in grading instrument fidelity or sample size. It is also possible that the dominant period of skill acquisition for mastoidectomy and posterior tympanotomy are primarily acquired during the junior training.
BackgroundTemporal bone simulations are critiqued for poor drill‐bone interaction. This project appraises the import of increasing haptic device and manipulandum fidelity on the perceived realism of drilling a virtual temporal bone.Virtual surgical contact forces rely on haptic device fidelity and are transmitted through a manipulandum. With identical software, both device hardware and manipulandum may each contribute to realism. We compare the three degrees of freedom (DOF), 3N Geomagic Touch (3D Systems, SC) to a 6DOF, 5.5N HD2 (Quanser, ON) with the both standard (“HD2–Standard”) and in‐house customized otic drill manipulandum (“HD2–Modified”).MethodsSix otologic surgeons performed three virtual mastoidectomy surgeries on a temporal bone surgical simulator. The HD2 manipulandum was modified for attached otic drill with gravity compensation and requisite mechanical modifications. Surgeons, in random order, performed the dissection with the different hardware platforms.ResultsTwo‐tailed t‐tests demonstrate that for the acoustic properties of each simulation, the HD2–Modified manipulandum was favored (p ≤ 0.0004). For overall similarity of bone, both HD2–Standard (p ≤ 0.05) HD2–Modified (p ≤ 0.03)) were favored over the Geomagic; however they were not appreciably different when directly compared to each other. There was no preference for increasing haptic device fidelity in virtual drill bone interaction.In forced rank, users favored the HD2–Modified in osseus, vibrational and overall realism, as well as being preferred for education and preoperative rehearsal (p ≤ 0.0164).ConclusionIncreasing manipulandum realism was favored. However surprisingly, there was no preference for increased device fidelity, illustrating incremental stiffness had nominal impact. There may be a ceiling to drill bone interaction in virtual haptic simulation.Level of Evidence2b.
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