Our results indicate that the tool we have developed is a feasible, valid, and reliable instrument for the assessment of competency in mastoidectomy. The instrument can be used to provide formative feedback and to identify procedural tasks for which additional training may be necessary.

Our results and experience suggest that a feasible, reliable, and valid instrument for objective evaluation of operative competency can be developed for ESS. Further experience at other otolaryngology programs and efforts focused on faculty development will be needed to enhance faculty buy-in. The instrument can be used for formative and summative feedback as well as for identifying residents needing remediation.

Our assessment tool is a feasible and valid method of evaluating acquisition of mastoidectomy skills in the operating room. It can be integrated into surgical teaching in the operating room and yields information for direct formative feedback.

An institutionally subsidized, multi-disciplinary percutaneous tracheostomy program can improve the quality of care in a cost-effective manner by decreasing the incidence of tracheostomy complications and improving both the time to tracheostomy, duration of procedure, and postprocedural intensive care unit stay.

Technical skills in mastoidectomy surgery can be acquired during even brief practice on the VR temporal bone simulator. It is anticipated that longer periods of practice presented within the fundamentals of comprehensive curriculum will facilitate procedural learning. Further studies are required to elucidate evidence of transference of these skills to the operating room and to procedures of greater complexity.