SimTube: A National Simulation Training and Research Project

Abstract

Objective To test the feasibility and impact of a simulation training program for myringotomy and tube (M&T) placement. Study Design Prospective randomized controlled. Setting Multi-institutional. Subjects and Methods An M&T simulator was used to assess the impact of simulation training vs no simulation training on the rate of achieving competency. Novice trainees were assessed using posttest simulator Objective Structured Assessment of Technical Skills (OSATS) scores, OSATS score for initial intraoperative tube insertion, and number of procedures to obtain competency. The effect of simulation training was analyzed using χ2 tests, Wilcoxon-Mann-Whitney tests, and Cox proportional hazards regression. Results A total of 101 residents and 105 raters from 65 institutions were enrolled; however, just 63 residents had sufficient data to be analyzed due to substantial breaches in protocol. There was no difference in simulator pretest scores between intervention and control groups; however, the intervention group had better OSATS global scores on the simulator (17.4 vs 13.7, P = .0003) and OSATS task scores on the simulator (4.5 vs 3.6, P = .02). No difference in OSATS scores was observed during initial live surgery rating ( P = .73 and P = .41). OSATS scores were predictive of the rate at which residents achieved competence in performing myringotomy; however, the intervention was not associated with subsequent OSATS scores during live surgeries ( P = .44 and P = .91) or the rate of achieving competence ( P = .16). Conclusions A multi-institutional simulation study is feasible. Novices trained using the M&T simulator achieved higher scores on simulator but not initial intraoperative OSATS, and they did not reach competency sooner than those not trained on the simulator.

A novel approach to myringotomy simulation

“…Participants were evaluated on their performance using a modified version of the Objective Structured Assessment of Technical Skills for surgical trainees by Wiet et al . 9 We utilized a Delphi technique to develop our modifications and a finalised global grading scale.…”

“…The model was a modification of that described by Malekzadeh et al ('SimTube'), which was recently used in a national simulation study. 5,9…”

Current Evidence for Simulation-Based Training and Assessment of Myringotomy and Ventilation Tube Insertion: A Systematic Review

“…In the studies that included assessment of performance (39)(40)(41)(42)(43)45,47,49,(51)(52)(53)(54)(55)59,60,62), different assessment methods and tools were used. These were mainly Global Rating Scales (GRS) where the rater for example assigns an overall score based on observation of the performance (39,41,42,45,(51)(52)(53)(54)(55)62);…”

“…Task-Based/Task-Specific Checklists where the rater for example checks if specific sub-tasks are performed or errors made (41,42,(51)(52)(53)55,62); and metrics such as time to completion of the procedure (39)(40)(41)(42)(43)45,49,(52)(53)(54)(55)60). Two studies used completely automated metrics derived from the VR simulators such as procedure time, contact with the external ear canal, number of attempts of tube insertion, etc.…”

Simulated Surgical Model Design for Myringotomy and Tympanostomy Tube Insertion in Children using Medical Image Processing and 3D-Printing Technologies

“…7 Many simulation models are designed for practicing myringotomy and tympanostomy tube insertion. But use easily found materials, such as boxes and syringes to simulate the ear holes, [8][9][10] which model appearance is unrealistic. [11][12][13] Also the medical models are designed as adult, and have not been designed as a child, where the symptom most occurs.…”