Tube Education Device (TED) Simulator for Myringotomy with Tube Insertion for Resident Training Purposes

Abstract

Objectives: 1) Implement a training device to train otolaryngology residents to perform myringotomy with tube insertion. 2) Analyze data on the performance of medical students with this device. Methods: After approval by University of Texas Medical Branch Institutional Review Board, medical students were recruited to partake in the study from June 2012 to present. An instructional video on this procedure was shown to each subject before each trial. In the operating room, the subjects performed the procedure 5 consecutive times while being recorded through the ear microscope. An otolaryngology resident performed the duties of a surgical tech. The videos were then all randomized and reviewed by 3 attending otolaryngologists with the following criteria: average time, number of errors, and subjective numerical grading of each attempt. Results: To date, 7 subjects have participated. From the first attempt to the fifth attempt, the average time for procedure decreased from 160 seconds to 80 seconds. The average times the myringotomy knife touched the sides of the simulated ear canal dropped from over 2.6 to 0.7 times. The average percentage of instances the grader would allow the subject to perform procedure on a real patient increased from 38% to 91%. The success of the procedure determined by the grader increased from 52% to 95%. Conclusions: No standardized training is available for myringotomy with tube insertion. Training with this device can decrease procedure time by 50%, reduce errors, and increase the confidence of attending otolaryngologists of trainees. These results show potential benefits to translate to real patients.

Patient Safety and Quality Improvement in Otolaryngology Education: A Systematic Review

“…While this systematic review identified a wide variety of topics, the most‐studied area was the use of simulation in surgical training. Some of the simulated scenarios included fresh tissue models, 11‐15 computer models, 16‐19 and surgical training models using synthetic materials 20‐26 . Regardless of the specific design, simulation is a logical focus for PS/QI in education as it provides a means to increase iterations of performing a complex task without exposing patients to additional risk associated with lack of experience.…”

“…Some of the simulated scenarios included fresh tissue models, [11][12][13][14][15] computer models, [16][17][18][19] and surgical training models using synthetic materials. [20][21][22][23][24][25][26] Regardless of the specific design, simulation is a logical focus for PS/QI in education as it provides a means to increase iterations of performing a complex task without exposing patients to additional risk associated with lack of experience. A number of studies centered on performance and competency evaluation.…”

Ventilation tube insertion simulation: a literature review and validity assessment of five training models

“…Eleven different VTI simulators are described in the literature. [8][9][10][11][12][13][14][15][16][17][18][19] Two models showed face validity data, 16,18 three studies reported on the effect of iteration, 14,15,19 and one included construct validity data. 15 The remainder were purely descriptive articles.…”

“…Ventilation tube insertion simulators in the literature[8][9][10][11][12][13][14][15][16][17][18][19] Some of the included figures apply to the models replicated by the group and may vary when reproduced by others.…”