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

Mahalingam, Sridhayan; Awad, Zaid; Tolley, Neil; Khemani, Sameer

doi:10.1111/coa.12543

Cited by 10 publications

(17 citation statements)

References 17 publications

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“…24,26 The current reality of residency time constraints has sparked the development of multiple feasible task trainers for common procedures. 9,11,19,25,27,28 Use of low-cost, well-described, and readily accessible task trainers in this study makes dissemination and implementation of the described curriculum feasible at other institutions.…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing of Entry‐Level Otolaryngology Simulation

et al. 2019

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Objective Appropriate timing of subspecialty simulation is critical to maximize learner benefit and guide resource utilization. We aimed to determine optimal timing of a simulation-based curriculum designed to teach entry-level procedural skills for otolaryngology residency. Study Design Simulation curriculum intervention tested among 3 comparison groups of varying clinical levels. Setting Academic otolaryngology training program and medical school. Subjects and Methods We developed a simulation-based technical skills curriculum incorporating the following task trainers: flexible laryngoscopy, peritonsillar abscess drainage, and myringotomy and tube insertion. Preclinical medical students (n = 40), subintern rotators (n = 35), and midyear interns (n = 8) completed the simulation-based curriculum. Pre- and postintervention knowledge/confidence and “level appropriateness” were rated on a 5-point Likert scale, and effect size was calculated. Results Overall self-reported knowledge/confidence levels improved in all 3 groups preintervention (1.05, 2.15, 3.17) to postintervention (2.79, 3.45, 4.38, respectively; all P < .01). Preclinical medical students uniformly reported very little to no familiarity with the procedures prior to the curriculum, while interns approached independence following the intervention. Large effect sizes were seen in all tasks for preclinical students ( d = 3.13), subinterns ( d = 1.46), and interns ( d = 2.14). Five-point Likert scale measures of level appropriateness (1 = too challenging, 5 = too easy) for preclinical students, subinterns, and interns were 2.70 (95% CI, 2.56-2.84), 3.11 (95% CI, 2.97-3.25), and 3.75 (95% CI, 3.35-4.15), respectively. Conclusion Subinternship may represent the optimal timing for entry-level skills simulation training. The proposed curriculum shows utility for clinical levels ranging from medical students to postgraduate year 1 resident levels, with large effect sizes for all tested groups.

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Section: Discussionmentioning

confidence: 99%

Optimal Timing of Entry‐Level Otolaryngology Simulation

et al. 2019

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“…The chosen simulator was Jesudason and Smith's (2004) Bradford Grommet Trainer, 12 which was the preferred low-fidelity ventilation tube insertion trainer in a recent review. 13 Two disposable auricular temperature probe covers are arranged in series; the membrane of the internal cylinder is pulled taut by the second probe cover, acting as the tympanic membrane. The simulator was inserted into the right ear of a manikin and draped for enhanced realism.…”

Section: Methodsmentioning

confidence: 99%

Investigating the learning curve in endoscopic compared to microscopic myringotomy and ventilation tube insertion

et al. 2020

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AbstractObjectiveRate of learning is often cited as a deterrent in the use of endoscopic ear surgery. This study investigated the learning curves of novice surgeons performing simulated ear surgery using either an endoscope or a microscope.MethodsA prospective multi-site clinical research study was conducted. Seventy-two medical students were randomly allocated to the endoscope or microscope group, and performed 10 myringotomy and ventilation tube insertions. Trial times were used to produce learning curves. From these, slope (learning rate) and asymptote (optimal proficiency) were ascertained.ResultsThere was no significant difference between the learning curves (p = 0.41). The learning rate value was 68.62 for the microscope group and 78.71 for the endoscope group. The optimal proficiency (seconds) was 32.83 for the microscope group and 27.87 for the endoscope group.ConclusionThe absence of a significant difference shows that the learning rates of each technique are statistically indistinguishable. This suggests that surgeons are not justified when citing ‘steep learning curve’ in arguments against the use of endoscopes in middle-ear surgery.

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“…Mahalingam et al performed a 2015 literature review of 11 simulation models, of which only 5 underwent validity assessment, 2 relied on virtual reality and only 5 were deemed feasible to replicate. 1 The diameter of the tympanic membrane in these models ranged from 6 to 10 mm while the length of the external auditory canal ranged from 2.1 to 4.0 cm. The various materials used for the tympanic membrane included plastic, adhesive tape, latex, vinyl, cellophane and nitrile.…”

Section: Discussionmentioning

confidence: 97%

“…The study concluded that none of these models achieved face or global content validity. 1 In 2008, Uy and Martinez 3 fashioned a do-it-yourself myringotomy model from recycled plastic egg crate, 3-cc plastic syringe, medical tape and modeling clay that then cost approximately PhP 100 (approximately USD 1.90 in 2008 and approximately USD 2.50 or PhP 130 in 2018). However, we believe the materials they used are easily prone to wear and tear and would have to be constantly replaced and refashioned.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous simulation platforms for MVTI have already been made internationally and locally using various materials with different levels of replicability, validity and cost. [1][2][3] There have also been a number of innovations to make this procedure simpler and less traumatic for the patient such as the use of a self-made tube with a corresponding applicator, 4,5 performing the procedure endoscopically 6 and using an optical myringotomy knife. 7 However, there is a need to evaluate and improve a trainee's dexterity in performing this basic procedure beginning with adult then in pediatric ears.…”

Section: Original Articlesmentioning

confidence: 99%

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Simulation Platform for Myringotomy with Ventilation Tube Insertion in Adult Ears

Chan

Carrillo

Ong

2018

Philipp J Otolaryngol Head Neck Surg

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Objective: To develop a ventilation tube insertion simulator for training and evaluation of otorhinolaryngology residents in myringotomy with ventilating tube insertion. Methods: Design: Cross - Sectional Study Setting: Tertiary National University Hospital Participants: Otologists and otorhinolaryngology resident trainees A simulation tool for myringotomy with ventilation tube insertion was fabricated using silicone sealant, aluminum tube, rubber ball, plaster of paris and plastic sheet, and pretested by our expert panel. Residents were then evaluated using an objective structured clinical examination (OSCE) checklist while performing the procedure using the same model. Three trials were given, and OSCE scores were obtained, for each resident. Result: The pinna, ear canal, tympanic membrane, malleus handle were deemed realistic by the expert panel. Residents performed the procedure at an average of 87 seconds. Average OSCE score for all residents was 17.17, with senior residents having a higher average score (18.3) than junior residents (16.6). However, this was not statistically significant (2 tailed t-value, significance level 0.05 = -1.27, p = .227). The most common cause of trial failure was dropping of the tube in the middle ear, while the most common error made was using more than 2 attempts at performing the incision. Conclusion: This simulation platform may be a valuable tool to use in educating and developing skills and proper technique of myringotomy with ventilation tube insertion. It is reproducible, affordable, realistic, sturdy and versatile in its applications. Residents who show adequate dexterity and consistency during simulation may eventually be allowed to perform the procedure on patients and provide feedback regarding the usefulness of the simulation. Keywords: otitis media with effusion, middle ear ventilation, tympanic membrane, models, educational, simulation training, patient simulation

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

Abstract: The quality of simulation models is moderate and there is room for improvement. There is a need for new models to be developed or existing ones to be refined in order to construct a more realistic training platform for VTI simulation.

Cited by 10 publications

References 17 publications

Optimal Timing of Entry‐Level Otolaryngology Simulation

Optimal Timing of Entry‐Level Otolaryngology Simulation

Investigating the learning curve in endoscopic compared to microscopic myringotomy and ventilation tube insertion

Simulation Platform for Myringotomy with Ventilation Tube Insertion in Adult Ears

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