Content Validity of a High-Fidelity Surgical Middle Ear Simulator: A Randomized Prospective International Multicenter Trial

Emily R. Youner, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA.
Yeshwant R. Chillakuru, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA.
Helen Xu, Department of Otolaryngology, Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California, USA.
Matthew Dedmon, Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, North Carolina, USA.
Robert Labadie, Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Hamid Djalilian, Department of Otolaryngology-Head and Neck Surgery and Biomedical Engineering, University of California, Irvine, California, USA.
Hossein Mahboubi, PIH Health, Downey, California, USA.
Brian Westerberg, BC Rotary Hearing and Balance Centre at St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Yona Vaisbuch, Department of Otolaryngology-Head and Neck Surgery, Rambam Medical Center, Haifa, Israel.
Nikolas Blevins, Department of Otolaryngology, Stanford University, Stanford, California.
Joseph Chen, Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto.
Vincent Lin, Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Canada.
Morgan G. Joyce, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA.
Paola X. Moncada, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA.
Sasan Dabiri, Department of Otolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Richard K. Gurgel, Division of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Ali Kouhi, Department of Otolaryngology-Head and Neck Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Ashkan S. Monfared, Division of Otolaryngology-Head and Neck Surgery, The George Washington University School of Medicine & Health Sciences. Washington, DC, USA.

Document Type

Journal Article

Publication Date

8-16-2023

Journal

Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology

DOI

10.1097/MAO.0000000000003998

Abstract

OBJECTIVE: After demonstration of face validity of a surgical middle ear simulator (SMS) previously, we assessed the content validity of the simulator with otolaryngology residents. STUDY DESIGN: Multicenter randomized prospective international study. SETTING: Four academic institutions. METHODS: Novice participants were randomized into control, low-fidelity (LF), and high-fidelity (HF) groups. Control and LF produced 2 recordings from 2 attempts, and HF produced 4 recordings from 10 attempts, with trials 1, 4, 7, and 10 used for scoring. Three blinded experts graded videos of the simulated stapedectomy operation using an objective skills assessment test format consisting of global and stapedotomy-specific scales. RESULTS: A total of 152 recordings from 61 participants were included. Baseline characteristics did not differ significantly between groups. Depending on the step of the operation, inter-rater reliability ranged from 24 to 90%. For LF and HF, years of training was significantly associated with improved scores in certain objective skills assessment test subparts. HF outperformed the control group on stapes and global scores (p < 0.05). The HF group demonstrated improvement in global score over trials, but plateaued after four trials. Scores varied greatly for participants from different institutions in certain operative steps, such as transecting incudostapedial joints, likely due to differences in instrumentation and time elapsed since manufacture. CONCLUSION: Practice with SMS led to better performance in both global and stapes-specific scores. Further studies are needed to examine construct validity and to create otology-appropriate grading systems. Variables like instrumentation and decline in flexibility of the simulator after 12 months greatly affect performance on the simulator.

Department

Surgery

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