Al-Shahrestani Fahd, Sørensen Mads Sølvsten, Andersen Steven Arild Wuyts
Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Centre for HR, The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), The Capital Region of Denmark, Copenhagen, Denmark.
Eur Arch Otorhinolaryngol. 2019 Mar;276(3):657-664. doi: 10.1007/s00405-018-05265-9. Epub 2019 Jan 2.
To investigate validity evidence, and strengths and limitations of performance metrics in mastoidectomy training.
A systematic review following the PRISMA guidelines. Studies reporting performance metrics in mastoidectomy/temporal bone surgery were included. Data on design, outcomes, and results were extracted by two reviewers. Validity evidence according to Messick's framework and level of evidence were assessed.
The search yielded a total of 1085 studies from the years 1947-2018 and 35 studies were included for full data extraction after abstract and full-text screening. 33 different metrics on mastoidectomy performance were identified and ranked according to the number of reports. Most of the 33 metrics identified had some amount of validity evidence. The metrics with most validity evidence were related to drilling time, volume drilled per time, force applied near vital structures, and volume removed.
This review provides an overview of current metrics of mastoidectomy performance, their validity, strengths and limitations, and identifies the gap in validity evidence of some metrics. Evidence-based metrics can be used for performance assessment in temporal bone surgery and for providing integrated and automated feedback in virtual reality simulation training. The use of such metrics in simulation-based mastoidectomy training can potentially address some of the limitations in current temporal bone skill assessment and ease assessment in repeated practice. However, at present, an automated feedback based on metrics in VR simulation does not have sufficient empirical basis and has not been generally accepted for use in training and certification.
2a.
探讨乳突切除术训练中性能指标的有效性证据、优势和局限性。
按照PRISMA指南进行系统综述。纳入报告乳突切除术/颞骨手术性能指标的研究。由两名评价者提取关于设计、结局和结果的数据。根据梅西克框架评估有效性证据和证据水平。
检索共得到1947年至2018年的1085项研究，经摘要和全文筛选后，35项研究纳入完整数据提取。确定了33项关于乳突切除术性能的不同指标，并根据报告数量进行排序。所确定的33项指标中的大多数都有一定程度的有效性证据。有效性证据最多的指标与钻孔时间、每次钻孔体积、重要结构附近施加的力以及切除体积有关。
本综述概述了当前乳突切除术性能指标、其有效性、优势和局限性，并确定了一些指标在有效性证据方面的差距。基于证据的指标可用于颞骨手术的性能评估，并在虚拟现实模拟训练中提供综合和自动反馈。在基于模拟的乳突切除术训练中使用此类指标可能会解决当前颞骨技能评估中的一些局限性，并便于在重复练习中进行评估。然而，目前，基于虚拟现实模拟中指标的自动反馈没有足够的实证依据，尚未被普遍接受用于训练和认证。
2a。
