Department of Otolaryngology Head and Neck Surgery.
Department of Internal Medicine, Section of Critical Care, Laboratory for Surgical Modeling, Simulation and Robotics, Faculty of Health Sciences.
Otol Neurotol. 2019 Aug;40(7):e698-e703. doi: 10.1097/MAO.0000000000002285.
: Patient safety demands enhancements in training. Graduated cadaveric bone exposure is fundamental to otologic training. Printed bone models (PBM) provide a low-cost, anatomically consistent adjunct to cadaveric materials in trainee skill acquisition.The purpose of this study is to determine if resident training level can be distinguished on the basis of performance employing a printed temporal bone model, graded by a previous validated scale.
Nineteen residents (11 male, 8 female) from 9 graduate programs, attending a National Otolaryngology Conference, completed a mastoidectomy with posterior tympanotomy on identic 3D PBMs and a Likert scale (1-7) survey on subjective appreciation of the simulation. Four experts graded participant performance using the previously validated Welling Scale.
ANOVA revealed significant performance differences between the junior/intermediate and junior/senior PGY cohorts. No difference was observed between intermediate/senior cohorts on the basis of PGY or subjective temporal bone dissection experience. Clustering aspects of the scale with specific focus on thinning tasks found a similar outcome to the composite scale scores.Subjective experience judged printed bone to be similar to cadaveric in drill-bone interaction. Participants believed the simulation would improve surgical performance, comfort with actual patients, and operative speed.
Subjectively, printed bone compared favorably to cadaveric.The simulation demonstrated construct validity but was challenged in differentiating senior from intermediate trainee performance. This may be a function of the PBM inherent character, limitations in grading instrument fidelity or sample size. It is also possible that the dominant period of skill acquisition for mastoidectomy and posterior tympanotomy are primarily acquired during the junior training.
：患者安全需要加强培训。耳科学培训的基础是逐步增加尸体骨骼暴露。打印骨模型（PBM）为尸体材料的补充，提供了一种低成本、解剖一致的方法，有助于学员获得技能。本研究旨在确定是否可以根据使用打印颞骨模型的表现来区分住院医师的培训水平，该模型通过以前验证的量表进行分级。
来自 9 个研究生项目的 19 名住院医师（11 名男性，8 名女性）参加了全国耳鼻喉科会议，在相同的 3D PBM 上完成乳突切除术和后鼓室切开术，并对模拟的主观评价进行了 Likert 量表（1-7）调查。四位专家使用以前验证的 Welling 量表对参与者的表现进行分级。
方差分析显示，初级/中级和初级/高级 PGY 队列之间存在显著的性能差异。基于 PGY 或主观颞骨解剖经验，中级/高级队列之间没有差异。对量表的聚类方面进行特定关注，发现与综合量表评分有类似的结果。主观经验认为打印骨在钻头-骨相互作用方面与尸体相似。参与者认为模拟将提高手术性能、对实际患者的舒适度和手术速度。
主观上，打印骨与尸体相比表现良好。该模拟具有结构有效性，但在区分高级和中级学员的表现方面存在挑战。这可能是 PBM 固有特性、分级仪器保真度或样本量的限制所致。也有可能是乳突切除术和后鼓室切开术的主要技能获得阶段主要是在初级培训期间。
