Virtual Reality Simulation as a Tool for ENT Training: An Autoethnographic Study

OBJECTIVE: To investigate the factors influencing a novice trainee's surgical skill acquisition using virtual reality (VR) temporal bone (TB) drilling simulation as a training tool. This study is the first application of autoethnography in the surgical simulation literature. DESIGN: This study uses autoethnography to examine the factors underpinning simulated surgical skill acquisition using VR TB drilling (ethnography) through systematically documenting and analyzing the researcher's reflections over a prolonged period of time (autobiography). The primary researcher undertook 16 3-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) simulator over 8 months. Data collected comprised qualitative field notes and reflective journal logs, and quantitative scores from formative assessments. Data were coded using NVivo12 and analyzed using inductive thematic analysis. SETTING: University Hospitals Birmingham ENT Simulation Dry Lab, Queen Elizabeth Hospital, Birmingham, United Kingdom. PARTICIPANTS: The primary researcher, a surgical novice, was responsible for the study design and execution, with supervision from a consultant ENT surgeon and 2 simulation fellows. RESULTS: The study yielded 6 themes: About 3 themes highlight new insights: 1) VMT as a surgical learning tool, 2) overcoming technological issues, 3) and physical impacts of simulated surgery; About 3 themes support existing evidence relating to surgical skill acquisition: 4)rushing leading to inaccuracy, 5) reflections and feedback, and 6) overcoming demotivation. CONCLUSION: The application of autoethnography to the study of surgical skill acquisition is new. Our results enable a deeper insight into surgical skill acquisition using VR TB simulation, with 6 specific themes identified as impacting learning with this tool. An understanding of these factors will facilitate future research in this area, and enable constructive adjustments to the learning experience, ultimately improving training program delivery and outcomes going forward. ( J Surg Ed 82:103439. Crown Copyright (c) 2025 Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)