Development and Validation of a Modular Endoscopic Ear Surgery Skills Trainer

Objective: Endoscopic ear surgery (EES) is an emerging technique requiring single-handed dissection with limited depth perception. Current options for EES simulation and training are limited. Herein, we introduce a versatile, low-cost surgical skills trainer that aims to improve the fine motor control necessary for EES. Study Design: Prospective validation study. Setting: Surgical simulation laboratory. Participants: Seven subjects ranging in experience from medical students ("Novices'') to experienced ear surgeons ("Experts'') participated in the validation study. Experts (n = 3) were defined as performing > 10 EES cases per year. Methods: The skills trainer was constructed from a 3'' diameter polyvinyl chloride pipe cap modified with two ports for instrument passage. A wooden platform was placed inside at an appropriate working distance for ear surgery. Eight interchangeable skills modules were fabricated on wooden squares (3 cm x 3 cm) using materials such as # 19 wire brads, 1.6 mm glass beads, and 26-gauge jewelry wire. The material cost of this reusable model was $15. Subjects completed each skills module in triplicate, followed by a Likert-based survey. Results: Expert performance was superior to novices in 100% (8/8) of skills modules, i.e., threading beads on a wire (43 versus 127 s, p < 0.001) and placing a simulated prosthesis (13 versus 68 s, p = 0.01). Most participants (86%) agreed the trainer orientation was accurate and all participants (100%) were satisfied with the experience. Conclusions: This low-cost modular task trainer may help fill a void in otologic training by allowing efficient, deliberate practice of validated exercises designed to improve fine motor control with EES instrumentation.