Great Debate: Simulation A Resident’s Perspective Ernest (Ted) Gomez, MD, MTR PGY-3 Resident Department of Otorhinolaryngology – Head and Neck Surgery Hospital of the University of Pennsylvania, Philadelphia, PA SUO/AADO/OPDO Combined Meeting November 13, 2015

Disclosures No financial disclosures relevant to this presentation Data in this work have been presented at the 2014 AAO-HNSF Annual Meeting in Orlando, FL, and the 2015 COSM meeting in Boston, MA.

Simulation: A Resident’s Perspective as… …a surgical trainee …a researcher

Simulation at Penn CHOP Airway Foreign Body Course PGY-2 Simfest PGY-3 Simfest Cadaveric Temporal Bone course Cadaveric Skull Base course Virtual Reality Temporal Bone Dissection Joint airway simulations with CRNA students

Reasons to Love Simulation Feeling better prepared Having a safe space to make errors

Reasons to Hate Simulation Time Cost We have adequate operative volume Limitations in simulator fidelity

Simulation as a Research Subject Can simulation be used to assess surgical skill?

Methods – Study Tasks

Methods Workload Assessment –National Aeronautics and Space Administration Task Load Index (NASA-TLX) Hart SG, Staveland LE. Development of NASA-TLX (Task Load Index): Results of Empirical and Theoretical Research. In: Peter AH, Najmedin M, editors. Advances in Psychology: North-Holland; p

Methods - Skill Assessment Anchor Descriptors OSATS Domain12345 Respect for Tissue Frequently used unnecessary force on tissue or caused damage by inappropriate use of instruments Careful handling of tissue but occasionally caused inadvertent damage Consistently interacted with tissue appropriately with minimal damage Time and MotionMany unnecessary moves Efficient time/motion but some unnecessary moves Economy of movement and maximum efficiency Instrument Handling Frequently asked for the wrong instrument or used an inappropriate instrument Knew the names of most instruments and used appropriate instrument for the task Obviously familiar with the instruments required and their names Knowledge of Instruments Frequently stopped operating or needed to discuss next move Demonstrated ability for forward planning with steady progression of operative procedure Obviously planned course of operation with effortless flow from one move to the next Use of Assistants Consistently placed assistant poorly or failed to use assistants Good use of assistants most of the time Strategically used assistant to the best advantage at all times Knowledge of Specific Procedure Deficient knowledge. Needed specific instruction at most operative steps Knew all important aspects of the operation Demonstrated familiarity with all aspects of the operation Martin JA, Regehr G, Reznick R, Macrae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. British Journal of Surgery. 1997;84(2): doi: /j x.

Results 232 endoscopic grasping trials 327 myringotomy trials All but one subject performed both tasks at least 3 times during the allotted time period

Results

Stepwise regression included no applicant characteristics (USMLE Step 1 score, AOA status, percentage of honors marks in clinical rotations, or participation in sports, music, or the performing arts) into a regression model (p > 0.05)

The Current State of Simulation

Key Goals for Simulation –Developing cost- effective simulation training –Determining the role of simulation in skill assessment and potentially certification –Establishing methods of feedback and debriefing –Linking simulation to patient outcomes

Acknowledgements