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Great Debate: SimulationA Residents PerspectiveErnest (Ted) Gomez, MD, MTRPGY-3 ResidentDepartment of Otorhinolaryngology Head and Neck SurgeryHospital of the University of Pennsylvania, Philadelphia, PA

SUO/AADO/OPDO Combined MeetingNovember 13, 20151DisclosuresNo financial disclosures relevant to this presentationData 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 Residents Perspective asa surgical traineea researcherSimulation at PennCHOP Airway Foreign Body CoursePGY-2 SimfestPGY-3 SimfestCadaveric Temporal Bone courseCadaveric Skull Base courseVirtual Reality Temporal Bone DissectionJoint airway simulations with CRNA students

Reasons to Love SimulationFeeling better preparedHaving a safe space to make errors

Reasons to Hate SimulationTimeCostWe have adequate operative volumeLimitations in simulator fidelitySimulation as a Research SubjectCan simulation be used to assess surgical skill?

Methods Study Tasks

MethodsWorkload AssessmentNational 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; 1988. p. 139-83. Methods - Skill AssessmentAnchor DescriptorsOSATS Domain12345Respect for TissueFrequently used unnecessary force on tissue or caused damage by inappropriate use of instrumentsCareful handling of tissue but occasionally caused inadvertent damageConsistently interacted with tissue appropriately with minimal damageTime and MotionMany unnecessary movesEfficient time/motion but some unnecessary movesEconomy of movement and maximum efficiencyInstrument HandlingFrequently asked for the wrong instrument or used an inappropriate instrumentKnew the names of most instruments and used appropriate instrument for the taskObviously familiar with the instruments required and their namesKnowledge of InstrumentsFrequently stopped operating or needed to discuss next moveDemonstrated ability for forward planning with steady progression of operative procedureObviously planned course of operation with effortless flow from one move to the nextUse of AssistantsConsistently placed assistant poorly or failed to use assistantsGood use of assistants most of the timeStrategically used assistant to the best advantage at all timesKnowledge of Specific ProcedureDeficient knowledge. Needed specific instruction at most operative stepsKnew all important aspects of the operationDemonstrated familiarity with all aspects of the operationMartin 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):273-8. doi: 10.1046/j.1365-2168.1997.02502.x. Results232 endoscopic grasping trials327 myringotomy trials

All but one subject performed both tasks at least 3 times during the allotted time period

ResultsResultsResultsStepwise 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

The Current State of Simulation

Key Goals for SimulationDeveloping cost-effective simulation trainingDetermining the role of simulation in skill assessment and potentially certificationEstablishing methods of feedback and debriefingLinking simulation to patient outcomes

Acknowledgements