Slide 1
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