title: The validation of an endoscopic sinus surgery skills training model: a pilot study.
abstract: BACKGROUND
  Performing functional endoscopic sinus surgery (FESS) requires a trainee surgeon to develop both thorough anatomic understanding and new manual dexterity skills. Traditionally, these skills were learned in the operating room setting. In an era of available surgical  simulation, this practice introduces ethical concerns about exposing patients to unnecessary risks during surgical skills development. Additionally, cost-effective rhinologic training has become increasingly important. To address these problems, a low-cost, intermediate-fidelity FESS training  model was developed, and both speed and accuracy of task completion were measured to assess both immediate and intermediate-term skills retention.
  
  
  METHODS
  Preliminary data were collected on 12 medical students and 10 resident-level (PGY1, -2, and -3) learners. Distinct  tasks were performed five times on the initial day of testing and repeated after 2 weeks.
  
  
  RESULTS
  Both groups attained statistically significant improvement in time to complete both tasks by the second iteration of each task and retained this effect after 2 weeks. Similarly,  statistically significant improvement was seen for accuracy relative to the initial attempt by the fifth iteration for residents. This effect was also seen by the third through fifth iterations and after 2 weeks for students. Additionally, when the 2-week follow-up testing was compared with  the fifth attempt, the only skills that deteriorated significantly were the resident group with the complex task times and the students with measures of accuracy. However, in both cases a highly significant improvement from initial attempts was maintained (p = 0.02 and p = 0.005, respectively).  Residents were significantly faster than medical students at both simple and complex tasks for attempts 1 through 4, but this difference was not significant for attempt 5 and after 2 weeks. Residents had significantly fewer errors for all but the 2-week data point.
  
  
  CONCLUSIONS
  The data from this pilot study support improved FESS skills for both medical students and residents using this low-cost, intermediate-fidelity model.
authors.affiliation: Department of Otorhinolaryngology, Oklahoma University College of Medicine, Oklahoma City, Oklahoma 73104, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Burge
authors.forename: Leon
authors.initials: L
authors.lastname: Bunegin
authors.forename: Erik K
authors.initials: EK
authors.lastname: Weitzel
authors.forename: K Christopher
authors.initials: KC
authors.lastname: McMains
mesh_terms: D002102:Cadaver; D002983:Clinical Competence / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D017145:Models, Educational; D057605:Natural Orifice Endoscopic Surgery / Q000193:education*; D010036:Otolaryngology / Q000193:education*; D010256:Paranasal Sinuses / Q000601:surgery*; D010865:Pilot Projects