title: Mastoidectomy performance assessment of virtual simulation training using final-product analysis.
abstract: OBJECTIVE
  The future development of integrated automatic assessment in temporal bone virtual surgical simulators calls for validation against currently established assessment tools. This study aimed to explore the relationship between mastoidectomy final-product performance assessment in virtual simulation and traditional dissection training.
  
  
  METHODS
  Prospective trial with blinding.
  
  
  METHODS
  A total of 34 novice residents performed a mastoidectomy on the Visible Ear Simulator and on a cadaveric temporal bone. Two blinded senior otologists assessed the final-product performance using a modified Welling scale. The simulator gathered basic metrics on time, steps, and volumes in relation to the on-screen tutorial and collisions with vital structures.
  
  
  RESULTS
  Substantial inter-rater reliability (kappa = 0.77) for virtual simulation and moderate inter-rater reliability (kappa = 0.59) for dissection final-product assessment was found. The simulation and dissection performance scores had significant correlation (P = .014). None of the basic simulator metrics correlated significantly with the final-product score except for number of steps completed in the simulator.
  
  
  CONCLUSIONS
  A modified version of a validated final-product performance assessment tool can be used to assess mastoidectomy on virtual temporal bones. Performance assessment of virtual mastoidectomy could potentially save the use of cadaveric temporal bones for more advanced training when a basic level of competency in simulation has been achieved.
  
  
  METHODS
  NA.
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital of Copenhagen/Rigshospitalet, Copenhagen, Denmark.
authors.forename: Steven A W
authors.initials: SA
authors.lastname: Andersen
authors.forename: Per
authors.initials: P
authors.lastname: Cayé-Thomasen
authors.forename: Mads S
authors.initials: MS
authors.lastname: Sørensen
mesh_terms: D002102:Cadaver; D002983:Clinical Competence; D003198:Computer Simulation; D004210:Dissection; D004503:Education, Medical, Graduate; D005246:Feedback; D006801:Humans; D008416:Mastoid / Q000601:surgery*; D010036:Otolaryngology / Q000193:education*; D011446:Prospective Studies; D015203:Reproducibility of Results
keywords: Virtual reality simulation; final-product assessment; mastoidectomy training; surgical simulation training; temporal bone dissection