title: Face and content validity of a novel, web-based otoscopy simulator for medical education.
abstract: BACKGROUND
  Despite the fact that otoscopy is a widely used and taught diagnostic tool during medical training, errors in diagnosis are common. Physical otoscopy simulators have high fidelity, but they can be expensive and only a limited number of students can use them at a given time.
  
  
  OBJECTIVE
  1) To develop a purely web-based otoscopy simulator that can easily be distributed to students over the internet. 2) To assess face and content validity of the simulator by surveying experts in otoscopy.
  
  
  METHODS
  An otoscopy simulator, OtoTrain™, was developed at Western University using web-based programming and Unity 3D. Eleven experts from academic institutions in North America were recruited to test the simulator and respond to an online questionnaire. A 7-point Likert scale was used to answer questions related to face validity (realism of the simulator), content validity (expert evaluation of subject matter and test items), and applicability to medical training.
  
  
  RESULTS
  The mean responses for the face validity, content validity, and applicability to medical training portions of the questionnaire were all ≤3, falling between the "Agree", "Mostly Agree", and "Strongly Agree" categories. The responses suggest good face and content validity of the simulator. Open-ended questions revealed that the primary drawbacks of the simulator were the lack of a haptic arm for force feedback, a need for increased focus on pneumatic otoscopy, and few rare disorders shown on otoscopy.
  
  
  CONCLUSIONS
  OtoTrain™ is a novel, web-based otoscopy simulator that can be easily distributed and used by students on a variety of platforms. Initial face and content validity was encouraging, and a skills transference study is planned following further modifications and improvements to the simulator.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada. wickensb@gmail.com.
authors.forename: Brandon
authors.initials: B
authors.lastname: Wickens
authors.affiliation: Department of Medical Biophysics, Western University, London, Ontario, Canada. jlewis95@uwo.ca.
authors.forename: Jordan
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. DP.Morris@dal.ca.
authors.forename: David P
authors.initials: DP
authors.lastname: Morris
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada. murad.husein@lhsc.on.ca.
authors.forename: Murad
authors.initials: M
authors.lastname: Husein
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada. hladak@uwo.ca.|Department of Medical Biophysics, Western University, London, Ontario, Canada. hladak@uwo.ca.|Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada. hladak@uwo.ca.
authors.forename: Hanif M
authors.initials: HM
authors.lastname: Ladak
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada. Sumit.Agrawal@lhsc.on.ca.|Department of Medical Biophysics, Western University, London, Ontario, Canada. Sumit.Agrawal@lhsc.on.ca.|Department of Electrical & Computer Engineering, Western University, London, Ontario, Canada. Sumit.Agrawal@lhsc.on.ca.|London Health Sciences Centre, Room B1-333, University Hospital, 339 Windermere Rd., London, Ontario, N6A 5A5, Canada. Sumit.Agrawal@lhsc.on.ca.
authors.forename: Sumit K
authors.initials: SK
authors.lastname: Agrawal
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D003194:Computer-Assisted Instruction; D003479:Curriculum; D004867:Equipment Design; D005180:Faculty, Medical; D006801:Humans; D021621:Imaging, Three-Dimensional; D020407:Internet; D010036:Otolaryngology / Q000193:education; D038781:Otoscopy / Q000379:methods / Q000592:standards; D000066908:Simulation Training / Q000379:methods*; D012984:Software; D011795:Surveys and Questionnaires; D014584:User-Computer Interface