The McGill simulator for endoscopic sinus surgery (MSESS): a validation study.
BACKGROUND
Endoscopic sinus surgery (ESS) is a technically challenging procedure, associated with a significant risk of complications. Virtual reality simulation has demonstrated benefit in many disciplines as an important educational tool for surgical training. Within the field of rhinology, there is a lack of ESS simulators with appropriate validity evidence supporting their integration into residency education. The objectives of this study are to evaluate the acceptability, perceived realism and benefit of the McGill Simulator for Endoscopic Sinus Surgery (MSESS) among medical students, otolaryngology residents and faculty, and to present evidence supporting its ability to differentiate users based on their level of training through the performance metrics.


METHODS
10 medical students, 10 junior residents, 10 senior residents and 3 expert sinus surgeons performed anterior ethmoidectomies, posterior ethmoidectomies and wide sphenoidotomies on the MSESS. Performance metrics related to quality (e.g. percentage of tissue removed), efficiency (e.g. time, path length, bimanual dexterity, etc.) and safety (e.g. contact with no-go zones, maximum applied force, etc.) were calculated. All users completed a post-simulation questionnaire related to realism, usefulness and perceived benefits of training on the MSESS.


RESULTS
The MSESS was found to be realistic and useful for training surgical skills with scores of 7.97 ± 0.29 and 8.57 ± 0.69, respectively on a 10-point rating scale. Most students and residents (29/30) believed that it should be incorporated into their curriculum. There were significant differences between novice surgeons (10 medical students and 10 junior residents) and senior surgeons (10 senior residents and 3 sinus surgeons) in performance metrics related to quality (p < 0.05), efficiency (p < 0.01) and safety (p < 0.05).


CONCLUSIONS
The MSESS demonstrated initial evidence supporting its use for residency education. This simulator may be a potential resource to help fill the void in endoscopic sinus surgery training.
Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada. rickul.varshney@gmail.com.|Royal Victoria Hospital, 687 Ave Des Pins O., Rm E4.41, Montreal, Quebec, H3A 1A1, Canada. rickul.varshney@gmail.com.
Rickul
R
Varshney
Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada. sfrenkie@jgh.mcgill.ca.
Saul
S
Frenkiel
Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada. lily.hp.nguyen@gmail.com.|Centre for Medical Education, McGill University, Montreal, Canada. lily.hp.nguyen@gmail.com.
Lily H P
LH
Nguyen
Centre for Medical Education, McGill University, Montreal, Canada. meredith.young@mcgill.ca.|Department of Medicine, McGill University, Montreal, Canada. meredith.young@mcgill.ca.
Meredith
M
Young
Neurosurgical Simulation Research Center, McGill University, Montreal, Canada. rolando.del_maestro@mcgill.ca.
Rolando
R
Del Maestro
Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada. anthony.zeitouni@mcgill.ca.
Anthony
A
Zeitouni
Department of BioMedical Engineering, McGill University, Montreal, Canada. elias.saad@mail.mcgill.ca.
Elias
E
Saad
Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada. robert.funnell@mcgill.ca.|Department of BioMedical Engineering, McGill University, Montreal, Canada. robert.funnell@mcgill.ca.
W Robert J
WR
Funnell
Department of Otolaryngology, Head and Neck Surgery, McGill University, Montreal, Canada. marc.tewfik@mcgill.ca.
Marc A
MA
Tewfik
D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D004724:Endoscopy / Q000193:education*; D004867:Equipment Design; D006801:Humans; D007396:Internship and Residency; D010036:Otolaryngology / Q000193:education*; D010256:Paranasal Sinuses / Q000601:surgery*; D012189:Retrospective Studies; D014584:User-Computer Interface