title: Peak and ceiling effects in final-product analysis of mastoidectomy performance.
abstract: BACKGROUND
  Virtual reality surgical simulation of mastoidectomy is a promising training tool for novices. Final-product analysis for assessing novice mastoidectomy performance could be limited by a peak or ceiling effect. These may be countered by simulator-integrated tutoring.
  
  
  METHODS
  Twenty-two participants completed a single session of self-directed practice of the mastoidectomy procedure in a virtual reality simulator. Participants were randomised for additional simulator-integrated tutoring. Performances were assessed at 10-minute intervals using final-product analysis.
  
  
  RESULTS
  In all, 45.5 per cent of participants peaked before the 60-minute time limit. None of the participants achieved the maximum score, suggesting a ceiling effect. The tutored group performed better than the non-tutored group but tutoring did not eliminate the peak or ceiling effects.
  
  
  CONCLUSIONS
  Timing and adequate instruction is important when using final-product analysis to assess novice mastoidectomy performance. Improved real-time feedback and tutoring could address the limitations of final product based assessment.
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery,Rigshospitalet,Copenhagen,Denmark.
authors.forename: N
authors.initials: N
authors.lastname: West
authors.affiliation: Center for Clinical Education,Centre for HR,Capital Region of Denmark,Copenhagen,Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Konge
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery,Rigshospitalet,Copenhagen,Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Cayé-Thomasen
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery,Rigshospitalet,Copenhagen,Denmark.
authors.forename: M S
authors.initials: MS
authors.lastname: Sørensen
authors.affiliation: Department of Otorhinolaryngology - Head & Neck Surgery,Rigshospitalet,Copenhagen,Denmark.
authors.forename: S A W
authors.initials: SA
authors.lastname: Andersen
mesh_terms: D003198:Computer Simulation; D004521:Educational Measurement; D005246:Feedback; D006801:Humans; D059032:Learning Curve; D008416:Mastoid / Q000601:surgery*; D010027:Osteotomy / Q000193:education*; D000066908:Simulation Training / Q000379:methods; D014584:User-Computer Interface
keywords: Clinical Competence; Computer Simulation; Education; Medical; Temporal Bone