title: Comparing surgical experience with performance on a sinus surgery simulator.
abstract: BACKGROUND
  This study evaluates whether surgical experience influences technical competence using the Flinders sinus surgery simulator, a virtual environment designed to teach nasal endoscopic surgical skills.
  
  
  METHODS
  Ten experienced sinus surgeons (five consultants and five registrars) and 14 novices (seven resident medical officers and seven interns/medical students) completed three simulation tasks using haptic controllers. Task 1 required navigation of the sinuses and identification of six anatomical landmarks, Task 2 required removal of unhealthy tissue while preserving healthy tissue and Task 3 entailed backbiting within pre-set lines on the uncinate process and microdebriding tissue between the cuts.
  
  
  RESULTS
  Novices were compared with experts on a range of measures, using Mann-Whitney U -tests. Novices took longer on all tasks (Task 1: 278%, P < 0.005; Task 2: 112%, P < 0.005; Task 3: 72%, P < 0.005). In Task 1, novices' instruments travelled further than experts' (379%, P < 0.005), and provided greater maximum force (12%, P < 0.05). In Tasks 2 and 3 novices performed more cutting movements to remove the tissue (Task 2: 1500%, P < 0.005; Task 3: 72%, P < 0.005). Experts also completed more of Task 3 (66%, P < 0.05).
  
  
  CONCLUSIONS
  The study demonstrated the Flinders sinus simulator's construct validity, differentiating between experts and novices with respect to procedure time, instrument distance travelled and number of cutting motions to complete the task.
authors.affiliation: Medical Device Research Institute, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Diment
authors.affiliation: Medical Device Research Institute, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Ruthenbeck
authors.affiliation: Flinders ENT, Department of Surgery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Nuwan
authors.initials: N
authors.lastname: Dharmawardana
authors.affiliation: Medical Device Research Institute, Flinders University, Adelaide, South Australia, Australia.|Flinders ENT, Department of Surgery, Flinders University, Adelaide, South Australia, Australia.|Southern ENT Ear Nose and Throat Specialists, Flinders Private Hospital, Adelaide, South Australia, Australia.
authors.forename: A Simon
authors.initials: AS
authors.lastname: Carney
authors.affiliation: Flinders ENT, Department of Surgery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Charmaine M
authors.initials: CM
authors.lastname: Woods
authors.affiliation: Flinders ENT, Department of Surgery, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Eng H
authors.initials: EH
authors.lastname: Ooi
authors.affiliation: Medical Device Research Institute, Flinders University, Adelaide, South Australia, Australia.|Cooperative Research Centre for Alertness, Safety and Productivity, Adelaide, South Australia, Australia.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Reynolds
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D004724:Endoscopy / Q000193:education*; D006801:Humans; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education*; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D010865:Pilot Projects; D014584:User-Computer Interface
keywords: competency-based education; computer simulation; endoscopy; nasal surgical procedure; user-computer interface