title: Current Status of Simulation in Otolaryngology: A Systematic Review.
abstract: OBJECTIVE
  Otolaryngology is a highly technical and demanding specialty and the requirements for surgical trainees to acquire proficiency remains challenging. Simulation has been purported to be an effective tool in assisting with this. The aim of this systematic review is to identify the available otolaryngology simulators, their status of validation, and evaluation the level of evidence behind each training model and thereby establish a level of recommendation.
  
  
  METHODS
  PubMed, ERIC, and Google Scholar databases were searched for articles that described otolaryngology simulators or training models between 1980 and April 2016. Any validation studies for simulators were also retrieved. Titles and abstracts were screened for relevance using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Level of evidence (LoE) and Level of recommendation (LoR) was awarded to each study and model, respectively.
  
  
  RESULTS
  A total of 70 studies were identified describing 64 simulators. Out of these, at least 54 simulators had 1 validation study. Simulators for the ear and temporal bone surgery were the most common (n = 32), followed by laryngeal and throat (n = 20) and endoscopic sinus surgery (n = 12). Face validity was evaluated by 29 studies, 20 attempted to show construct, 20 assessed content, 20 transfer, and only 2 assessed concurrent validity. Of the validation assessments, 2 were classified as Level 1b, 10 Level 2a, and 48 Level 2b. No simulators received the highest LoR, but 8 simulators received a LoR of 2.
  
  
  CONCLUSIONS
  Despite the lack of evidence in outcome studies and limited number of high-validity otolaryngology simulators, the role of simulation continues to grow across surgical specialties Hence, it is imperative that the simulators are of high validity and construct for trainees to practice and rehearse surgical skills to develop confidence.
authors.affiliation: Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
authors.forename: Omar
authors.initials: O
authors.lastname: Musbahi
authors.affiliation: MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom.
authors.forename: Abdullatif
authors.initials: A
authors.lastname: Aydin
authors.affiliation: Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Al Omran
authors.affiliation: Department of ENT and Head and Neck Surgery, Guy's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Christopher James
authors.initials: CJ
authors.lastname: Skilbeck
authors.affiliation: MRC Center for Transplantation, Guy's Hospital, King's College London, London, United Kingdom. Electronic address: kamran.ahmed@kcl.ac.uk.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
mesh_terms: D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D008297:Male; D010036:Otolaryngology / Q000193:education*; D015203:Reproducibility of Results; D000066908:Simulation Training / Q000379:methods*; D006113:United Kingdom
keywords: ENT; Interpersonal and Communication Skills; Patient Care; Practice-Based Learning and Improvement; otolaryngology; simulation; systematic review; training; validation