title: Pilot testing of a novel surgical simulator for endoscopic zenker's diverticulotomy.
abstract: Restrictions on resident work hours and the increasing purview of otolaryngology reduce the efficacy of the traditional surgical training model. With limited case volumes at many institutions and the unique instrumentation of endoscopic Zenker's diverticulotomy (EZD), simulation may be useful to improve training. In this study, a novel surgical simulator for EZD is developed and validated.
  
  
  
  Simulation model development.
  
  
  
  An EZD model was designed using an intubation trainer and disposable diverticulum inserts. A novel objective structured assessment of technical skill (OSATS) for EZD was developed. Performance of otolaryngology residents on simulations using the OSATS and time to completion were evaluated during an instructional course. Pre- and postencounter surveys were completed. Inter-rater and intrarater reliability were evaluated via blinded video review of resident performance.
  
  
  
  Seventeen residents participated (n = 17). Surveys showed confidence improved two points on a five-point scale (P < .001), and 94% agreed that the model would improve resident performance with in vivo EZD. More experienced trainees (postgraduate year [PGY] 3-5, n = 11 vs. PGY 1-2, n = 6) had shorter times to completion (P < .001) and higher assessment scores on initial attempts (P = .006). Both groups showed significant improvements from initial to final attempts on 30-point scales for global rating by 6.2 ± 4.2 (mean ± standard deviation, P < .001). The novel OSATS demonstrated fair live/video reliability (к = 0.40) and inter-rater reliability (к = 0.44), and moderate intrarater reliability (к = 0.60).
  
  
  
  Pilot testing of an EZD simulator demonstrated acceptability, content validity, and construct validity. A novel OSATS was developed and evaluated. Further investigation of the impact on operative performance and validation of the OSATS in vivo is needed.
  
  
  
  NA Laryngoscope, 127:592-596, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wiebracht
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
authors.forename: John P
authors.initials: JP
authors.lastname: Giliberto
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.|Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Charles
authors.initials: C
authors.lastname: Myer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.
authors.forename: Keith
authors.initials: K
authors.lastname: Casper
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's and the Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.
authors.forename: Kaalan E
authors.initials: KE
authors.lastname: Johnson
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D004724:Endoscopy / Q000193:education* / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008953:Models, Anatomic; D015588:Observer Variation; D010036:Otolaryngology / Q000193:education; D010865:Pilot Projects; D015203:Reproducibility of Results; D000066908:Simulation Training / Q000379:methods*; D018709:Statistics, Nonparametric; D016672:Zenker Diverticulum / Q000601:surgery*
keywords: Simulation; Zenker's diverticulum; education; evaluation; low cost; resident; task trainer