title: Comparison of Experts and Residents Performing a Complex Procedure in a Temporal Bone Surgery Simulator.
abstract: To investigate the use of automated metrics from a virtual reality (VR) temporal bone surgery simulator to determine how the performance of experts and trainees differs when performing a complex otological procedure (mastoidectomy with posterior tympanotomy and cochleostomy).
  
  
  
  Cohort study.
  
  
  
  Using the University of Melbourne VR temporal bone surgery simulator, seven ENT consultants and seven ENT residents performed two trials of the surgical approach to cochlear implantation on a virtual temporal bone. Simulator recordings were used to calculate a range of automated metrics for each stage of the procedure, capturing efficiency, technique characteristics, drilled bone regions, and damage to vital anatomical structures.
  
  
  
  Results confirm that experts drilled more efficiently than residents. Experts generally used larger burrs and applied higher forces, resulting in faster material removal. However, they exercised more caution when drilling close to anatomical structures. Residents opened the temporal bone more widely, but neglected important steps in obtaining a clear view toward the round window, such as thinning the external ear canal wall and skeletonizing the medial aspect of the facial nerve. Residents used higher magnification and reoriented the temporal bone more often than experts.
  
  
  
  VR simulation provides metrics that allow the objective analysis of surgical technique, and identification of differences between the performance of surgical residents and their senior colleagues. The performance of residents could be improved with more guidance regarding how much force they should apply, what burr size they should use, how they should orient the bone, and for cochlear implant surgery guidance regarding anatomical regions requiring particular attention, to visualize the round window.
authors.affiliation: *Department of Surgery (Otolaryngology), University of Melbourne, East Melbourne, Victoria, Australia †Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand ‡Centre for the Study of Higher Education, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Ioannou
authors.forename: Yun
authors.initials: Y
authors.lastname: Zhou
authors.forename: Sudanthi
authors.initials: S
authors.lastname: Wijewickrema
authors.forename: Patorn
authors.initials: P
authors.lastname: Piromchai
authors.forename: Bridget
authors.initials: B
authors.lastname: Copson
authors.forename: Gregor
authors.initials: G
authors.lastname: Kennedy
authors.forename: Stephen
authors.initials: S
authors.lastname: O'Leary
mesh_terms: D002983:Clinical Competence; D003051:Cochlea / Q000601:surgery*; D019929:Cochlear Implantation / Q000592:standards*; D015331:Cohort Studies; D003253:Consultants; D004424:Ear Canal; D005154:Facial Nerve; D006801:Humans; D007396:Internship and Residency; D000074406:Mastoidectomy / Q000592:standards*; D061646:Operative Time; D010036:Otolaryngology / Q000193:education*; D013506:Otologic Surgical Procedures / Q000592:standards; D012405:Round Window, Ear; D013701:Temporal Bone / Q000601:surgery*; D014432:Tympanic Membrane / Q000601:surgery*; D000076142:Virtual Reality