Virtual Reality Simulator for Training in Myringotomy with Tube Placement

Myringotomy refers to a surgical incision in the eardrum, and it is often followed by ventilation tube placement to treat middle-ear infections. The procedure is difficult to learn; hence, the objectives of this work were to develop a virtual-reality training simulator, assess its face and content validity, and implement quantitative performance metrics and assess construct validity. A commercial digital gaming engine (Unity3D) was used to implement the simulator with support for 3D visualization of digital ear models and support for major surgical tasks. A haptic arm co-located with the stereo scene was used to manipulate virtual surgical tools and to provide force feedback. A questionnaire was developed with 14 face validity questions focusing on realism and 6 content validity questions focusing on training potential. Twelve participants from the Department of Otolaryngology were recruited for the study. Responses to 12 of the 14 face validity questions were positive. One concern was with contact modeling related to tube insertion into the eardrum, and the second was with movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64% of the responses were positive, 21% were neutral, and 15% were negative. In the final phase of this work, automated performance metrics were programmed and a construct validity study was conducted with 11 participants: 4 senior Otolaryngology consultants and 7 junior Otolaryngology residents. Each participant performed 10 procedures on the simulator and metrics were automatically collected. Senior Otolaryngologists took significantly less time to completion compared to junior residents. Junior residents had 2.8 times more errors as compared to experienced surgeons. The senior surgeons also had significantly longer incision lengths, more accurate incision angles, and lower magnification keeping both the umbo and annulus in view. All metrics were able to discriminate senior Otolaryngologists from junior residents with a significance of p \u3c 0.002. The simulator has sufficient realism, training potential and performance discrimination ability to warrant a more resource intensive skills transference study

Développement et validation d’un outil d’évaluation de la compétence chirurgicale pour l’évidement cervical

Objectifs : Développer et valider un outil servant à évaluer les compétences chirurgicales des résidents en Oto-rhino-laryngologie et chirurgie cervico-faciale (ORL-CCF) pour l’évidement cervical. Méthodes : Une revue systématique de la littérature a été réalisée afin de recenser les méthodes validées pour évaluer les compétences chirurgicales en ORL-CCF. Les procédures chirurgicales pour lesquelles elles ont été développées ont été répertoriées. La revue a permis d’identifier un déficit en outils d’évaluation spécifiques aux procédures oncologiques en ORL-CCF, incluant l’évidement cervical. Une méthode de Delphi modifiée a été utilisée afin de développer une liste d’étapes essentielles à la complétion d’un évidement cervical. Cette liste a été combinée à la grille générale du Objective Structured Assessment of Technical Skills (OSATS) pour développer un outil spécifique à l’évidement cervical. Cet outil a été validé en salle d’opération auprès de l’équipe d’oncologie ORL-CCF de l’Université de Montréal et de ses résidents. Résultats : Un total de vingt-neuf évaluations ont été complétées au cours de l’année académique 2016-2017. L’acceptabilité a été jugée élevée auprès des résidents et des chirurgiens d’ORL-CCF, avec pour seule disparité l’utilisation formative ou sommative de l’outil. Les études de validation ont démontré des scores significativement plus élevés chez les résidents séniors que chez les juniors, ainsi qu’une progression significative des scores au fil du temps (p<0,05). La tendance des scores sur la grille spécifique corrélait avec les résultats obtenus sur la grille générale précédemment validée (p<0,05). ii Conclusions : Le premier outil évaluant spécifiquement les compétences chirurgicales des résidents en ORL pour l’évidement cervical a été développé et validé.Objectives: To develop and validate a new tool assessing surgical competency for Otolaryngology – Head & Neck Surgery (OTL-HNS) residents learning neck dissection. Methods: A systematic review of literature was done to list methods developed to assess surgical competency in OTL-HNS. The surgical procedures for which these tools were developed were catalogued. A lack of evaluation tools specific to oncologic procedures in OTLHNS was identified, which includes neck dissection. A modified Delphi method was used to develop a list of steps deemed essential to a group of experts in order to complete a neck dissection. This list was combined to the general list of the Objective Structured Assessment of Technical Skills (OSATS) tool to develop a tool specific to neck dissection. This tool was validated in the operating room with the collaboration of the OTL-HNS oncology team of Université de Montréal and of the residents of this program. Results: A total of twenty-nine evaluations were completed throughout the 2016-2017 academic year. Acceptability ranked high for both residents and staff, with a single discrepancy in responses regarding a potential formative as opposed to summative use of the tool. Validation study results demonstrated significantly higher checklist scores for senior residents as opposed to junior residents, as well as a significant score progression over time (p<0,05). Trends in scores on the task-specific tool correlated highly to results obtained on a validated global rating scale (p<0,05). Conclusion: The first tool assessing surgical competency in OTL-HNS residents for neck dissection was successfully developed and validated

WONCA Rural Medical Education Guidebook

We are very excited to launch the WONCA Rural Medical Education Guidebook at the 12th WONCA World Rural Health Conference, Gramado, Brazil. The roots for the Guidebook go back to 1992 when a very important meeting was held on the sidelines of the WONCA Global Family Doctor conference in Vancouver, Canada. At this meeting an interested group of rural practitioners saw the need for WONCA to develop a specific focus on rural doctors. As a result, the WONCA Working Party on Rural Practice (WWPRP) was formed. The group set about producing a visionary roadmap for rural medical education in the form of a seminal document, the WONCA policy on Training for Rural Practice 1995. This was followed four years later by further recommendations made in a companion document, the WONCA policy on Rural Health and Rural Practice 1999, which was revised in 2001