Author(s)
Kevin Wong, MD
Scott Gorthey, MD
Annie E. Arrighi-Allisan, BA
Caleb J. Fan, MDZachary G. Schwam, MD
George B. Wanna, MD
Maura K. Cosetti, MD
Affiliation(s)
1 Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY2 Department of Otolaryngology, Albert Einstein College of Medicine, New York, NY3 Department of Otolaryngology, University of Arizona College of Medicine, Tucson, AZ;
Abstract:
Objectives: 1) Quantify the learning curve for transcanal endoscopic ear surgery (TEES) and 2) determine if demographic
factors or previous experiences influence skill development.
Study Design: Prospective, multi-center study.
Setting: Two academic teaching hospitals.
Subjects: 38 otolaryngology residents from two residency programs in the United States, 26 from program A and 12 from
program B.
Interventions: Each participant completed a demographics survey and questions regarding previous otoendoscopy, sinus
endoscopy, and video game experience. Residents then completed 10 amassed trials of a “precision stacking” task using a
validated endoscopic ear simulator.
Main Outcome Measures: Trial completion times; rate of improvement over time; inverse regression learning curves.
Results: Mean age was 30 years old (range 26-34 years). Fifteen participants were female and 23 were male. Combined
task completion times were analyzed over 10 trials to create inverse learning curves using non-linear regressions. The
greatest improvements occurred over the first 3 trials and plateau reached before the 10th trial. Prior experience with
otoendoscopy (B=-16.7, p=0.005) and sinus endoscopy (B=-23.4, p=0.001) independently correlated with lower overall
trial times. However, on multivariate logistic regression, residents without prior endoscopic experience improved at a faster
rate than those with experience (p<0.001). Age, gender, postgraduate year, handedness, interest in otology, and video game
experience did not correlate with trial times.
Conclusions: Novice surgeons can acquire endoscopic ear experience with simulation training. Specific task competencies
can be achieved within 10 trials, suggesting that prior experiences, or lack thereof, may not dictate the ability to acquire
new skills. There may be a translational value to previous endoscopic sinus experience on learning TEES.
Define Professional Practice Gap & Educational Need: As the prevalence of endoscopic ear surgery grows, uncertainties
remain in regards to many aspects of its teaching and training. Defining the learning curve is one crucial step with
implications for both patient safety and residency education.
LearningObjective: 1) Understand the learning curve for novice surgeons learning endoscopic ear surgery; 2) recognize
the benefit of previous endoscopic experience –ear and sinus alike – for skills development.
Desired Result: 1) Increased incorporation of simulation into otology training; 2) recognition of learning curves as an
important metric to optimize teaching, improve surgical outcomes, and minimize patient risk.
Level of Evidence: III - Cohort
Indicate IRB or IACUC: Mount Sinai Institutional Review Board (IRB- 20-01637)