Cochlear implant surgery: Learning curve in virtual reality simulation training and transfer of skills to a 3D-printed temporal bone – A prospective trial. (2nd November 2021)

• Record Type: Journal Article
• Authors: Frendø, Martin; Frithioff, Andreas; Konge, Lars; Sørensen, Mads Sølvsten; Andersen, Steven A. W.
• Is Part Of: Cochlear implants international. Volume 22:Number 6(2021)
• Page Start: 330
• Page End: 337
• Publication Date: 2021-11-02
• Subjects: Cochlear implant -- Simulation training -- Temporal bone -- Mastoidectomy -- Virtual reality -- 3D print -- Surgical skills -- Posterior tympanotomy; Cochlear implants -- Periodicals; 617.882
• DOI: 10.1080/14670100.2021.1940629
• Languages: English
• ISSNs: 1467-0100

Abstract

Abstract : Objective: Mastering Cochlear Implant (CI) surgery requires repeated practice, preferably initiated in a safe – i.e. simulated – environment. Mastoidectomy Virtual Reality (VR) simulation-based training (SBT) is effective, but SBT of CI surgery largely uninvestigated. The learning curve is imperative for understanding surgical skills acquisition and developing competency-based training. Here, we explore learning curves in VR SBT of CI surgery and transfer of skills to a 3D-printed model. Methods: Prospective, single-arm trial. Twenty-four novice medical students completed a pre-training CI inserting test on a commercially available pre-drilled 3D-printed temporal bone. A training program of 18 VR simulation CI procedures was completed in the Visual Ear Simulator over four sessions. Finally, a post-training test similar to the pre-training test was completed. Two blinded experts rated performances using the validated Cochlear Implant Surgery Assessment Tool (CISAT). Performance scores were analyzed using linear mixed models. Results: Learning curves were highly individual with primary performance improvement initially, and small but steady improvements throughout the 18 procedures. CI VR simulation performance improved 33% ( p < 0.001). Insertion performance on a 3D-printed temporal bone improved 21% ( p < 0.001), demonstrating skills transfer. Discussion: VR SBT of CI surgery improves novices' performance. It is useful for introducing the procedure and acquiring basic skills. CI surgery training should pivot on objective performance assessment for reaching pre-defined competency before cadaver – or real-life surgery. Simulation-based training provides a structured and safe learning environment for initial training. Conclusion: CI surgery skills improve from VR SBT, which can be used to learn the fundamentals of CI surgery.