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Cochlear implant surgery: Virtual reality simulation training and transfer of skills to cadaver dissection—a randomized, controlled trial

Cochlear implantsOtologySurgical trainingTechnical skillsTemporal bone surgeryVR simulation
Frendø M, Frithioff A, Konge L, Cayé-Thomasen P, Sørensen MS, Andersen SA
J Int Adv Otol. 2021 Aug 31 [Accepted]
Publication year: 2021

Cochlear Implant Surgery: Learning Curve in Virtual Reality Simulation Training and Transfer of Skills to a 3D-printed Temporal Bone—a prospective Trial.

3D-printingAssessmentCochlear implantsDirected self-regulated learningOtologyTechnical skillsTemporal bone surgeryVR simulation
Frendø M, Frithioff A, Konge L, Sørensen MS, Andersen SA
Cochlear Implants Int . 2021 Nov;22(6):330-337.
Publication year: 2021

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.