Improved Training and Testing OtoscopySimulation: From Classroom to OSCE

A. Chiodo, MD, FRCSCAssociate Professor and Otolaryngologist-in-Chief,

Toronto East General HospitalDepartment of Otolaryngology-Head and Neck Surgery

University of Toronto

Disclosures• No conflict of interest for Dr. Chiodo

• Supporters:

Objectives• Challenges of Otoscopy Training

• OtoSim™ (Ear) Novel Validated Training & Testing

Solutions

• Training and Testing Modes

Self Training

One-on-One & Small Workshops

Mass Training (Lecture Format)

OSCE’s and other testing

The Challenges of Otoscopy Training

• 95% of recent grads NOT comfortable with their otology skills

• <50% Diagnostic Accuracy for GP’s and Pediatricians

• Gaps in accuracy leads to $5B over-prescription of antibiotics

Limited Field of View

The Challenges of Otoscopy Training

Learning by reading Limited field of view in practice

Doesn’t transfer to the clinic Uncooperative patients

The Previous Gold Standard in Training

Lectures and Reading Books - Results in 50% Accuracy

Otoscopy Training Limitations

1. Time within the curriculum2. PowerPoint presentations,

large 2-D photos in books 3. Practice on each other (normal ears)4. Painful for patients5. Limited breadth of pathology6. There is no way for the teacher to

confirm that students actually see it

The Evolution of the Concept

Otoscope

Model Ear Canal

ScreenComputer

Requirements

• Small, light weight

• Easy to connect and use

• Reliable, simple optics

• Separation of computer from simulator

• Excellent optical quality

• Ergonomic design

• Inexpensive

Otologic SimulationEarform:

o realistic feel, shape, and composition with various ear canal complexities.

Tympanic Membrane: o Unique optics enables OtoSimTM to project a 1cm wide image of the tympanic

membrane—a realistic clinical scenario.

o Combined with the use of an otoscope, the small image and narrow field of view caused by the speculum creates a realistic simulation

Content: o Proprietary database of over 200 high-resolution images of various ear pathologies.

o Detailed educational descriptions

Otologic Simulation• Allow for otoscope positioning

o Holding otoscope

o Bracing otoscope

o Straightening canal

o Pneumatic otoscopy

• Normative Anatomyo Ossicular landmarks

o pars tensa/flacida

o Cone of light

o Ear Canal

• Pathologic Slideso External ear diseases

o Middle ear diseases

Why do this in the Classroom or

Seminar Room?• Classroom Instructor can use

landmarking function on software

• Enables the instructor and students

to interact through the device.

• Real-time and immediate guidance

is provided to students through the

device’s internal display mechanism

and through their otoscope.

• Stimulates student to do this on their

own later

Technology Platform is Growing

Q4 ‘11

Q4 ‘12

Q2 ‘13

Q2 ‘14

Q4 ‘14

OtoSim™ 1.0

PneumatoSim™

OphthoSim™ 1.0

Mass Trainer

V2.0 ’s

Ad

dre

ssa

ble

Ma

rket

Siz

e

Ear

Examination

Additional

Features

Pneumatic

Otoscopy

Eye

Examination

Full Class

Training

Used in Training and Testing

1. Student Self Teaching

2. Student Review with OtoSim™ Companion – before or after a training

session

3. One-On-One and Small Group – 4 to12 OtoSim’s depending on platform

and OS

4. Mass Training – Teach an entire lecture theater at a time (66 at U of

Toronto)

5. Remote Training - Lecturer and students in different locations (in Beta)

6. Use in OSCE’s and other testing

7. Student Log-in, testing and tracking – in the next software release

Used in Training and Testing

Use in OSCE’s and other testing

• Set up a Single unit and Laptop in a Standardized Patient exam room

• Student debrief’s the standardized patient for history and symptoms

(or have a case study to read)

• Refer the student to the OtoSim™ to view the Pathology

• Write down or give diagnosis verbally

Validation Studies• Otoscopy - Looking at residents in various specialties

and retention to 6 months

• Large Class-room Session or Mass Training

• Seminar Based Otoscopy Training

• Teaching Normative Anatomy to 1st Year Med. Students

• Validating Use in OSCE examinations

Laryngoscope 121 (suppl.):S246, 2011

•65 Medical students participated in the study. •Control (n = 24) vs. simulation group (n = 41)

• Methodology:o Randomized, prospective

trialo Students randomized to

• Standard curriculum• Standard curriculum +

OtoSim sessiono The students were

presented a panel of 15 pathological states via the otoscope**.

o The percentage of correct answers and the time to complete the task were recorded

Pre-StudyAssessment

Week 1 Week 2

Recruitment Simulation**

Evaluation

Teaching Otoscopy and Normative

Anatomy to 1st Year Medical Students

Otosim Mass Training

THANK YOU