Teaching frontal sinus anatomy using the frontal sinus masterclass 3- D conceptualization model

Students with access to 3D study materials are better able to translate spatial relationships between abdominal organs and correctly interpret abnormal radiographic images

Previous studies have demonstrated evidence that three-dimensional (3D) visualization techniques can be helpful as learning tools. This prospective randomized control study was designed to test the hypothesis that 3D learning tools would have improved translation into interpreting normal and abnormal canine abdominal radiographic images over traditional learning tools. Sagittal and dorsal plane 3D image scenes were created from CT scans, with canine abdominal organs labeled using virtual reality and 3D visualization software tools. Eighty students from the first- and second-year veterinary classes at a single institution participated in the study. The control group studied canine abdominal anatomy from a textbook and the experimental group studied canine abdominal anatomy using the 3D learning tools for a set time. Each participant then took a three-part written examination to assess their learning for the following categories: 3D anatomy organ identification, radiographic anatomy organ identification of normal structures and radiographic anatomy organ identification of abnormal structures. All participants were also asked to identify the sex of the test patient from the 3D study. Participants from the experimental group performed statistically better than participants in the control group for all parts of the examination, with the exception of normal radiographic anatomy.

The Otolaryngology boot camp: a scoping review evaluating commonalities and appraisal for curriculum design and delivery

OBJECTIVE

Surgical boot camps are becoming increasingly popular in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Despite pioneering virtual reality and simulation-based surgical education, these boot camps have lacked critical appraisal. The objective of this article was to examine the adoption and utility of surgical boot camps in OHNS residency training programs around the world.

DATA SOURCES

Ovid Medline and PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. Additionally, a grey literature search was performed.

REVIEW METHODS

Inclusion criteria were peer-reviewed publications and grey literature sources that reported on OHNS boot camps for the novice learner. The search was restricted to human studies published in English. Studies were excluded if they were not examining junior trainees.

RESULTS

A total of 551 articles were identified. Following removal of duplicates, screening, and full text review, 16 articles were included for analysis. Seven major boot camps were identified across various academic sites in the world. Most boot camps were one-day intensive camps incorporating a mixture of didactic, skill specific, and simulation sessions using an array of task trainers and high-fidelity simulators focusing on OHNS emergencies. Studies measuring trainee outcomes demonstrated improvement in trainee confidence, immediate knowledge, and skill acquisition.

CONCLUSION

Surgical boot camps appear to be an effective tool for short term knowledge and skill acquisition. Further studies should examine retention of skill and maintenance of confidence over longer intervals, as little is known about these lasting effects.

Development of a self-directed sinonasal surgical anatomy video curriculum: Phase 1 validation

BACKGROUND

Sinusitis is a common outpatient diagnosis made by physicians and is a reason for referral to otolaryngologists. A foundation in basic sinonasal anatomy is critical in understanding sinus pathophysiology and avoiding complications. Our objective in this study was to develop and to validate a self-directed surgical anatomy video for medical students.

METHODS

Two multimedia videos were developed highlighting sinonasal anatomy. In Video 1 we included audio narration and radiologic imaging. Video 2 incorporated highlighted images from a sinus surgery video. An assessment was developed to test sinonasal anatomy landmarks, spatial recognition of structures, and their clinical relevance. An expert panel of rhinologists scored face and content validity of the curriculum videos and assessment. Factor analysis was used to separate questions into face and content validity domains, and a one-sample t test was performed.

RESULTS

The panel scored face validity (Videos 1 and 2: 4.4/5) and content validity (Video 1: 4.5/5, 0.83; Video 2: 4.3/5, 0.75) significantly higher than a neutral response. There were no statistical differences for face or content validity between videos. The assessment was rated suitable (29%) or very suitable (57%) for testing basic sinonasal surgical anatomy, and the majority (71%) of respondents agreed (14%) or strongly agreed (57%) that the assessment thoroughly covered the sinus anatomy content with which medical students should be familiar.

CONCLUSION

We have developed two videos and an assessment that highlight and test sinonasal anatomy. Future studies will aim to identify whether the use of a self-directed video curriculum improves sinonasal anatomy awareness and whether incorporation of surgical endoscopic videos augments training.

Use of 3D-Printed and 2D-Illustrated International Frontal Sinus Anatomy Classification Anatomic Models for Resident Education

OBJECTIVE

To examine the impact of 2-dimensional (2D) illustrations and 3-dimensonal (3D)-printed anatomic models of the frontal sinuses according to the International Frontal Sinus Anatomy Classification in the education of otolaryngology and radiology residents.

STUDY DESIGN

A crossover study design with half of the study participants randomized to the 2D illustration intervention first and the other half randomized to the 3D-printed model first.

SETTING

Regularly scheduled resident didactic lectures at a tertiary care center.

SUBJECTS AND METHODS

Forty-one otolaryngology and radiology residents were assessed with pre- and postintervention questionnaires that included subjective and objective methods of assessment.

RESULTS

Overall, there was a statistically significant improvement in total number of answers correct and in confidence score between the pre- and postintervention assessments (P < .0001). The primary outcome of order of intervention (ie, 2D → 3D vs 3D → 2D) did not result in statistically significant differences in postevaluation scores. In regard to the secondary outcome of learner preference for educational modality, radiology residents favored the 2D illustrations to understand anatomic relationships, while otolaryngology residents preferred the 3D model to be more helpful in surgical planning (P = .0075).

CONCLUSION

There is no difference between 2D-illustrated and 3D-printed International Frontal Sinus Anatomy Classification anatomic models in overall educational outcome, despite the preference of learners. Together, these models can be used as helpful tools in frontal sinus education for otolaryngology and radiology trainees.

Construction of three-dimensional printed anatomic models for frontal sinus education

BACKGROUND

The anatomy of the frontal sinus can pose a challenge for many neuroradiolgists and otolaryngologists, especially trainees. While much of resident education occurs in didactics, self-study or in the operating room, studies suggest that some trainees prefer hands-on learning. Three-dimensional (3D) printing technology provides users the opportunity to make customizable low-cost objects that provide tactile learning-a learning modality that may be preferable in education.

METHODS

Three-dimensional printed models of frontal sinus anatomy based on selected patient computed tomography scans that represent various air cells according to the International Frontal Sinus Classification (IFAC) as different colored solid structures were printed using binder jetting.

RESULTS

Seven unique de-identified patient scans were selected as the basis for the models so that all frontal cell types described in the IFAC scheme are represented between all 3D printed models.

CONCLUSION

This paper describes the technology and process necessary to create these models.

International assessment of inter- and intrarater reliability of the International Frontal Sinus Anatomy Classification system

BACKGROUND

Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS).

METHODS

Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement.

RESULTS

Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98.

CONCLUSION

Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC.

Construct validity of a low-cost medium-fidelity endoscopic sinus surgery simulation model

OBJECTIVE

Assess construct validity of a low-cost medium-fidelity silicone injection molded model task trainer for endoscopic sinus surgery (ESS) training.

METHODS

Fellowship-trained rhinologists, otolaryngology attendings, and otolaryngology residents at various levels of training performed sinus endoscopy and seven procedures on the model. Construct validity was evaluated by comparing novice to various levels of experienced performance using a validated checklist.

RESULTS

Thirty-two subjects participated in this study. Otolaryngology attendings and postgraduate year (PGY) 3 to 5 otolaryngology residents significantly outperformed PGY 1 to 2 otolaryngology residents on most tasks in the task-specific checklist.

CONCLUSIONS

This study demonstrated the construct validity of the low-cost medium-fidelity ESS model.

LEVEL OF EVIDENCE

NA Laryngoscope, 129:1505-1509, 2019.

Teaching Residents Frontal Sinus Anatomy Using a Novel 3-Dimensional Conceptualization Planning Software-Based Module

BACKGROUND

The Frontal Sinus Masterclass (FSMC) is an effective method for teaching frontal sinus anatomy. A third party developed new software using the same 3-dimensional building block concept. The authors sought to determine whether the use of the software for the educational module yielded similar results to the original FSMC, which used wooden blocks.

METHODS

The study was performed at a sinus course for residents. A precourse test assessed the ability to decipher frontal sinus anatomy prior to the course. Computed tomography (CT) scans of the sinuses were evaluated in triplanar view, and participants attempted to reconstruct the anatomy using the new software. Subsequently, the course instructor explained the anatomy and showed a short corresponding surgical video of the frontal sinusotomy. Cases progressed in anatomical difficulty and inflammatory load. A postcourse test determined knowledge after the course.

RESULTS

In sum, 50 residents completed the pre- and postcourse tests. Overall scores increased from 60.5% to 65.2% ( P = .004). Subanalysis also demonstrated improved ability to locate the frontal drainage pathway from 32.5% to 46% ( P = .011) and label the frontal recess cell structures from 64% to 67.6% ( P = .045).

CONCLUSION

There is minimal literature on proven methods for teaching frontal sinus anatomy. Objectively, participants of the modified FSMC simulation training using new software improved their ability to recognize cells of the frontal recess on CT scans. They especially exhibited better localization of the frontal sinus drainage pathway. Subjectively, participants reported benefit from the course and felt they would be better surgeons.