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Padia R, Miller C, Patak L, Friedman SD, Stone K, Otjen J, Johnson K. Simulation‐Guided Tracheotomy in a Patient With Fibrodysplasia Ossificans Progressiva. Laryngoscope 2018; 129:812-817. [DOI: 10.1002/lary.27520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Reema Padia
- Division of Otolaryngology–Head and Neck SurgerySeattle Children's Hospital Seattle Washington U.S.A
| | - Craig Miller
- Division of Otolaryngology–Head and Neck SurgerySeattle Children's Hospital Seattle Washington U.S.A
| | - Lance Patak
- Department of AnesthesiologySeattle Children's Hospital Seattle Washington U.S.A
| | - Seth D. Friedman
- Department of RadiologySeattle Children's Hospital Seattle Washington U.S.A
| | - Kimberly Stone
- Division of Pediatrics, Division of Emergency MedicineUniversity of Washington School of Medicine and Seattle Children's Hospital Seattle Washington U.S.A
| | - Jeffrey Otjen
- Department of RadiologySeattle Children's Hospital Seattle Washington U.S.A
| | - Kaalan Johnson
- Division of Otolaryngology–Head and Neck SurgerySeattle Children's Hospital Seattle Washington U.S.A
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Sandhaus H, Chen PG. Intraoperative Functional Endoscopic Sinus Surgery Training: Efficient Teaching Techniques-A New Method. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2018. [PMID: 29531479 PMCID: PMC5843097 DOI: 10.1177/1179550618758647] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Functional endoscopic sinus surgery is a complex procedure used by otorhinolaryngologists to treat a host of nasal sinus pathologies. Due to the involved nasal anatomy and the nature of the procedure, teaching residents to use an endoscope is challenging. Simulation labs have been helpful but intraoperative instruction can still present difficulty in communication between resident and attending physicians during the teaching process. The purpose of this is to hypothesize a method of teaching intraoperatively that can be used supplemental to or independently of virtual reality teaching. Method: Literature review to determine current intraoperative verbal teaching methods used by surgeons was performed. Review was also performed on the effects of simulation techniques in preparing residents for the operating room. Although this was not a systematic review including statistical analysis, a gap was found in the literature on how residents can be efficiently taught intraoperatively to navigate an endoscope while maintaining patient safety. A novel and inexpensive method has been devised as a possible teaching method. Conclusions: Extensive literature is not available in intraoperative teaching techniques. It is therefore uncertain whether such a method has been used before. Further study, possibly in the form of surveys and intraoperative trials, must be done to determine the effectiveness of this mechanism.
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Affiliation(s)
- Henya Sandhaus
- Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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3
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Stepan K, Zeiger J, Hanchuk S, Del Signore A, Shrivastava R, Govindaraj S, Iloreta A. Immersive virtual reality as a teaching tool for neuroanatomy. Int Forum Allergy Rhinol 2017; 7:1006-1013. [PMID: 28719062 DOI: 10.1002/alr.21986] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/21/2017] [Accepted: 06/13/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Three-dimensional (3D) computer modeling and interactive virtual reality (VR) simulation are validated teaching techniques used throughout medical disciplines. Little objective data exists supporting its use in teaching clinical anatomy. Learner motivation is thought to limit the rate of utilization of such novel technologies. The purpose of this study is to evaluate the effectiveness, satisfaction, and motivation associated with immersive VR simulation in teaching medical students neuroanatomy. METHODS Images of normal cerebral anatomy were reconstructed from human Digital Imaging and Communications in Medicine (DICOM) computed tomography (CT) imaging and magnetic resonance imaging (MRI) into 3D VR formats compatible with the Oculus Rift VR System, a head-mounted display with tracking capabilities allowing for an immersive VR experience. The ventricular system and cerebral vasculature were highlighted and labeled to create a focused interactive model. We conducted a randomized controlled study with 66 medical students (33 in both the control and experimental groups). Pertinent neuroanatomical structures were studied using either online textbooks or the VR interactive model, respectively. We then evaluated the students' anatomy knowledge, educational experience, and motivation (using the Instructional Materials Motivation Survey [IMMS], a previously validated assessment). RESULTS There was no significant difference in anatomy knowledge between the 2 groups on preintervention, postintervention, or retention quizzes. The VR group found the learning experience to be significantly more engaging, enjoyable, and useful (all p < 0.01) and scored significantly higher on the motivation assessment (p < 0.01). CONCLUSION Immersive VR educational tools awarded a more positive learner experience and enhanced student motivation. However, the technology was equally as effective as the traditional text books in teaching neuroanatomy.
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Affiliation(s)
- Katelyn Stepan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Zeiger
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie Hanchuk
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alfred Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
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Dharmawardana N, Ruthenbeck G, Woods C, Elmiyeh B, Diment L, Ooi EH, Reynolds K, Carney AS. Validation of virtual-reality-based simulations for endoscopic sinus surgery. Clin Otolaryngol 2016; 40:569-79. [PMID: 25809675 DOI: 10.1111/coa.12414] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Virtual reality (VR) simulators provide an alternative to real patients for practicing surgical skills but require validation to ensure accuracy. Here, we validate the use of a virtual reality sinus surgery simulator with haptic feedback for training in Otorhinolaryngology - Head & Neck Surgery (OHNS). METHODS Participants were recruited from final-year medical students, interns, resident medical officers (RMOs), OHNS registrars and consultants. All participants completed an online questionnaire after performing four separate simulation tasks. These were then used to assess face, content and construct validity. anova with post hoc correlation was used for statistical analysis. RESULTS The following groups were compared: (i) medical students/interns, (ii) RMOs, (iii) registrars and (iv) consultants. Face validity results had a statistically significant (P < 0.05) difference between the consultant group and others, while there was no significant difference between medical student/intern and RMOs. Variability within groups was not significant. Content validity results based on consultant scoring and comments indicated that the simulations need further development in several areas to be effective for registrar-level teaching. However, students, interns and RMOs indicated that the simulations provide a useful tool for learning OHNS-related anatomy and as an introduction to ENT-specific procedures. CONCLUSIONS The VR simulations have been validated for teaching sinus anatomy and nasendoscopy to medical students, interns and RMOs. However, they require further development before they can be regarded as a valid tool for more advanced surgical training.
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Affiliation(s)
| | - G Ruthenbeck
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - C Woods
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - B Elmiyeh
- Flinders Medical Centre, Adelaide, Australia
| | - L Diment
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - E H Ooi
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - K Reynolds
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - A S Carney
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
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Chen PG, Chang DR, Weitzel EK, Peel J, Chandra RK, McMains KC. The role of simulation in teaching sinus surgery in otolaryngology residency: A survey of rhinologists. ALLERGY & RHINOLOGY 2016; 7:244-248. [PMID: 28683252 PMCID: PMC5244285 DOI: 10.2500/ar.2016.7.0180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Simulation is currently recognized as an effective surgical training tool. However, no standardized curriculum exists for endoscopic sinus surgery (ESS) simulation training. The goal of this study was to obtain an understanding of current ESS simulation use to aid the future development of an ESS training curriculum. METHODS A 14-question survey regarding sinus simulation in residency training was developed through the education committee of the American Rhinologic Society. The survey was administered to academic American Rhinologic Society members in the United States, Canada, and Puerto Rico. The participants provided information regarding the type, amount, and effectiveness of simulation use in their residency program. RESULTS Responses were received from 67 training programs; 45% of the programs endorsed using simulation training, although only 23.9% used ESS simulation, and all the programs used cadavers. Only 12.5% of respondent programs required ESS simulation training before operating on live patients, and trainees had an average of <6 hours of simulation training before live operations. A majority of respondents observed subjective improvement in residents' endoscope handling, dexterity, and understanding of anatomy after ESS simulation. The greatest obstacles identified were associated cost and lack of realistic simulators. CONCLUSION A majority of responders observed improved surgical technique and knowledge in residents after simulation training. However, <25% of the survey responders used ESS simulation and cited cost and limited availability as the most common barriers. A curriculum of validated simulators has potential to improve the quality of ESS training during residency.
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Affiliation(s)
- Philip G Chen
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
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Ishman SL, Stewart CM, Senser E, Stewart RW, Stanley J, Stierer KD, Benke JR, Kern DE. Qualitative synthesis and systematic review of otolaryngology in undergraduate medical education. Laryngoscope 2015; 125:2695-708. [PMID: 25945425 DOI: 10.1002/lary.25350] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Although 25% of primary care complaints are otolaryngology related, otolaryngology instruction is not required in most medical schools. Our aim was to systematically review existing literature on the inclusion of otolaryngology in undergraduate medical education. DATA SOURCES PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center. STUDY DESIGN/REVIEW METHODS Our search encompassed all indexed years through December 29, 2014. Inclusion criteria were English language, original human data, and a focus on medical student education. Data regarding study design, teacher, educational topic, educational methods, and setting were extracted from each article. Two investigators independently reviewed all articles. RESULTS Our initial search yielded 436 articles; 87 underwent full-text evaluation and 47 remained in the final review. The majority of studies were conducted in the United States (40%), United Kingdom (23%), and Canada (17%) and represented a single institutional experience. Studies were classified as needs assessments (36%), curriculum descriptions (15%), educational methods (36%), and skills assessments (32%); 81% were levels of evidence 3 or 4. Most reports indicated that otolaryngology rotations are not compulsory. CONCLUSIONS Studies indicated the need for increased exposure to otolaryngology. Educational methods such as team-based learning, simulation, online learning, and clinical skills assessments may offer ways to increase exposure without overburdening clinical faculty and require further study. Data suggest that a universal otolaryngology medical student curriculum would be valuable and aid in resource sharing across institutions. We recommend that an assessment be performed to determine topics and skills that should comprise this curriculum. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Stacey L Ishman
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Otolaryngology-Head and Neck Surgery, Cincinnati, Ohio
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ethan Senser
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rosalyn W Stewart
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - James Stanley
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Kevin D Stierer
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - James R Benke
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - David E Kern
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Javia L, Deutsch ES. A Systematic Review of Simulators in Otolaryngology. Otolaryngol Head Neck Surg 2012; 147:999-1011. [DOI: 10.1177/0194599812462007] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To conduct a systematic review of published articles that describe simulators that could be used in otolaryngology for education, skill acquisition, and/or skill improvement. Data Sources Ovid and Embase databases searched July 14, 2011. Review Methods Three hundred fifty-three abstracts were independently reviewed by both authors, then 154 eligible articles were reviewed by both authors, and 95 articles were categorized by organ system (eg, otologic); type of simulator (eg, physical, virtual); whether the simulator was a prototype, could be purchased, or was constructed; validation; and level of learning assessment. Discrepancies were resolved by re-review and discussion. Results In addition to 11 overview articles, 28 articles described 16 otology simulators, most of which are virtual and prototypes. Ninteen articles described 10 sinus/rhinology simulators; most are virtual surgery simulators and prototypes. Eight articles described 8 oral cavity simulators, and 8 articles described neck simulators. Seventeen articles described 13 bronchoscopy simulators; several are full-body high-technology manikins adapted from other purposes. Five articles described eclectic simulators, including some for learning nontechnical and teamwork skills. Half of the simulators have been validated. Learning levels were often not assessed or assessment was limited to the learners’ perceptions. Conclusion A wide variety of simulators are available or under development. Lack of unified validation concepts and limited descriptions restricted our ability to assess model characteristics, availability, and validation. Simulators are emerging as powerful tools to facilitate learning; this review may provide a platform for discussion and refinement of the information reported and analyzed in evaluating simulators.
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Affiliation(s)
- Luv Javia
- Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Department of Otorhinolaryngology/Head and Neck Surgery, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ellen S. Deutsch
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Technology-assisted education in graduate medical education: a review of the literature. Int J Emerg Med 2011; 4:51. [PMID: 21824405 PMCID: PMC3162483 DOI: 10.1186/1865-1380-4-51] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 08/08/2011] [Indexed: 11/23/2022] Open
Abstract
Studies on computer-aided instruction and web-based learning have left many questions unanswered about the most effective use of technology-assisted education in graduate medical education.
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10
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Leung RM, Leung J, Vescan A, Dubrowski A, Witterick I. Construct validation of a low-fidelity endoscopic sinus surgery simulator. ACTA ACUST UNITED AC 2009; 22:642-8. [PMID: 19178806 DOI: 10.2500/ajr.2008.22.3245] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Before a simulator becomes widely accepted, it must be relevant, affordable, and accessible. We have developed a low-cost model emphasizing the basic skills required for endoscopic sinus surgery (ESS). It is noninvasive, free from risk of infection, and an excellent low-pressure learning opportunity. The current study was designed to assess the construct validity of our simulator. METHODS We conducted a stratified randomized crossover-control study. Otolaryngology residents, fellows, and faculty performed predetermined tasks on the model or cadaver, and then switched. Evaluation included hand motion analysis, task time, and blinded expert review. RESULTS Sixteen subjects at various levels of training participated. Cadaver performance correlated well with level of training and previous experience with ESS. However, model performance did not demonstrate statistically significant correlation. CONCLUSION Our model was unable to demonstrate clear construct validity at this time. Materials and structural modifications are in progress. Pending further validation, its low-cost construction possesses potential for integration into otolaryngology residency curricula. Assessment of the simulator's ability to improve surgical skill is also planned.
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Affiliation(s)
- Randy M Leung
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada
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Solyar A, Cuellar H, Sadoughi B, Olson TR, Fried MP. Endoscopic Sinus Surgery Simulator as a teaching tool for anatomy education. Am J Surg 2008; 196:120-4. [PMID: 18374890 DOI: 10.1016/j.amjsurg.2007.06.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Revised: 06/22/2007] [Accepted: 06/22/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Virtual reality simulators provide an effective learning environment and are widely used. This study evaluated the Endoscopic Sinus Surgery Simulator (ES3; Lockheed Martin) as a tool for anatomic education. METHODS Two medical student groups (experimental, n = 8; control, n = 7) studied paranasal sinus anatomy using either the simulator or textbooks. Their knowledge was then tested on the identification of anatomic structures on a view of the nasal cavities. RESULTS The mean scores were 9.4 +/- 0.5 and 5.1 +/- 3.0 out of 10 for the simulator and textbook groups, respectively (P = .009). Moreover, the simulator group completed the test in a significantly shorter time, 5.9 +/- 1.1 versus 8.3 +/- 2.0 minutes (P = .021). A survey asking the students to rate their respective study modality did not materialize significant differences. CONCLUSION The ES3 can be an effective tool in teaching sinonasal anatomy. This study may help shape the future of anatomic education and the development of modern educational tools.
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Affiliation(s)
- Alla Solyar
- Department of Otolaryngology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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12
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Bibliography. Current world literature. Nose and paranasal sinuses. Curr Opin Otolaryngol Head Neck Surg 2007; 15:48-55. [PMID: 17211184 DOI: 10.1097/moo.0b013e32802e6d9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fried MP, Uribe JI, Sadoughi B. The role of virtual reality in surgical training in otorhinolaryngology. Curr Opin Otolaryngol Head Neck Surg 2007; 15:163-9. [PMID: 17483684 DOI: 10.1097/moo.0b013e32814b0802] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This article reviews the rationale, current status and future directions for the development and implementation of virtual reality surgical simulators as training tools. RECENT FINDINGS The complexity of modern surgical techniques, which utilize advanced technology, presents a dilemma for surgical training. Hands-on patient experience - the traditional apprenticeship method for teaching operations - may not apply because of the learning curve for skill acquisition and patient safety expectation. The paranasal sinuses and temporal bone have intricate anatomy with a significant amount of vital structures either within the surgical field or in close proximity. The current standard of surgical care in these areas involves the use of endoscopes, cameras and microscopes, requiring additional hand-eye coordination, an accurate command of fine motor skills, and a thorough knowledge of the anatomy under magnified vision. A surgeon's disorientation or loss of perspective can lead to complications, often catastrophic and occasionally lethal. These considerations define the ideal environment for surgical simulation; not surprisingly, significant research and validation of simulators in these areas have occurred. SUMMARY Virtual reality simulators are demonstrating validity as training and skills assessment tools. Future prototypes will find application for routine use in teaching, surgical planning and the development of new instruments and computer-assisted devices.
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Affiliation(s)
- Marvin P Fried
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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