Development and evaluation of a rigid esophagoscopy simulator for residency training

Abstract

Objectives/hypothesis: Rigid esophagoscopy is performed less frequently by resident trainees. Nonetheless, it remains important for certain indications, including foreign body extraction. This study describes the construction of a simulator and evaluates its utility in training residents.

Study design: Simulator development, fabrication, and procedural evaluation of postgraduate trainees.

Methods: A simulator was developed and constructed in collaboration with a biomedical engineering team. Residents with varied experience in upper aerodigestive procedures performed rigid esophagoscopy on the model. Key steps and Accreditation Council for Graduate Medical Education's Objective Structured Assessment of Technical Skills (OSATS) criteria for rigid esophagoscopy were evaluated by a faculty surgeon. Pressure measurements were obtained from force sensors at the tip of the endoscope and incisors.

Results: Fourteen trainees were evaluated. Operative rigid esophagoscopy and direct laryngoscopy case numbers were noted for each subject. OSATS scores and key steps of the procedure correlated with resident experience (R(2) = 0.75, P < .0001 and R(2) = 0.66, P < .001, respectively). Maximal pressure exerted on the simulator esophagus by the esophagoscope was inversely correlated with case number and was statistically significant (R(2) = 0.51, P = .02), whereas length of procedure did not correlate (R(2) = 0.04, P = .49). Maximal pressure on the incisors did not correlate (R(2) = 0.25, P = .15).

Conclusions: A simulator for training residents to perform rigid esophagoscopy was developed and utilized by a faculty proctor to objectively evaluate trainees. OSATS scores, performance of key procedural steps, and pressure exerted on the simulator tissue correlated with upper aerodigestive cases performed, demonstrating validity of the simulator.

Level of evidence: NA Laryngoscope, 126:616-619, 2016.

Keywords: Esophagoscopy; head and neck surgery; laryngology; simulation; simulator; training.