Low-cost otolaryngology simulation models for early-stage trainees: a scoping review

Abstract

Background: Medical simulation is essential for surgical training yet is often too expensive and inaccessible in low- and middle-income countries (LMICs). Furthermore, in otolaryngology-head and neck surgery (OHNS), while simulation training is often focused on senior residents and specialists, there is a critical need to target general practitioners who carry a significant load of OHNS care in countries with limited OHNS providers. This scoping review aims to describe affordable, effective OHNS simulation models for early-stage trainees and non-OHNS specialists in resource-limited settings and discuss gaps in the literature.

Methods: This scoping review followed the five stages of Arksey and O'Malley's Scoping Review Methodology. Seven databases were used to search for articles. Included articles discussed physical models of the ear, nose, or throat described as "low-cost," "cost-effective," or defined as <$150 if explicitly stated; related to the management of common and emergent OHNS conditions; and geared towards undergraduate students, medical, dental, or nursing students, and/or early-level residents.

Results: Of the 1706 studies screened, 17 met inclusion criteria. Most studies were conducted in HICs. Most models were low-fidelity (less anatomically realistic) models. The most common simulated skills were peritonsillar abscess aspiration and cricothyrotomy. Information on cost was limited, and locally sourced materials were infrequently mentioned. Simulations were evaluated using questionnaires and direct observation.

Conclusion: Low-cost simulation models can be beneficial for early medical trainees and students in LMICs, addressing resource constraints and improving skill acquisition. However, there is a notable lack of contextually relevant, locally developed, and cost-effective models. This study summarizes existing low-cost OHNS simulation models for early-stage trainees and highlights the need for additional locally sourced models. Further research is needed to assess the effectiveness and sustainability of these models.

Keywords: Low- and middle-income country; Low-cost; Medical student; Otolaryngology; Simulation; Task trainer; Trainee.

Fig. 1

PRISMA Flow diagram of data analysis procedure

Fig. 2

Global distribution of Low-Cost ENT Simulation Model Studies Reflexivity Statement This scoping review emerged from collaborative work within the Global OHNS Initiative involving LMIC and HIC researchers. This piece was written to promote more accessible and equitable avenues to education and training for LMIC researchers. Our authorship group consists of five LMIC authors and five HIC authors. Five of the ten authors are women. All authors contributed substantially to the conception, drafting, and revision of this piece. All authors approved the final version. Everyone has agreed to be accountable for all aspects of the work, aligning with ICJME Authorship Criteria