Methods of teaching stapedectomy

Establish a better method of teaching residents stapes surgery, with the goal of improving surgical outcome.

A stapes surgery teaching module was developed with specific criteria to evaluate resident performance. A prospective study of stapes surgery performed by teaching module trained residents was compared with a retrospective review of stapes surgery performed by non-teaching module trained residents.

Four residents naive to stapes surgery were assigned to a stapes surgery teaching module. Stapedectomy of 20 temporal bones per resident, with six 3-hour laboratory sessions, was performed. Laser (CO2 and argon) as well as mechanical techniques were used. Specific scoring criteria were applied to measure performance. Results of actual stapes surgery of teaching module trained residents were compared with those of a comparable group of non-teaching module trained residents.

Laser techniques in the laboratory resulted in statistically significantly better scores by defined criteria than mechanical techniques. Results of actual stapes surgery performed by teaching module trained residents demonstrated a trend toward better surgical results, although this was not statistically significant.

Graded operative experience and standard temporal bone surgery courses may not adequately prepare residents for stapes surgery. A teaching module with criteria to evaluate performance better prepares residents for this delicate procedure. Lasers provide a significant advantage in the laboratory model and should be used by residents at surgery. Residents not wishing to perform stapes surgery because of career pathway should be encouraged to turn over their cases to fellow residents.