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Updated: Jun 12, 2026
Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Defining milestones toward competency in mastoidectomy using a skills assessment paradigm
Howard W Francis1, Hamid Masood, Kulsoom Laeeq
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland 21287, USA.
Objectives/Hypothesis:
To establish milestones toward achievement of surgical competency by using an objective assessment tool designed to measure the development of mastoidectomy skills in the operating room (OR).
Study Design:
Prospective longitudinal validation study.
Methods:
Fifty-six evaluations were conducted in the OR on nine otolaryngology residents from PGY (postgraduate year) 2 to PGY 5 over a period of 3 years. Technical performance was measured over time using a task-based checklist developed for assessment of mastoidectomy skills.
Results:
Three sets of technical milestones represented achievement of competency for progressively more complicated procedural steps: the first set was achieved after a mean of 6 +/- 4.3 cases, the second set after 9 +/- 6.7 cases (range of mean = 8-10 cases), and the third set after 13 +/- 6.4 cases (range of mean = 12-14 cases).
Conclusions:
The acquisition of mastoidectomy skills can be integrated into surgical teaching in the OR, and this approach yields information that can aid individual skill development and program improvement. The identification of milestones in particular can help establish training benchmarks toward achievement of competency and in identifying trainees in need of remediation.