[The methodology of simulation training of the skills]

The technical aspects of endoscopic otosugery imply the necessity of the long-term intense preparation of the specialists. Mastering new endoscopic techniques constitute a serious challenge even for a physician having the many years' experience of work with the binocular microscope which dictates the necessity of introduction of the simulation technologies for the training in endoscopic operations. The results of the analysis of the relevant literature publications provided a basis for the development of the methodology for teaching the skills of endoscopic tympanoplasty (ET) based on the use of the simulation models. MATERIAL AND METHODS: We have undertaken the morphometric analysis of various structures of the sheep external and internal ears based on the results of investigations with the use of computed tomography (n=15). The consideration of the data obtained by this radiodiagnostic technique made it possible to determine the mean length and the horizontal diameter of the external auditory meatus, the horizontal size and the area of the tympanic membrane, and the slope angle of the tympanic membrane with respect to the external auditory meatus, the volume of the tympanic cavity, and the length and width of hypotympanum. The results of the analysis of the technical aspects of endoscopic surgery of the middle ear were used to propose the approach to the mastering of the skills necessary for the performance of endoscopic tympanoplasty using a sheep head as the learning aid. This approach comprises the detailed algorithm of all stages of the surgical intervention including the preparation of the working place for the surgeon, various aspects of space ergonomics in the training laboratory, and step-by-step operations on the sheep head with the description of all phases of the surgical intervention. RESULTS: The results of the present study allowed to recommend the simulation training for the mastering of ET skills with the use of the biological model in the form of the sheep's head. The specific technical peculiarities of endoscopic tympanoplasty have been adapted to the proposed simulation system. It is concluded that the system has all anatomical topographic and morphometric characteristics necessary for the development of the ET skills in the future specialists in endoscopic otosurgery.