Metrics of Proficiency in a 3D-Printed Spatially-Calibrated Flexible Nasolaryngoscopy Trainer

Flexible nasolaryngoscopy (FNL) is a fundamental skill in otolaryngology. It is typically learned in clinical settings, with impacts on patient comfort and safety. Objective assessment, specific feedback, and a better understanding of learner trajectory in a simulation setting could improve the efficiency of FNL training and ultimately improve the patient experience. This study sought to employ a novel FNL model with trajectory tracking to identify metrics and critical steps that distinguish less and more experienced trainees and identify indicators of proficiency.

FNL trainees in an otolaryngology simulation course performed three FNL trials on a novel CT-based 3D-printed FNL model with embedded location and trajectory tracking. Participants were stratified by prior experience. Outcomes included procedure time, number of pauses or backtracks, and undesirable contact time with critical anatomic regions.

A total of 29 trainees, ranging from medical students to fourth year residents, participated in this study. More experienced trainees demonstrated shorter procedure time, fewer pauses and backtracks, and less time in contact with the posterior nasopharynx (p < 0.05). There was a statistically significant difference between participant groups who had performed 1-5 and > 15 prior FNL.

Procedure time, pauses, backtracks, and contact with critical structures represent objective, measurable metrics of proficiency in FNL simulation training. Post hoc analyses suggest the threshold for procedural proficiency occurs with intermediate prior experience, overlapping with prior literature reports from video-rating of proficiency. Future study could examine how metrics change with FNL practice to optimize targeted feedback that improves efficiency and ultimately reduces patient risk and discomfort.

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