cross-institutional evaluation of a mastoidectomy assessment instrument thomas kerwin-匠人.pdf

该【cross-institutional evaluation of a mastoidectomy assessment instrument thomas kerwin-匠人 】是由【刘备文库】上传分享，文档一共【10】页，该文档可以免费在线阅读，需要了解更多关于【cross-institutional evaluation of a mastoidectomy assessment instrument thomas kerwin-匠人 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。ORIGINALREPORTSCross-InstitutionalEvaluationofaMastoidectomyAssessmentInstrument?ThomasKerwin,PhD,*BradHittle,BS,*DonStredney,MA,*PaulDeBoeck,PhD,and?GregoryWiet,MD,§?*InterfaceLab,puterCenter,Columbus,Ohio;DepartmentofPsychology,OhioState?University,Columbus,Ohio;DepartmentofOtolaryngology,OhioStateUniversity,Columbus,Ohio;and§DepartmentofOtolaryngology,NationwideChildren’sHospital,Columbus,OhioOBJECTIVE:,wesuggestusingevidenceforanevaluationinstrumentusedtoassesstheamultiplepointscaleinsteadofabinarypass/.(JSurgEd]:]]]-]]].-.)DESIGN:MastoidectomieswereperformedonavirtualKEYWORDS:mastoidectomy,surgicalperformanceeval-temporalbonesystemandthenratedbyexpertsusingauation,virtualrealitysimulation,assessmentpreviouslydescribed15elementtask-:MedicalKnowledge,Practice-Basedontheresults,asecond,:Twelveotolaryngologicalsurgicaltrainingpro-:Inall,65mastoidectomyperformancesFortheresultsofperformanceteststobevaluableforingfrom37individualswithavarietyofmakingdecisions,caremustbegiventounderstandthetemporalbonedissectionexperience,-,sinceitgivesunfoundedcon?-RESULTS:Intraclasscorrelationscoresvariedgreatlyulumoruseincerti?cation,asurgicalperformanceinstru--basedchecklistisnecessaryforaBothoftheseframeworksemphasizetheimportanceofaratertoconsideramastoidectomytobeperformedatthecoherentargumenttowardtheuseofameasurementlevelofanexpertbutahighscoreisnotasuf?-CONCLUSIONS:Rewordingoftheinstrumentitemstofocustioninstrumentusedtoassesstheperformancelevelofaonsafetydoesnotresultinincreasedreliabilityoftheinstru--suggeststhatgoingbeyondsimplecorrelationmeasurescangivements,althoughtheworkinvolvedincreationandevalua-,NationalInstitutesofHealth,USA,:InquiriestoThomasKerwin,PhD,1224KinnearRoad,Columbus,;e-mail:******@&-7204/$://dx./.--(.,nonpatho-“universalmetrics”basedonalogical).(14individualsfrom12differentinsti-joysticks(with6degree-of-freedommovement)areusedtotutions),-?nedsothatauniforminterpretationmanipulateboneorientation,changemagni?cation,andessorfailure(binaryselectdifferentdrillburrsizesandtypeswhentheyaredecisionprocess),,residents,andsoftwareincludestheabilitytoviewsectionsofthemedicalstudents(MS)from12institutions,,(NCA)isintroducedasanreviewers,rading,,pareourresultswithstudiesexaminingothermastoidectomyevaluationscales,:bothhaveatask-basedchecklistResidentsandfacultyatallsitesusedthesimulation(TBC)andaglobalratingscale(GRS).pletemastoidectomiestheHopkinsscaleTBCarenearlythesameasinours,,ourperformedonseparatevirtualbones,,includingdistributionofskilllevels:medicalstudents(MS),post-thoseusingtheJohnHopkinsinstrument,isthatthenumberofgraduateyear(PGY)2-5,fellows,andattendingphysiciansinstitutionsinvolvedinboththedevelopmentandapplicationof(experts).,our?ndingsInall,249data?leswerecreatedbytheparticipants,83willbediscussedintermsofreliabilityandvalidity,usingofthosewereadequateforanalysis:theotherswerefalseMessick’,aseriesofstepsforthemastoidectomywereindicatedandtheuserswentthroughthem,pressing“next”,,datasetswherenodrillingwasThisstudywasapproved(ID2011H0253)?ceofResponsibleResearchOutofthose83,66wereselectedrandomlytogiveanbiomedicalinstitutionalreviewboard(IRB)-,,notall3mastoidectomiesperformedonthedifferentbonesSimulationandGradingEnvironmentfromeachparticipantwasselected:23participantshadThesurgicalsimulationsystemthatwasusedtogather1performanceselected,2participantshad2performancesthemastoidectomyandadaptedtoprovideagradingselected,Volume]/Number]]2017Eachof12expertreviewers,,wasassigned11gradingtasks(individualsecondinstrumentisarevisedversionofthe?rstthatmastoidectomyperformances).,pleted,?,?rsttrialhadalistof16items(,graded),soweeliminatedthatperformancefromthedata,basedonfeedbackfromtheexpertreviewersandanaddi-leaving65performances,withatotalof130evaluationsforeachtionalDelphimethod,weattemptedtomoresharplyde?,emphasizingsessionscollectedfromfacultyand27collectedfromfellows,,atthesuggestionoftheexpertgroup,2residents,andmedicalstudents(MS)(Expert?38,Fellow?3,?1,PGY1?3,PGY2?4,PGY3?5,PGY4?5,trialusedalistof15items;itemnumber10wasremovedfromPGY5?3,PGY6?3).?cratingswerebinaryintermsofpass(?1)andfailperformancerepresents(atypeofglobalrating).Forthe(?0).Atotalinstrumentscorewascalculatedbycountingthesubjectiveassessment,theglobalratingchoiceswere:novice,,?nedas“readyToascertaintheevidenceforvalidityoftheinstrument,forthetemporalbonelab,”Intermediatelevelas“readyforweuseinter-raterreliabilitymeasures,correlationsbetweenrealpatientsintheoperatingroom”(undersupervision),scoresandexperienceandnecessaryconditionanalysis,allandExpertlevelas“readytooperatewithoutsupervision.”-RaterReliability2-:Severalmeasuresofinter-raterreliabilitywerecalculated,allratingsfromthe?rstinstrumentwerecollectedseveralbothper-#10intheFirstTrialhadnoCorrespondingQuestionintheSecondTrialNumberTrial1Trial21MaintainsvisibilityofburrwhileremovingboneMaintainssafeviewoftheburrthroughouttheprocedure2ExcessiveforcewillnotbeusednearMaintainssafeforcenearcriticalstructuresthroughoutthecriticalstructuresprocedure3AppropriatedepthofcavitySuf?cientremovalofmastoidaircellsforpropervisualizationofdeepstructures4NoholesintegmenMaintainsintegrityoftegmen5SelectappropriateburrEf?cientandsafeburrselection6ViolationofthesigmoidsinusMaintainsintegrityofsigmoidsinus7Identi?cationofchordatympaninerveIdenti?eschordatympaninervesuf?cientlytoperformfacialrecessapproach8DrillinbestdirectionEf?cientandsafedirectionofdrilling(paralleltocriticalstructures)9ExternalauditorycanalwallwillremainupSuf?cientthinningofposteriorexternalauditorycanalwalltovisualizefacialnerve10NoholesinexternalauditorycanalwallpletesaucerizationSuf?cientsaucerizationforsafedrilling12PosteriorexternalauditorycanalwallthinnedAvoidsoverthinningorholesinposteriorauditorycanalwallappropriately13ViolationofthefacialnerveMaintainsintegrityoffacialnerve14Violationofthehorizontal(lateral)Maintainsintegrityofhorizontalsemicircularcanalsemicircularcanal15DrillcontactwithossiclesMaintainsinteg