Upright, Bright, Instruments in Sight: A Multimodal Training Module for Assisting in Endoscopic Endonasal Procedures for Junior Surgical Residents

Introduction: Junior neurosurgery and otolaryngology residents are provided minimal structured training regarding the basics of endoscopic, endonasal procedures before starting their respective skull base or rhinology rotations. However, mastery of this complex skill set is expected very early in the rotation, which can lead to inefficiency and frustration in the operating room.

Objective and Methods: The primary goal of this project was to develop a focused, multimodal training module for junior neurosurgery and otolaryngology residents to learn four specific components of endoscopic endonasal skull base procedures, and the principles that support being an effective first assistant. A secondary goal was to assess whether the module improves the confidence, knowledge, and performance of the residents in simulated setting, and whether these skills are transferred to the operating room. Junior neurosurgical and otolaryngology residents at Emory University are being recruited for participation.

Results: A two-part video and hands-on cadaver-based module was created to teach learners the basics of setting up and assisting in endoscopic endonasal skull base procedures. A short, comprehensive, and narrated video described the following skills: application of Mayfield's head holder, head positioning, endoscope assembly, and functionality. It emphasized the key rules for driving the endoscope to effectively assist a primary surgeon: to keep the image bright, upright, with the instruments in sight. This was followed by an engaging hands-on cadaver-based session meant to reinforce these concepts based on Peyton's 4-step approach. It included an opportunity to solidify the specific skills taught in the video and dynamically simulate taking the position of a first assistant in an endoscopic operation.

Recruitment for evaluating module effectiveness is ongoing. Planned outcome measures include a pre- and postmodule survey assessing knowledge and confidence of skills, as well as performance of learned tasks in the laboratory and operating room setting based on direct observation and video-based criteria.

Conclusion: Creation of a simple, yet comprehensive, multimodal module for targeted, basic surgical skill sets is a feasible and valuable resource for busy surgical residency programs. Ongoing evaluation of module effectiveness, and accommodation to the learners' needs within their particular context is a crucial part of the development of meaningful surgical curricula.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021