• Simulation;
  • resident;
  • myringotomy and tube placement;
  • education;
  • Objective Structured Assessment of Technical Skills;
  • low cost;
  • Level of Evidence: 1b



Simulation is emerging as a mandatory component of surgical training and a means of demonstrating surgical competency. We designed a cost-effective, low-fidelity model to further acquisition of technical skills related to myringotomy and ventilation tube insertion (M&T). The purpose of the study was to examine the skills trainer as a method of assessment to evaluate competency, timeliness, and procedure confidence in junior residents.

Study Design:

Prospective, randomized.


A simplistic M&T skills box was developed. General surgery interns (n = 20) with no prior procedure training were randomized to receive either didactic instruction or skills training using the model. One hour of lecture or technical skills training was provided to each group. A blinded examiner evaluated the subjects in both groups before and after training. Performance was measured using a global rating scale, task-specific checklist, and time-to-completion. Pre- and postsession questionnaires assessed procedure confidence.


Analysis revealed a trend toward improvement in global rating scores between groups. There was a statistically significant difference in time improvement between groups (P = .0211). The skills lab group felt they could perform the procedure faster and with improved abilities, as compared to the didactic group (P = .0069 and 0.0007, respectively).


Junior surgical residents performed an M&T procedure using a novel, low-cost model. This study demonstrated the skills lab's positive effect on training as measured by global rating scale, time-to-completion, and overall resident confidence. We anticipate its application to be valuable not only in training residents but also in assessing competency.