Evaluation of a 3D-Printed-Head Simulation Technique for Teaching Flexible Nasopharyngoscopy to Radiation Oncology Residents

Goodman, Christopher D.; Pautler, Justin D.; Balestrini, Christopher S.; Cobos, Santiago; D’Souza, Leah; Eansor, Paige; Jaswal, Jasbir; Nichols, Anthony; Norris, Madeleine; Sharma, Manas; Willmore, Katherine; Warner, Andrew; Murrell, Donna H.; Palma, David A.

Purpose Simulation-based medical education (SBME) is an effective tool for medical teaching, but SBME deployment in radiation oncology (RO) is limited. Flexible nasopharyngoscopy (FNP), an essential skill for RO residents, requires practice that typically occurs on volunteer patients, introducing the potential for stress and discomfort. We sought to develop a high-fidelity simulator and intervention that provides RO residents the opportunity to develop FNP skills in a low-pressure environment. Methods CT images were utilized to create an anatomically-accurate 3D-printed model of the head and neck region. An intervention incorporating didactic instruction, multimedia content, and FNP practice on the model was designed and administered to RO residents attending the Anatomy and Radiology Contouring Bootcamp. Participants completed pre- and post-intervention evaluations of the training session and model fidelity, and self-assessments of FNP skill and confidence performing FNP. Participants were video-recorded performing FNP pre- and post-intervention. Videos were scored by a blinded observer on a pre-defined rubric. Changes in scores were evaluated using the Wilcoxon signed rank test. Results Twenty-four participants from 17 institutions and 4 countries completed the intervention, 50% were female, and most were senior residents. Post-intervention, FNP confidence and FNP performance improved significantly (mean ± SD on a 10-point scale: 1.8 ± 1.8, p < 0.001; 2.2 ± 2.0, p < 0.001 respectively). Participants felt the model was helpful (mean ± SD on a 5-point scale: 4.2 ± 0.6), anatomically correct (4.1 ± 0.9), and aided in spatial comprehension (4.3 ± 0.8). Overall satisfaction intervention was high (4.3 ± 0.8). Participants strongly agreed the intervention should be integrated into RO training programs (4.3 ± 0.8). Conclusions A 3D-printed model and associated intervention were effective at improving FNP performance and the teaching method was rated highly by participants. RO residents may benefit from broader dissemination of this technique to improve trainee performance.