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Evaluation of a low-fidelity ear surgery simulator in a low-resource setting

  • K Luu (a1), L Straatman (a1), D Nakku (a2), B Westerberg (a1), N Carter (a3) and M Clark (a4)...



The provision of healthcare education in developing countries is a complex problem that simulation has the potential to help. This study aimed to evaluate the effectiveness of a low-cost ear surgery simulator, the Ear Trainer.


The Ear Trainer was assessed in two low-resource environments in Cambodia and Uganda. Participants were video-recorded performing four specific middle-ear procedures, and blindly scored using a validated measurement tool. Face validity, construct validity and objective learning were assessed.


The Ear Trainer provides a realistic representation of the ear. Construct validity assessment confirmed that experts performed better than novices. Participants displayed improvement in all tasks except foreign body removal, likely because of a ceiling effect.


This study validates the Ear Trainer as a useful training tool for otological microsurgical skills in developing world settings.


Corresponding author

Address for correspondence: Dr Brian D Westerberg, BC Rotary Hearing and Balance Centre at St Paul's Hospital, 2600–1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada Fax: +1 604 806 8777 E-mail:


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