Simulation-Based Certification for Mastoidectomy Surgery

Objectives: To design and evaluate a simulation-based certification pathway for mastoidectomy using VR simulation and 3D-printed temporal bone models. An adapted Learning Curve–Cumulative Summation (LC-CUSUM) method was used to establish a credible competency threshold. We aimed to examine training effects, item-level performance patterns, and transfer to cadaveric dissection. Methods: Seven senior residents and early-career otologic surgeons completed a structured curriculum consisting of VR simulation training followed by 3D-printed model drilling. Competency thresholds were defined using an adapted LC-CUSUM design requiring 4 consecutive high scoring performances (≥22/26 points on a modified Welling Scale, without damage to the lateral semicircular canal or facial nerve). Cadaveric mastoidectomy performance was assessed at baseline, after VR simulation training, and after 3D-printed training. Linear mixed-effects models were used to evaluate changes in cadaver performance and predictors of final outcomes. Item-level performance was explored across modalities. Results: Five of seven participants (71%) met VR simulation certification criteria, and four (57%) met certification criteria on 3D-printed models. Cadaver performance improved significantly across tests (baseline 14.1; post-VR 15.8; post-3D-print, ie, final, 16.3 points; P = .02). Certified participants scored significantly higher on the final cadaver test than non-certified participants (17.1 vs 13.7 points; P < .001). Item level analysis identified persistent challenges (eg, performance related to sigmoid sinus, tegmen, mastoid tip, chorda tympani) and simulation to cadaver discrepancies. Conclusion: A simulation-based certification pathway for mastoidectomy is feasible and produces measurable improvements in cadaveric performance. Achieving certification in both VR simulation and 3D-printed modalities was necessary for any cadaveric passing performance, supporting the use of mastery learning with LC-CUSUM–based thresholds in otologic surgical training.