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Decentralized virtual reality mastoidectomy simulation training: a prospective, mixed-methods study

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Virtual reality (VR) training of mastoidectomy is effective in surgical training—particularly if organized as distributed practice. However, centralization of practice facilities is a barrier to implementation of distributed simulation training. Decentralized training could be a potential solution. Here, we aim to assess the feasibility, use, and barriers to decentralized VR mastoidectomy training using a freeware, high-fidelity temporal bone simulator.


In a prospective, mixed-methods study, 20 otorhinolaryngology residents were given three months of local access to a VR mastoidectomy simulator. Additionally, trainees were provided a range of learning supports for directed, self-regulated learning. Questionnaire data were collected and focus group interviews conducted. The interviews were analyzed using thematic analysis and compared with quantitative findings.


Participants trained 48.5 h combined and mainly towards the end of the trial. Most participants used between two and four different learning supports. Qualitative analysis revealed five main themes regarding implementation of decentralized simulation training: convenience, time for training, ease of use, evidence for training, and testing.


Decentralized VR training using a freeware, high-fidelity mastoidectomy simulator is feasible but did not lead to a high training volume or truly distributed practice. Evidence for training was found motivational. Access to training, educational designs, and the role of testing are important for participant motivation and require further evaluation.

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The authors want to thank computer scientist Peter Trier, The Alexandra Institute for developing the simulation software, and professor Per Cayé-Thomasen and Dr. Martin Nue Møller for their assistance with implementation of the Visible Ear Simulator.


The Oticon Foundation and Med-El supported the development of the Visible Ear Simulator software. Funding bodies were not involved in the conception, execution, interpretation, or publication of the study.

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Correspondence to Martin Frendø.

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Frendø, M., Thingaard, E., Konge, L. et al. Decentralized virtual reality mastoidectomy simulation training: a prospective, mixed-methods study. Eur Arch Otorhinolaryngol 276, 2783–2789 (2019). https://doi.org/10.1007/s00405-019-05572-9

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  • Decentralized training
  • Simulation
  • Temporal bone dissection
  • Mastoidectomy
  • Virtual reality
  • Surgical training