A time-sensitive rubric for assessing mastoidectomy proficiency

Anthony M Tolisano, Philip D Littlefield

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To develop a time-sensitive, standardized rubric for cadaveric temporal bone dissection for otolaryngology resident education.

METHODS: This is a five-year prospective cohort study that evaluated otolaryngology resident performance during sequential cadaveric temporal bone dissection courses at a single otolaryngology residency training program. A canal-wall-up mastoidectomy with a facial recess approach was performed adhering to a 30-minute time limit and graded according to a standardized rubric. Main outcome measures included: (1) correct structure identification and (2) injuries sustained to structures as compared by resident post-graduate year (PGY) level.

RESULTS: Thirteen residents were evaluated from October 2012 to March 2017. This included 57 individual graded exercises performed over ten dissection courses. The average score for PGY-2 residents was lowest (68.9), and PGY-5 residents achieved the highest average score (87.7). Junior residents correctly identified fewer structures (77.5%) when compared to senior residents (91.3%), p < 0.0001. Correct performance of a facial recess approach was achieved by 100% of senior residents, but only 59.3% of junior residents (p = 0.0003). The percentage of major injuries, which included the facial nerve, tegmen, labyrinth, and ossicular chain, decreased each PGY-level from a maximum of 17% by PGY-2 residents to a minimum of 5% by PGY-5 residents.

CONCLUSION: Senior residents correctly identify more structures and are able to complete a facial recess approach with higher fidelity when subjected to a time-sensitive graded mastoidectomy rubric.

Original languageEnglish
Pages (from-to)102457
JournalAmerican journal of otolaryngology
Issue number6
StatePublished - 2020


  • Cadaver
  • Cohort Studies
  • Education, Medical, Graduate/methods
  • Humans
  • Internship and Residency
  • Mastoidectomy/education
  • Otolaryngology/education
  • Prospective Studies
  • Simulation Training/methods
  • Temporal Bone/anatomy & histology
  • Time Factors


Dive into the research topics of 'A time-sensitive rubric for assessing mastoidectomy proficiency'. Together they form a unique fingerprint.

Cite this