Does “Just in Time” teaching of ergonomic principles improve posture of trainees during otologic microscopic surgery?

Brandon S. Gold, Samuel J. Oh, Eleni A. Varelas, Annie E. Arrighi-Allisan, Evan S. Kominsky, Enrique R. Perez, Maura K. Cosetti

Research output: Contribution to journalArticlepeer-review


Purpose: Musculoskeletal disorders are prevalent among otolaryngologists and otologists with symptoms starting during residency. Prior data suggested that high-risk joint angles were often adopted at procedure onset, suggesting a detrimental “natural” operating position. Despite its importance, dedicated ergonomic teaching is not systematically introduced into residency training. The objective of this study was to compare initial ergonomic positioning during microscopic temporal bone surgery between those who receive “Just in Time” ergonomic teaching prior to starting dissection with those who did not. Materials and methods: This was a pilot, prospective trial in which otolaryngology residents at an urban, multicenter tertiary care academic institution (n = 14) wore ergonomic sensors (inertial measurement units) during microscopic temporal bone lab drilling. Prior to recording, participants were randomized to receive an instructional presentation on ergonomic principles (n = 8, intervention group) or not (n = 6, control group). The inertial measurement units analyzed neck and back angles for the initial 5 min of drilling. Results: Of 14 trainees, 78.6 % had prior experience with otologic microscopic cases and 14.3 % reported prior surgical ergonomic training or instruction. The groups were matched in trainee height (P = 0.54), handedness (P = 0.83), stage of otolaryngology training (P = 0.64), prior otologic microscopic surgery experience (P = 0.35), prior temporal bone drilling experience (P = 0.35), and prior teaching in ergonomic principles (P = 0.47). Junior trainees (PGY 1–3) who did not receive “Just in Time” teaching adopted a posture with significantly higher risk back flexion compared to junior trainees who received the training (25.3° vs. 5.7°, P = 0.04). There was no difference in back positioning among senior trainees (12.6° vs. −5.7°, P = 0.13). While there was a trend towards those in the intervention group adopting safer procedural posture, there was no significant difference in the overall cohort between the intervention and control groups in both neck positioning (−11.0° vs. −19.1°, P = 0.17) and back positioning (8.6° vs. 19.1°, P = 0.18). Conclusions: Musculoskeletal related pain is prevalent among otolaryngologists and otologists with data suggesting that symptoms begin during residency. Targeted “Just in Time” teaching of ergonomic principles is feasible and may be effective for development of healthy postural habits, especially among junior trainees.

Original languageEnglish
Article number103682
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Issue number1
StatePublished - 1 Jan 2023


  • Ergonomics
  • Otologic surgery
  • Resident education
  • Surgical ergonomics
  • Temporal bone lab


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