Built on Evidence
Otoscopic diagnostic accuracy in primary care hovers around 50%. We built OtoSim to change that number, and we think a training tool should have to prove it works — not just claim it. Some of the research on this page comes from our own team — the clinicians and educators who helped design OtoSim and OphthoSim in the first place. A good amount comes from researchers with no connection to us at all, testing our devices independently. We're proud of both, and we're not done! Below is what the science shows so far, and an open invitation to help us learn more.
OtoSim® Peer-Reviewed Evidence
Evaluation of an Otoscopy Simulator and Traditional Learning with Observation in Teaching Ear Diseases to Phase III Part I Medical Students.
Savita Lasrado, Anita Aramani, Lulu Sherif Mahmood, Kuldeep Moras.
Indian Journal of Otolaryngology and Head & Neck Surgery. 2025;77:639–643.
In this prospective interventional study, 60 third-year medical students were randomized to either traditional observation-based teaching or training with the OtoSim otoscopy simulator. Students trained using OtoSim achieved significantly higher OSCE scores than those receiving traditional instruction alone (6.37 ± 0.72 vs. 5.60 ± 1.04; p = 0.002). Qualitative and quantitative feedback showed high learner satisfaction, with most students reporting improved confidence, greater interest in otolaryngology, and a preference for simulation-based learning. The authors concluded that OtoSim is an effective adjunct to conventional teaching, providing a safe environment for repetitive practice and improving acquisition of otoscopy skills
Effectiveness of discovery learning using a mobile otoscopy simulator on knowledge acquisition and retention in medical students: a randomized controlled trial.
Xu J, Campisi P, Forte V, Carrillo B, Vescan A, Brydges R. J Otolaryngol
Head Neck Surg. 2018;47(1):70.
Pre-clerkship medical students used a mobile otoscopy simulator alongside a smartphone app and a 3D ear attachment, following one of two curriculum sequences: simulator practice before a traditional lecture, or after it. Both sequences produced comparable and significant improvements in pathology-identification scores, measured at baseline, immediately post-intervention, and at a two-week retention check. The authors concluded that mobile, self-directed simulation is a valuable complement to traditional instruction, though students engaged with independent discovery learning only minimally when given no additional guidance — suggesting simulator use works best paired with structured teaching.
Ear Disease Knowledge and Otoscopy Skills Transfer to Real Patients: A Randomized Controlled Trial
Wu V, Sattar J, Cheon S, Beyea JA. J Surg Educ. 2018;75(4):1062–1069.
Medical students were randomized to one of three teaching methods — otoscopy simulation, a web-based module, or standard classroom instruction — and were then assessed on real volunteer patients (five patients, ten ears) both before and after their assigned intervention, with assessors blinded to group assignment. Diagnostic accuracy and hands-on otoscopy skill increased significantly only in the simulation and classroom-instruction groups, with the simulation group showing the largest overall gain. This was the first study in the OtoSim literature to demonstrate that simulator-trained skill actually transfers to live-patient examinations, rather than only to simulator-based testing.
Evaluation of otoscopy simulation as a training tool for real-time remote otoscopy
Venail F, Akkari M, Merklen F, Samson J, Falinower S, Cizeron G, Mondain M, Puel JL, Mura T. Int J Audiol. 2018;57(3):194–200.
Using an OtoSim2 simulator, this study trained neurotology experts and both trained and untrained facilitators to perform landmark-identification tasks in support of teleaudiology (remote otoscopy). Diagnostic accuracy was high both on-site (11.7% error) and remotely (0% error), and inter- and intra-rater agreement was strong (κ 0.80–1.0) across groups. Landmark-identification speed for trained facilitators matched on-site performance, while untrained facilitators were significantly slower — leading the authors to conclude that simulator-based training is an efficient way to prepare both experts and facilitators for remote otoscopy delivery.
Evaluation of a Web-Based Module and an Otoscopy Simulator in Teaching Ear Disease
Wu V, Beyea JA. Otolaryngol Head Neck Surg. 2017;156(2):272–277.
This study compared a web-based teaching module against hands-on otoscopy simulation for preclerkship medical students learning to diagnose ear disease, assessing both immediate skill gains and longer-term retention. Otoscopy clinical skills increased and were retained only in the group trained with the simulator — the web-based module alone did not produce durable skill gains. The authors concluded that preclerkship students' acquisition and retention of otolaryngology diagnostic skills is best supported by combining web-based teaching with hands-on otoscopy simulation, rather than relying on either method in isolation.
Objective Evaluation of Otoscopy Skills Among Family and Community Medicine, Pediatric, and Otolaryngology Residents
Oyewumi M, Brandt MG, Carrillo B, Atkinson A, Iglar K, Forte V, Campisi P. J Surg Educ. 2016;73(1):129–135.
Residents from three different training tracks — family and community medicine, pediatrics, and otolaryngology–head and neck surgery — participated in a single otoscopy simulator teaching session and were objectively evaluated on diagnostic accuracy before and after. Diagnostic accuracy improved significantly across all three resident groups, regardless of specialty or prior otolaryngology exposure. The findings supported the simulator's value as a shared training tool that generalizes across primary care and specialist training pathways, not just within dedicated ENT programs.
Evaluation of an otoscopy simulator to teach otoscopy and normative anatomy to first year medical students
Lee DJ, Fu TS, Carrillo B, Campisi P, Forte V, Chiodo A. Laryngoscope. 2015;125(9):2159–2162.
A large-group otoscopy simulator session was held for 29 first-year medical students at the University of Toronto to teach normal external and middle ear anatomy, followed by a post-session survey capturing student experience and confidence. All respondents rated the overall quality of the event as very good or excellent, and 93% indicated the simulator increased their confidence in performing otoscopy. The authors concluded that otoscopy simulation is an effective and novel addition to traditional learning methods, allowing students to build foundational anatomical knowledge and examination confidence early in training.
Otoscopy simulation training in a classroom setting: a novel approach to teaching otoscopy to medical students
Davies J, Djelic L, Campisi P, Forte V, Chiodo A. Laryngoscope. 2014;124(11):2594–2597.
A large-scale otoscopy simulator teaching session was held for 92 first- and second-year University of Toronto medical students, organized in small groups with facilitators guiding feature identification and diagnosis. Of the students who completed a follow-up survey, 91% rated the overall quality of the session as very good or excellent, and the same proportion reported improved confidence in diagnosing ear pathology. The authors concluded that large-group otoscopy simulator sessions are a practical, scalable method for exposing students to a wide range of ear pathology and building diagnostic confidence early in medical training.
OphthoSim® Peer-Reviewed Evidence
Evaluation of an Ophthalmoscopy Simulator to Teach Funduscopy Skills to Pediatric Residents
Kouzmitcheva E, Grover SA, Berenbaum T, Ali A, Atkinson A, Yeh EA. Can J Neurol Sci. 2018;45(3):320–324.
Seventeen pediatric residents (postgraduate years 1–3) were randomized to a control group or an intervention group that received self-study training on an ophthalmoscopy simulator, then asked to identify pathology across 20 fundus images before and after the intervention. Most participants (65%) reported minimal or no formal ophthalmology teaching during medical school, and there was no significant difference between groups at baseline. Intervention subjects showed a statistically significant improvement in diagnostic accuracy (from 9.89 to 12.78 out of 20, p=0.006), while control subjects showed no change — leading the authors to conclude that even a single simulator session can meaningfully improve diagnostic accuracy and build confidence in postgraduate pediatric trainees for a skill many receive little formal training in.
Have a question about the research behind OtoSim or OphthoSim? Contact us for more information on study methodology or full-text access.
INTERESTED IN DOING RESEARCH WITH OTOSIM AND OPHTHOSIM?
Nurse practitioners, physician assistants, nurses, audiologists, optometrists, and other clinicians already train on OtoSimTM and OphthoSimTM — which opens up a lot of research still waiting to be done. From tracking how long training gains last, to testing simulator-trained skill against a diagnostic gold standard, to studying use across these different disciplines, there's no shortage of good questions. We're open to studies that test our devices rigorously, including ones that might not favour us.
What we offer:
- Loaned or discounted equipment for the study period
- Access to our image library and relevant data
What we ask:
- You keep full editorial and analytical control — we don't see the data or manuscript
- You publish, whatever the result says
- You disclose our support, as any study should
Interested in doing research?
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