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Stanton E, Markarian E, Codero J, Roohani I, Kondra K, Lee J, Carey JN, Travieso R. A systematic review of surgical simulation in gender affirmation surgery. J Plast Reconstr Aesthet Surg 2024; 90:11-18. [PMID: 38335870 DOI: 10.1016/j.bjps.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/14/2023] [Accepted: 12/06/2023] [Indexed: 02/12/2024]
Abstract
The burgeoning field of gender affirmation surgery (GAS) has become increasingly complex, challenging plastic surgeons to meet high standards for their patients. During the COVID-19 pandemic, the emphasis on remote learning ushered in the increased use of surgical simulation training, offering residents the opportunity to trial challenging procedures before treating patients. This systematic review seeks to summarize current simulation training models used in GAS. A systematic review was conducted according to PRISMA-P guidelines using the following databases: PubMed, Medline, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were English-language peer-reviewed articles on surgical simulation techniques or training related to the field of gender surgery. Skills and techniques taught and assessed, model type, equipment, and cost were abstracted from articles. Our search criteria identified 1650 articles, 10 of which met the inclusion criteria for data extraction. Simulation models included those that involved cadavers (n = 2), synthetic benchtop (n = 5), augmented/virtual reality (n = 2), and 3D-printed interfaces (n = 1). The most common procedure involved breast or pectoral reconstruction and/or augmentation (n = 5), followed by vaginal reconstruction (n = 3). One simulation model involved facial GAS. All models focused on surgical technique and anatomy, three on suture skills or knot-tying, and one on surgical decision-making. The evolving field of GAS requires that plastic surgery trainees be knowledgeable on surgical techniques surrounding this scope of practice. Surgical simulation not only teaches residents how to master techniques but also helps address the sensitive nature of GAS.
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Affiliation(s)
| | | | - Justin Codero
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Idean Roohani
- Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Katelyn Kondra
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Jessica Lee
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA, USA; Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Joseph N Carey
- Keck School of Medicine of USC, Los Angeles, CA, USA; Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA, USA
| | - Roberto Travieso
- Division of Plastic and Reconstructive Surgery, Keck Medicine of USC, Los Angeles, CA, USA.
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Davis GL, Abebe MW, Vyas RM, Rohde CH, Coriddi MR, Pusic AL, Gosman AA. Results of a Pilot Virtual Microsurgery Course for Plastic Surgeons in LMICs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5582. [PMID: 38348462 PMCID: PMC10860934 DOI: 10.1097/gox.0000000000005582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 02/15/2024]
Abstract
Background The Plastic Surgery Foundation's Surgeons in Humanitarian Alliance for Reconstruction, Research and Education (SHARE) program seeks to expand surgical capacity worldwide through mentorship and training for local plastic surgeons. This study aims to define the need for microsurgery training among SHARE global fellows and describe results of a pilot course. Methods Ten participants of the SHARE Virtual Microsurgical Skills Course were asked to complete an anonymous survey. Pre- and post-course response rates were 100% and 50.0%, respectively. Results There was a high incidence of microsurgical problems encountered in the clinical setting. Resource availability was varied, with high access to loupes (100%), yet limited access to microsurgery instruments (50%), medications (40%), operating microscope (20%), skilled nursing (0%) and appropriate peri-operative care settings (0%). Participants identified vessel preparation, instrument selection, and suture handling as priority learning objectives for a microsurgery skills course. Post-course satisfaction with learning objectives was high (60% "very good," 40% "excellent"). Participants reported high levels of improvement in suture handling (Likert 4.60±0.55), end-to-end anastomosis (4.40±0.55), instrument selection (4.20±0.45), vessel preparation (4.20±0.45), and economy of motion (4.20±0.45). Conclusions This study demonstrates a high frequency of reconstructive problems encountered by global fellows yet low access to appropriate resources to perform microsurgical procedures. Initial results from a pilot virtual microsurgery course demonstrate very high satisfaction and high self-rated improvement in key microsurgical skills. The virtual course is an effective and accessible format for training surgeons in basic microsurgery skills and can be augmented by providing longitudinal opportunities for remote feedback.
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Affiliation(s)
- Greta L. Davis
- From Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, San Francisco, Calif
| | - Metasebia W. Abebe
- Plastic and Reconstructive Surgery, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Raj M. Vyas
- Department of Plastic Surgery, University of California, Irvine, Orange, Calif
| | - Christine H. Rohde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Columbia University Medical Center, New York, N.Y
| | - Michelle R. Coriddi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - Andrea L. Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham Health, Boston, Mass
| | - Amanda A. Gosman
- Division of Plastic Surgery, Department of Surgery, University of California, San Diego, San Diego, Calif
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Won P, Premaratne ID, Stoneburner J, Naidu P, Collier ZJ, Yenikomshian HA, Carey JN. Gaps in plastic surgery training: A comparative literature review of assessment tools in plastic surgery and general surgery. J Plast Reconstr Aesthet Surg 2023; 87:238-250. [PMID: 37922663 DOI: 10.1016/j.bjps.2023.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/23/2023] [Accepted: 10/10/2023] [Indexed: 11/07/2023]
Abstract
Assessment tools for grading technical and nontechnical skills, such as operative technique and professionalism, are well established in general surgery. Less is known regarding the application of these tools in plastic surgery training. This study is a comparative review of the most prevalent assessment tools and rubrics utilized in general and plastic surgery. Two parallel systematic reviews of the literature utilizing PubMed and Cochrane were conducted for articles published between 1990 and 2022. Searches used Boolean operators specific to assessment tools in general and plastic surgery. Fourteen studies met the inclusion criteria for general surgery assessment tools, and 21 studies were included for plastic surgery assessment tools. Seven studies (50%) evaluated technical skills in general surgery, whereas 15 studies (71%) assessed technical skills in plastic surgery with commonality found in the evaluation of principles, such as tissue and instrument handling and operative flow. Task-specific evaluation tools were described for both general and plastic surgeries. Five studies evaluated nontechnical skills, such as communication and leadership in general surgery, whereas no plastic surgery studies solely examined nontechnical assessment tools. Our literature review demonstrates that standardized skill assessments in plastic surgery are lacking compared with those available in general surgery. Plastic surgery programs should consider implementing competency-based assessment tools in surgical coaching and training for technical and nontechnical skills. More research is necessary in plastic surgery to optimize the evaluation of nontechnical skills.
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Affiliation(s)
- Paul Won
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Ishani D Premaratne
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Jacqueline Stoneburner
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Priyanka Naidu
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Zachary J Collier
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA; Los Angeles County/University of Southern California Medical Center, Los Angeles, CA, USA.
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Competency-Based Education: Will This be the New Training Paradigm in Plastic Surgery? J Craniofac Surg 2023; 34:181-186. [PMID: 36104832 DOI: 10.1097/scs.0000000000009005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/14/2022] [Indexed: 01/11/2023] Open
Abstract
The Accreditation Council for Graduate Medical Education created the "Next Accreditation System" in 2013 requiring residents to meet educational milestones based on core competencies over the course of their training. The 6 core competencies include patient care and technical skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Since the traditional time-based model requires a predetermined length of training irrespective of learning style, pace, or activity, a competency-based model is appealing because it refocuses education on deliberate and relevant skills acquisition and retention. Plastic surgery has been slowly transitioning to competency-based education (CBE), thereby permitting residents to learn at their own pace to master each competency. We performed a nonsystematic literature review of the efficacy of CBE and implementation efforts, particularly within plastic surgery. The literature revealed perceived barriers to implementation, as well as the nuts and bolts of implementation. We highlighted possible solutions and training tools with practical applications in plastic surgery. Success of CBE in plastic surgery requires instituting a transparent process that involves continuously piloting multiple assessment tools and a discussion of related costs. CBE may be particularly appealing for trainees focused on further training in craniofacial or pediatric plastic surgery after completion of an integrated or independent training program in plastic surgery to allow them to focus on their career interests once competence is achieved in the core skills required of a plastic surgeon.
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Cleft Lip Repair Competence Can Be Evaluated with High-fidelity Simulation. Plast Reconstr Surg Glob Open 2022; 10:e4435. [PMID: 35923989 PMCID: PMC9307303 DOI: 10.1097/gox.0000000000004435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
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Takegawa PH, Kalil J, Bustorff-Silva JM, Miranda ML. Effectiveness of an inexpensive short-term theoretical-practical course on videosurgery for surgeons in training. BMC MEDICAL EDUCATION 2022; 22:527. [PMID: 35799171 PMCID: PMC9264716 DOI: 10.1186/s12909-022-03594-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The rapid development of video surgery and minimally invasive surgical techniques prompted many studies on the methods of teaching these techniques to young surgeons in training. However, the characteristics of a short-term course that is both easily accessible and efficient for this group of surgeons remain controversial. To investigate this issue, a short-term training method was proposed for first year surgery residents, using inexpensive handmade wooden simulation boxes with the students smartphones as cameras. Its effectiveness was evaluated, as well as possible factors that could influence student performance, such as gender and previous experience with video games. METHODS Thirty-six first-year General Surgery residents, entering in 2019 and 2020, participated in the study: 21 were males and 15 were females with ages between 22 and 29 years old, (mean 25.47 years). All participants performed a pre-established exercise (placing two simple stitches using a laparoscopic simulator), which was timed and scored. They then participated in a short theoretical-practical course, consisting of an initial lecture followed by 4 exercises on handcrafted wooden laparoscopic video surgery simulators. Afterwards, they were asked to repeat the same exercise from the first step. Finally, they answered a questionnaire that included questions on previous videogame experience. The data were tabulated and submitted to statistical analysis. RESULTS In the pre-training exercise, 15 (41.66%) participants were able to perform the two simple stitches in the simulator box within the maximum time limit of 5 minutes. After the short course, 22 (61.11%) of participants were able to perform the complete exercise. Improvement in the time to complete the practical exercise was statistically significant (p = 0.0296) after participating in the theoretical-practical course. A better pre- and post-training performance was demonstrated by the 17 participants with experience with video games (p = 0.0116), and a better post-training performance was demonstrated by female participants (p = 0.0405). CONCLUSION This short-term inexpensive theoretical-practical course in laparoscopic training for surgeons in training was effective in reducing the execution time of a laparoscopic stitch in a simulation box. Previous experience with video games and/or female gender appear to be associated with improved performance.
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Affiliation(s)
- Paula Haveroth Takegawa
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
| | - Jefferson Kalil
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
| | - Joaquim Murray Bustorff-Silva
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
| | - Márcio Lopes Miranda
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medical Sciences, State University of Campinas, Rua Tessalia Vieira de Camargo 126, Campinas, SP 13083-887 Brazil
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The Accreditation Council for Graduate Medical Education Milestones in Integrated Plastic Surgery Programs: How Competency-Based Assessment Has Been Implemented. Plast Reconstr Surg 2022; 149:1001-1007. [PMID: 35196298 DOI: 10.1097/prs.0000000000008938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The plastic surgery milestones are a central component of resident assessment. The authors performed a survey to evaluate how milestones have been implemented across integrated plastic surgery programs and how faculty perceive the Milestones Project has impacted their program. METHODS A 25-question survey was directed to the head of the clinical competency committee of all 82 integrated plastic surgery programs through the American Council of Academic Plastic Surgeons. The survey queried the composition of the committee, how ratings are generated, and the data used in generating these ratings. RESULTS Committee leaders from 57 programs (69.5 percent) responded to the survey. For most programs (73 percent), one faculty member completed milestone ratings for each resident and reviewed them with the residents. To determine milestone ratings, 92 percent utilized resident assessment after every rotation, and 63 percent utilized in-service examination scores. For documented resident assessment overall, 96 percent of programs assess residents after every rotation; 37 percent asses after every procedure. Feedback is most frequently provided to residents after every rotation (52 percent), rather than only during committee reviews (32 percent) or after every documented assessment (16 percent). Sixty-four percent of respondents did not believe that milestones have helped in the mentorship role. CONCLUSIONS Implementation of the milestones has varied among integrated plastic surgery programs. Structured training for core faculty directed to methods of assessment will make milestones a more effective a tool by which to improve resident evaluation and education. These findings provide a key data set by which to revise the milestones for their second iteration.
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Graduate Plastic Surgery Education and Seventy-Five Years of Plastic and Reconstructive Surgery. Plast Reconstr Surg 2021; 148:1429-1435. [PMID: 34847137 DOI: 10.1097/prs.0000000000008530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Serebrakian AT, Petrusa ER, McKinley SK, Amador RO, Austen WG, Phitayakorn R. Evaluating and Comparing Emotional Intelligence and Improvement Mindset of Plastic Surgery Residents. J Surg Res 2021; 268:750-756. [PMID: 34399991 DOI: 10.1016/j.jss.2021.06.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emotional Intelligence (EI) has been linked to burnout, job satisfaction, and work performance among resident physicians. Individuals with a growth mindset believe intelligence and ability are traits that can be increased or improved upon through learning. EI and mindset have yet to be studied among plastic surgeons in the United States. MATERIALS AND METHODS An online survey was distributed to plastic surgery residents and general surgery residents at a single institution containing a validated EI survey tool (TEIQue-SF). Second, a survey was sent to all plastic surgery residents in the United States containing the TEIQue-SF and a validated survey tool to assess mindset (ITIS). RESULTS The response rate for the local study was 82% (plastic surgery) and 75% (general surgery). Only 7.8% of plastic surgery residents had any prior formal EI training or education. Mean global EI scores of local plastic surgery residents were higher than the normative population sample (P <0.0001). Plastic surgery and general surgery residents had similar EI scores. Integrated residents and junior plastic surgery residents had higher Well-Being scores compared to independent (P = 0.04) and senior residents (P = 0.04). Sixty-four plastic surgery residents completed the national survey. No correlation was found between EI and ITIS scores among the national plastic surgery resident cohort. CONCLUSION Despite different work profiles, general surgery and plastic surgery residents may have similar EI profiles. Mindset does not appear to correlate to EI domains. Future studies will focus on how EI and mindset may develop over the course of residency training and their relationship to overall resident wellness.
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Affiliation(s)
- Arman T Serebrakian
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, WAC 435, 15 Parkman Street, Boston, Massachusetts 02114.
| | - Emil R Petrusa
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 506, Boston, Massachusetts 02114
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 506, Boston, Massachusetts 02114
| | - Ricardo O Amador
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, WAC 435, 15 Parkman Street, Boston, Massachusetts 02114
| | - William G Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, WAC 435, 15 Parkman Street, Boston, Massachusetts 02114
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 506, Boston, Massachusetts 02114
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Kazan R, Abi-Rafeh J, Viezel-Mathieu A, Gilardino M. "Identification of Essential Assessment Criteria in Facial Botulinum Toxin Injections". J Plast Reconstr Aesthet Surg 2021; 75:1209-1214. [PMID: 34896042 DOI: 10.1016/j.bjps.2021.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 05/16/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Facial botulinum toxin injections represent the most commonly performed aesthetic non-surgical procedures by plastic surgeons; however, post-graduate programs remain devoid of objective tools to adequately assess competence in trainees. In this study, the authors employ the Delphi methodology to establish a list of essential assessment criteria in facial botulinum toxin injections. METHODS A list of 10 suggested criteria was generated through a literature search and in consultation with an expert plastic surgeon. A panel of content experts was selected to which an online survey was administered; skills were ranked for their relevance using a 1-10 Likert scale. Recommendations for additional skills were solicited and survey rounds were repeated until consensus was achieved. The latter was a measure of panelist reliability and assessed using Cronbach α (≥0.8); skills with a rating of 7 or above were taken to be essential. RESULTS The survey process was successful at achieving consensus following two rounds of survey administration. Twenty-one participants completed the first round representing a response rate of 38%. Percent agreement among the panel was 83% and Cronbach α was computed as 0.78, necessitating further rounds. The response rate in the second round was 90%; one additional skill was added; percent agreement and Cronbach α improved to 88% and 0.87, respectively. CONCLUSION Nine assessment criteria were identified as essential in facial botulinum toxin injections; these findings provide the groundwork necessary for the development of an objective assessment tool for the more appropriate training of marginalized aesthetic procedures in plastic surgery.
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Affiliation(s)
- Roy Kazan
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada..
| | - Jad Abi-Rafeh
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alex Viezel-Mathieu
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Mirko Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada
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Anderson HL, Kurtz J, West DC. Implementation and Use of Workplace-Based Assessment in Clinical Learning Environments: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S164-S174. [PMID: 34406132 DOI: 10.1097/acm.0000000000004366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Workplace-based assessment (WBA) serves a critical role in supporting competency-based medical education (CBME) by providing assessment data to inform competency decisions and support learning. Many WBA systems have been developed, but little is known about how to effectively implement WBA. Filling this gap is important for creating suitable and beneficial assessment processes that support large-scale use of CBME. As a step toward filling this gap, the authors describe what is known about WBA implementation and use to identify knowledge gaps and future directions. METHOD The authors used Arksey and O'Malley's 6-stage scoping review framework to conduct the review, including: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consulting with relevant stakeholders. RESULTS In 2019-2020, the authors searched and screened 726 papers for eligibility using defined inclusion and exclusion criteria. One hundred sixty-three met inclusion criteria. The authors identified 5 themes in their analysis: (1) Many WBA tools and programs have been implemented, and barriers are common across fields and specialties; (2) Theoretical perspectives emphasize the need for data-driven implementation strategies; (3) User perceptions of WBA vary and are often dependent on implementation factors; (4) Technology solutions could provide useful tools to support WBA; and (5) Many areas of future research and innovation remain. CONCLUSIONS Knowledge of WBA as an implemented practice to support CBME remains constrained. To remove these constraints, future research should aim to generate generalizable knowledge on WBA implementation and use, address implementation factors, and investigate remaining knowledge gaps.
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Affiliation(s)
- Hannah L Anderson
- H.L. Anderson is research associate, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-9435-1535
| | - Joshua Kurtz
- J. Kurtz is a first-year resident, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel C West
- D.C. West is professor of pediatrics, The Perelman School of Medicine at the University of Pennsylvania, and associate chair for education and senior director of medical education, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0002-0909-4213
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What Is Your Reality? Virtual, Augmented, and Mixed Reality in Plastic Surgery Training, Education, and Practice. Plast Reconstr Surg 2021; 147:505-511. [PMID: 33235047 DOI: 10.1097/prs.0000000000007595] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY Virtual reality and other technological advancements both inside and outside the operating room have shown an exponential increase in the past two decades. Surgical technique and finesse in delicate procedures have become ever more important, and the onus is on plastic surgeons and plastic surgery residents to meet these needs to provide the best outcomes possible to patients. The ability to learn, simulate, and practice operating in a fashion that poses no harm to any patient is truly a gift from technology to surgery that any surgeon could benefit from, whether trainee or attending. This application of technology and simulation has been demonstrated in other fields such as in the airline industry with flight simulation. The ability to learn, synthesize, and incorporate learned materials and ideas through virtual, augmented, and mixed reality tools offers a great opportunity to put our field at the forefront of a paradigm shift in surgical education. The critical utility of digital education could not be further emphasized any more than in the unfortunate and infrequent situation of a worldwide pandemic. This article reviews some of the important recent technologies that have developed and their applications in plastic surgery education and offers a look into what we can expect in the future.
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Tatum SA. The Art of Teaching, Training, and Putting the Scalpel in Residents' Hands. Facial Plast Surg Clin North Am 2020; 28:469-475. [PMID: 33010865 DOI: 10.1016/j.fsc.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surgical education is under tremendous pressure due to ever-increasing medical knowledge and demands on trainees' time. They must continually learn more in less time due to work hour limitations, regulations, and electronic medical record demands. Surgical training must become more efficient. There is an unprecedented array of education and training opportunities for resident preparation. The preparation for each case has to be maximal. Preoperative, intraoperative, and postoperative simulation and discussions improve the educational benefit of the trainee experience. For the teaching surgeon, putting a scalpel in residents' hands requires patience, knowledge, judgment, and a leap of faith in the resident.
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Affiliation(s)
- Sherard Austin Tatum
- Department of Otolaryngology, Cleft and Craniofacial Center, Division of Facial Plastic and Reconstructive Surgery, Upstate Medical University, State University of New York, 750 East Adams Street, CWB, Syracuse, NY 13210, USA.
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Abstract
BACKGROUND Plastic surgery education consists of technical skills, surgical decision-making, and the knowledge necessary to provide safe patient care. Competency in these modalities is ensured by requiring case minimums and oral and written examinations. However, there is a paucity of information detailing what teaching modalities residency programs use outside of the operating room. METHODS A 16-question survey was sent to all integrated and independent program directors. Information regarding nonsurgical resident education was collected and analyzed. RESULTS There were 44 responses (46 percent). Most programs had six to 10 faculty (43 percent), and a majority (85 percent) required faculty to participate in resident education outside of the operating room. Residents most commonly had 3 to 4 hours (43 percent) of protected educational time 1 day per week (53 percent). Nonsurgical education consisted of weekly lectures by attending physicians (44 percent) and residents (54 percent), in addition to weekly CoreQuest (48 percent), teaching rounds (38 percent), and Plastic Surgery Education Network lectures (55 percent). Monthly activities included morbidity and mortality conference (81 percent) and journal club (86 percent). Indications conference was either monthly (41 percent) or weekly (39 percent). Cadaver laboratories, visiting professors, board preparation, in-service review, and meetings with the program director occurred yearly or several times per year. Forty-nine percent of programs sponsor one educational course per resident. In addition, most programs (65 percent) do not receive outside funding for education. CONCLUSIONS These findings improve understanding of the current state of nonsurgical resident education in plastic surgery. They illustrate that residents participate in a diverse number of nonsurgical educational activities without any significant standardization.
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Agrawal N, Turner A, Grome L, Abu-Ghname A, Davis MJ, Reece EM, Buchanan EP, Winocour S. Use of Simulation in Plastic Surgery Training. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2896. [PMID: 32802639 PMCID: PMC7413819 DOI: 10.1097/gox.0000000000002896] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
The nationwide focus on patient safety and the health of residents has increased the demand for educational tools outside the operating room. Simulation is a valuable tool for assessing and developing surgical skills in a controlled and safe environment. The use of simulation as a formal component of training has been increasing in various surgical subspecialties. In general surgery, simulation examinations such as the Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery have become a prerequisite to board certification. Although formal simulation examinations in plastic surgery are not universal, there has been an increase in the use of simulation to increase resident competency in the operating room. For now, we will review the current state of simulation in craniofacial, hand, microvascular, and esthetic surgery and discuss applications for the future. We will also discuss the evolving role of artificial intelligence, virtual reality, and augmented reality in plastic surgery training and testing.
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Affiliation(s)
- Nikhil Agrawal
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Acara Turner
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Luke Grome
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Amjed Abu-Ghname
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Matthew J. Davis
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Edward M. Reece
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Edward P. Buchanan
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
- Division of Plastic Surgery, Department of Surgery, Texas Children’s Hospital, Houston, Tex
| | - Sebastian Winocour
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
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Does Realism Matter? A Randomized Controlled Trial Comparing Models for Medical Student Suture Education. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2738. [PMID: 32440409 PMCID: PMC7209846 DOI: 10.1097/gox.0000000000002738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
Background We hypothesized that medical students trained in suturing using high-fidelity models (cadaveric tissue) would demonstrate greater proficiency when compared with those trained using low-fidelity models (synthetic tissue). Methods Forty-three medical students were randomized into 2 groups. Group 1 consisted of students taught to perform simple interrupted sutures using synthetic tissue, and group 2 consisted of those taught using human cadaveric tissue. Suturing proficiency was measured pre- and postinstruction using the Global Rating Scale and by measuring suture accuracy. Perceived confidence in suturing was measured on a scale of 0-100. Results Perceived confidence was measured as an average of 8.26 out of 100 pretraining and significantly improved after training (56.91 out of 100); however, there was no significant difference when comparing confidence between groups posttraining (57.65 cadaveric versus 56.05 synthetic; P = 0.78), nor in the measured confidence change pre- and posttraining (P = 0.53). Posttraining, participants displayed a significant improvement in the number of adequately placed sutures; however, there was no significant difference posttraining when comparing groups (2.43 cadaveric versus 2.75 synthetic; P = 0.48). The change in adequate suture placement pre- and posttraining did not reach statistical significance between groups (P = 0.27). After instruction, participants demonstrated a significant improvement in total suture performance scores; however, there was no significant difference when comparing groups (30.04 cadaveric versus 29.80 synthetic; P = 0.90), nor in the total change pre- and posttraining (P = 0.74). Conclusions Training medium fidelity (tissue versus synthetic) does not significantly influence a student's overall suturing performance. However, formal instruction significantly improves objective competence and perceived confidence. Regardless of the model, surgical departments should emphasize medical student exposure to basic surgical skills education.
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Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review. Plast Reconstr Surg 2020; 144:496e-507e. [PMID: 31461050 DOI: 10.1097/prs.0000000000005990] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. METHODS A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. RESULTS Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. CONCLUSIONS A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.
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Concepts of Organizational Excellence in Medical Associations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2300. [PMID: 31624691 PMCID: PMC6635220 DOI: 10.1097/gox.0000000000002300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022]
Abstract
Professional associations are integral to the field of medicine; every physician becomes affiliated with at least 1 association throughout his/her entire career. Obtaining membership in such groups advances career development, engages in mentorship, and contributes in legislation and advocacy. Numerous studies have reported the benefits of teamwork in health care, but few have thoroughly investigated the characteristics that lead to organizational success. This article aims to provide a conceptual model for successful high-performing organizations and discuss their fundamental qualities, including structure, trust, productive conflict, accountability, collective success, and leadership. Additionally, we shared evidence-based techniques to establish and maintain these ideals.
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Reevaluating the Current Model of Rhinoplasty Training and Future Directions. Plast Reconstr Surg 2019; 144:597e-605e. [DOI: 10.1097/prs.0000000000005911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Current status of simulation training in plastic surgery residency programs: A review. Arch Plast Surg 2018; 45:395-402. [PMID: 30282409 PMCID: PMC6177637 DOI: 10.5999/aps.2017.01585] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/03/2018] [Indexed: 01/22/2023] Open
Abstract
Increased emphasis on competency-based learning modules and widespread departure from traditional models of Halstedian apprenticeship have made surgical simulation an increasingly appealing component of medical education. Surgical simulators are available in numerous modalities, including virtual, synthetic, animal, and non-living models. The ideal surgical simulator would facilitate the acquisition and refinement of surgical skills prior to clinical application, by mimicking the size, color, texture, recoil, and environment of the operating room. Simulation training has proven helpful for advancing specific surgical skills and techniques, aiding in early and late resident learning curves. In this review, the current applications and potential benefits of incorporating simulation-based surgical training into residency curriculum are explored in depth, specifically in the context of plastic surgery. Despite the prevalence of simulation-based training models, there is a paucity of research on integration into resident programs. Current curriculums emphasize the ability to identify anatomical landmarks and procedural steps through virtual simulation. Although transfer of these skills to the operating room is promising, careful attention must be paid to mastery versus memorization. In the authors’ opinions, curriculums should involve step-wise employment of diverse models in different stages of training to assess milestones. To date, the simulation of tactile experience that is reminiscent of real-time clinical scenarios remains challenging, and a sophisticated model has yet to be established.
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The Use of a Novel Local Flap Trainer in Plastic Surgery Education. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1786. [PMID: 30276039 PMCID: PMC6157937 DOI: 10.1097/gox.0000000000001786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/26/2018] [Indexed: 11/26/2022]
Abstract
With the limitations of work hour restrictions and legal liability surgical resident’s operative experience is declining. We sought to find other methods of training using tactile surgical simulations for plastic surgery. With the collaborative efforts of a local artist, a local flap trainer was designed to simulate the natural properties, layers, and interaction between layers of tissue. A session was held with Plastic Surgery faculty, residents, and students to review and practice local flaps using the trainer. Afterward, the participants filled out a survey evaluating the simulated skin and tissue model and the effectiveness of the class as a teaching model. The survey given had multiple questions asking the participant to provide a ranking from 1 to 10. The results show that the class utilizing the new suture pad was an effective teaching tool with an average score of 9.56. The suture pad was given a score of 6.77 for simulating realistic skin. Overall, the group rated increased understanding and confidence of local flaps after the class. Surgical skill simulations are becoming increasingly more important with the decline of resident operative experience. There are limited options for surgical simulations that provide a realistic experience. We designed a suture pad that is effective at simulating human tissue. The surveys show that using this suture pad in flap workshops provides a valuable teaching tool.
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Pietruski P, Majak M, Antoszewski B. Clinically Oriented Software for Facial Symmetry, Morphology, and Aesthetic Analysis. Aesthet Surg J 2017; 38:NP19-NP22. [PMID: 29117367 DOI: 10.1093/asj/sjx163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Piotr Pietruski
- Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Marcin Majak
- Department of Systems and Computer Networks, Faculty of Electronics, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Boguslaw Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Norbert Barlicki Memorial Hospital, Lodz, Poland
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A National Curriculum of Fundamental Skills for Plastic Surgery Residency: Report of the Inaugural ACAPS Boot Camp. Ann Plast Surg 2017; 78:121-126. [PMID: 28009599 DOI: 10.1097/sap.0000000000000977] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Inaugural American Council of Academic Plastic Surgeons Plastic Surgery Boot Camp program was developed in response to ongoing changes in graduate medical education. The Boot Camp is a hands-on, practicum-based, 3-day course to introduce core concepts in plastic surgery for new plastic surgery residents (in both integrated and independent tracks). METHODS The course was held in Pittsburgh in July to August 2015. There were 43 attendees (35 integrated/8 independent) representing 22 residency programs across 15 states. Faculty was composed of 8 local personnel and 5 visiting. Lecture topics and practical sessions covered the full spectrum of plastic surgery. All trainees completed an online survey evaluation both during the course and at 6 months. RESULTS Participant responses were overwhelmingly positive. A total of 72% of respondents rated the Boot Camp ≥ 8 on a 1 to 10 scale (10 is excellent) for the overall course rating; 79% of respondents agreed or strongly agreed with the statement that the simulation scenarios were realistic; and 75% of participants agreed or strongly agreed with the statement that they found simulation-based training to be a valuable way to teach this material. Respondents reported an increase in comfort and confidence across topics after attending the Boot Camp at both 0- and 6-month time points. Instructors received positive evaluations across all topics. CONCLUSIONS This successful inaugural course serves as a benchmark for development of a logistical blueprint, business plan, and curriculum for a proposed expansion to regional centers, to potentially encompass all incoming residents in plastic surgery.
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Silvestre J, Serletti JM, Chang B. Disparities in Aesthetic Procedures Performed by Plastic Surgery Residents. Aesthet Surg J 2017; 37:582-587. [PMID: 28025234 DOI: 10.1093/asj/sjw215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Operative experience in aesthetic surgery is an important issue affecting plastic surgery residents. Objectives This study addresses the variability of aesthetic surgery experience during plastic surgery residency. Methods National operative case logs of chief residents in independent/combined and integrated plastic surgery residency programs were analyzed (2011-2015). Fold differences between the bottom and top 10th percentiles of residents were calculated for each aesthetic procedure category and training model. The number of residents not achieving case minimums was also calculated. Results Case logs of 818 plastic surgery residents were analyzed. There was marked variability in craniofacial (range, 6.0-15.0), breast (range, 2.4-5.9), trunk/extremity (range, 3.0-16.0), and miscellaneous (range, 2.7-22.0) procedure categories. In 2015, the bottom 10th percentile of integrated and independent/combined residents did not achieve case minimums for botulinum toxin and dermal fillers. Case minimums were achieved for the other aesthetic procedure categories for all graduating years. Conclusions Significant variability persists for many aesthetic procedure categories during plastic surgery residency training. Greater efforts may be needed to improve the aesthetic surgery experience of plastic surgery residents.
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Affiliation(s)
- Jason Silvestre
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph M Serletti
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Chang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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