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Podolsky DJ, Yasabala B, Wong Riff KW, Fisher DM. Evaluation of a high-fidelity cleft alveolar bone graft simulator. J Plast Reconstr Aesthet Surg 2024; 93:269-278. [PMID: 38728899 DOI: 10.1016/j.bjps.2024.04.034] [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: 01/28/2024] [Revised: 03/03/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Cleft alveolar bone graft surgery is technically challenging to perform as well as difficult to learn and teach. A high-fidelity cleft alveolar bone graft simulator was previously developed. However, further evaluation of the simulator is necessary to assess its efficacy. METHODS Two cleft simulation workshops were conducted in which participants were led through a simulated cleft alveolar bone graft. The first simulation workshop involved six plastic surgery trainees. The second workshop involved 43 practicing cleft surgeons. The participants were provided with a Likert-type questionnaire assessing the simulators' features, realism, and value as a training tool. The change in self-reported confidence was assessed by providing each participant with a pre- and post-simulation confidence questionnaire. RESULTS There was overall agreement in the realism of the simulators' features (average score of 4.67 and 3.80 out of 5 for the trainees and surgeons, respectively). There was overall agreement to strong agreement in the simulators value as a training tool (average score of 5 and 4.43 out of 5 for the trainees and surgeons, respectively). The self-reported confidence increased for all questionnaire items for both the trainees and surgeons. This was significant (p < 0.05) for five out of eight and all questionnaire items for the trainees and surgeons, respectively. The magnitude of the confidence increase was generally greater for less experienced participants. CONCLUSION The cleft alveolar bone graft simulator was found to be realistic and valuable as a training platform. Use of the simulator improved self-reported confidence in cleft alveolar bone graft surgery.
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Affiliation(s)
- Dale J Podolsky
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Posluns Center for Image Guided Innovation and Therapeutic Intervention, Toronto, Ontario, Canada; Simulare Medical, Division of Smile Train, Toronto, Ontario, Canada.
| | | | - Karen W Wong Riff
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David M Fisher
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Stanek K, Yao CA, Livingston KA, Weinstock PH, Rogers-Vizena CR. Teaching Unilateral Cleft lip Repair: Lessons from Simulation-Based Mining of Trainee Strengths and Performance Gaps. Cleft Palate Craniofac J 2024; 61:834-843. [PMID: 36529578 DOI: 10.1177/10556656221146736] [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] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To identify specific areas for improvement in cleft lip repair teaching. DESIGN Secondary analysis of prospectively-collected, blinded data. SETTING Three residency programs rotating at a single academic children's hospital. PARTICIPANTS Plastic surgery residents, and craniofacial/pediatric plastic surgery fellows. MAIN OUTCOME MEASURES Mean scores for each skill in an 18-item Unilateral Cleft Lip Repair competency assessment tool (UCLR) (1-3 scale for each item) were rank ordered. Correlation between level of training (PGY) and performance on steps of the procedure was examined using Pearson R. RESULTS Simulation participants (n = 26) scored highest on skills in the "Marking" subscale (2.38-2.63 mean score). Procedural steps that scored lowest were: closing the nasal floor (2.00), repairing oral mucosa (2.15) and avoiding over/under-dissection (2.19). Interestingly, none of these skills correlated with PGY, suggesting they do not improve with training. CONCLUSIONS These results suggest that marking cleft lip repair is taught well in our current teaching environment, while steps like closing the nasal floor and repairing the oral mucosa are taught less well. Improved teaching of these steps could be achieved with deliberate instruction, video, digital simulation, and high fidelity simulation.
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Affiliation(s)
- Krystof Stanek
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Caroline A Yao
- Department of Plastic Surgery, Shriner's Hospital for Children, Los Angeles, CA, USA
- Operation Smile, Virginia Beach, Virginia, USA
| | | | - Peter H Weinstock
- Boston Children's Hospital Simulator Program (SIMPeds), Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesia and Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Foppiani J, Stanek K, Alvarez AH, Weidman A, Valentine L, Oh IJ, Albakri K, Choudry U, Rogers-Vizena CR, Lin SJ. Merits of simulation-based education: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 90:227-239. [PMID: 38387420 DOI: 10.1016/j.bjps.2024.01.021] [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: 05/06/2023] [Revised: 11/07/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND The drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents. METHODS A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes. RESULTS Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1-5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1-5 scale. CONCLUSIONS Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery.
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Affiliation(s)
- Jose Foppiani
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Krystof Stanek
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Allan Weidman
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lauren Valentine
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Irena J Oh
- Georgetown University School of Medicine, Washington, DC, USA
| | - Khaled Albakri
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Umar Choudry
- Department of Plastic and Reconstructive Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Department of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA.
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Zaga-Galante J, Tse R, Hopper RA, Arnold A, Fisher DM, Wong-Riff KW, Podolsky DJ. Bilateral Cleft lip Simulation. Cleft Palate Craniofac J 2024:10556656241230882. [PMID: 38354301 DOI: 10.1177/10556656241230882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE To evaluate the features, anatomic accuracy, and educational value of a high-fidelity bilateral cleft lip simulator. DESIGN Evaluation of the simulator by expert cleft surgeons after performing a simulated bilateral cleft lip repair. SETTING The simulator was evaluated by the surgeons during the Latin American Craniofacial Association meeting. PARTICIPANTS Eleven experienced cleft surgeons evaluated the simulator. The cleft surgeons were selected based on their availability during the meeting. INTERVENTIONS The participants performed a simulated bilateral cleft lip repair. They were each provided with a questionnaire assessing the simulator's features, realism and value as a training tool. MAIN OUTCOME MEASURE (S) The main outcome measure are the scores obtained from a Likert-type questionnaire assessing the simulators features, realism and value. RESULTS Overall, the surgeons agreed with the simulator's realism and anatomic accuracy (average score of 3.7 out of 5). Overall, the surgeons strongly agreed with the value of the simulator as a training tool (average score of 4.6 out of 5). CONCLUSIONS A high-fidelity bilateral cleft lip simulator was developed that is realistic and valuable as a training tool. The simulator provides a comprehensive training platform to gain hands-on experience in bilateral cleft lip repair before operating on real patients.
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Affiliation(s)
- Jonathan Zaga-Galante
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Raymond Tse
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Richard A Hopper
- Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, USA
| | | | - David M Fisher
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen W Wong-Riff
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dale J Podolsky
- Division of Plastic & Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Posluns Center for Image Guided Innovation and Therapeutic Intervention (PCIGITI), Toronto, Ontario, Canada
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Rogers-Vizena CR, Saldanha FYL, Sideridis GD, Allan CK, Livingston KA, Nussbaum L, Weinstock PH. High-Fidelity Cleft Simulation Maintains Improvements in Performance and Confidence: A Prospective Study. JOURNAL OF SURGICAL EDUCATION 2023; 80:1859-1867. [PMID: 37679288 DOI: 10.1016/j.jsurg.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE High-fidelity simulation has a growing role in plastic surgical education. This study tests the hypothesis that cleft lip repair simulation followed by structured debriefing improves performance and self-confidence and that gains are maintained. DESIGN Prospective, single-blinded interventional study with repeated measures. Trainees performed cleft lip repair on a high-fidelity simulator followed by debriefing, immediately completed a second repair, and returned 3 months later for a third session. Anonymized simulation videos were rated using the modified Objective Structured Assessment of Technical Skills (OSATS) and the Unilateral Cleft Lip Repair competency assessment tool (UCLR). Self-assessed cleft lip knowledge/confidence and procedural self-confidence were surveyed after each simulation. SETTING Boston Children's Hospital, a tertiary care academic hospital in Boston, MA, USA. PARTICIPANTS All trainees rotating through the study setting were eligible. Twenty-six participated; 21 returned for follow-up. RESULTS Significant improvements (p < 0.05) occurred between the first and second simulations for OSATS, UCLR, and procedural self-confidence. Significant improvement occurred between the second and third simulations cleft lip knowledge/confidence. Compared to the first simulation, improvements were maintained at the third simulation for all variables. Training level moderately correlated with score for UCLR for the first simulation (r = 0.55, p < 0.01), deteriorated somewhat with the second (r = 0.35, p = 0.08), and no longer corelated by the third (r = 0.02, p = 0.92). CONCLUSIONS Objective performance and subjective self-assessed knowledge and confidence improve with high-fidelity simulation plus structured debriefing and improvement is maintained. Differences in procedure-specific performance seen with increasing training level are reduced with simulation, suggesting it may accelerate knowledge and skill acquisition.
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Affiliation(s)
- Carolyn R Rogers-Vizena
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Francesca Y L Saldanha
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Georgios D Sideridis
- Harvard Medical School, Boston, Massachusetts; Institutional Centers for Clinical & Translational Research, Boston Children's Hospital, Boston, Massachusetts
| | - Catherine K Allan
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Katie A Livingston
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts
| | - Lisa Nussbaum
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Peter H Weinstock
- Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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Lutz R, Schulz KL, Weber M, Olmos M, Möst T, Bürstner J, Kesting MR. An ex vivo model for education and training of unilateral cleft lip surgery. BMC MEDICAL EDUCATION 2023; 23:765. [PMID: 37828467 PMCID: PMC10571449 DOI: 10.1186/s12909-023-04667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Unilateral cleft lip surgery is a complex procedure, and the outcome depends highly on the surgeon's experience. Digital simulations and low-fidelity models seem inadequate for effective surgical education and training. There are only few realistic models for haptic simulation of cleft surgery, which are all based on synthetic materials that are costly and complex to produce. Hence, they are not fully available to train and educate surgical trainees. This study aims to develop an inexpensive, widely available, high-fidelity, ex vivo model of a unilateral cleft lip using a porcine snout disc. METHODS A foil template was manufactured combining anatomical landmarks of the porcine snout disc and the anatomical situation of a child with a unilateral cleft. This template was used to create an ex vivo model of a unilateral cleft lip from the snout disc. Millard II technique was applied on the model to proof its suitability. The individual steps of the surgical cleft closure were photo-documented and three-dimensional scans of the model were analysed digitally. Sixteen surgical trainees were instructed to create a unilateral cleft model and perform a unilateral lip plasty. Their self-assessment was evaluated by means of a questionnaire. RESULTS The porcine snout disc proved highly suitable to serve as a simulation model for unilateral cleft lip surgery. Millard II technique was successfully performed as we were able to perform all steps of unilateral cleft surgery, including muscle suturing. The developed foil-template is reusable on any porcine snout disc. The creation of the ex vivo model is simple and inexpensive. Self-assessment of the participants showed a strong increase in comprehension and an eagerness to use the model for surgical training. CONCLUSIONS A porcine snout disc ex vivo model of unilateral cleft lips was developed successfully. It shows many advantages, including a haptic close to human tissue, multiple layers, low cost, and wide and rapid availability. It is therefore very suitable for teaching and training beginners in cleft surgery and subsequently improving surgical skills and knowledge. Further research is needed to finally assess the ex vivo model's value in different stages of the curriculum of surgical residency.
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Affiliation(s)
- Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany.
| | - Katja Leonie Schulz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Manuel Olmos
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Tobias Möst
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Jan Bürstner
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
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Lutz R, Kesting MR, Weber M, Olmos M, Tasyürek D, Möst T, Bürstner J, Schulz KL. An ex vivo model for education and training of bilateral cleft lip surgery. BMC MEDICAL EDUCATION 2023; 23:582. [PMID: 37596574 PMCID: PMC10436624 DOI: 10.1186/s12909-023-04575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Bilateral cleft lip surgery is very challenging and requires a high level of skill, knowledge and experience. Existing high-fidelity simulation models that can be used by novice cleft surgeons to gain experience and expand their knowledge are rare and expensive. In this study, we developed a bilateral cleft lip model using porcine snout discs, which are available anywhere and inexpensive. METHODS Anatomic reference points of a patient with a bilateral cleft lip were superimposed with landmarks of the porcine snout disc on a foil template. The template was used to construct an ex vivo bilateral cleft lip model. Surgery was performed on the model according to Millard and the surgical steps were photodocumented analogous to two clinical cases of bilateral cleft lip surgery. The suitability of the model was further tested by twelve participants and evaluated using self-assessment questionnaires. RESULTS The bilateral cleft lip ex vivo model made of a porcine snout disc proved to be a suitable model with very low cost and ease of fabrication, as the template is reusable on any snout disc. The Millard procedure was successfully performed and the surgical steps of the lip plasty were simulated close to the clinical situation. Regarding the nasal reconstruction, the model lacks three-dimensionality. As a training model, it enhanced the participants comprehension of cleft surgery as well as their surgical skills. All participants rated the model as valuable for teaching and training. CONCLUSIONS The porcine snout discs can be used as a useful ex vivo model for bilateral cleft lip surgery with limitations in the construction of the nose, which cannot be realistically performed with the model due to anatomical differences with humans. Benefits include a realistic tissue feel, the simulation of a multi-layered lip construction, a wide and rapid availability and low cost. This allows the model to be used by novice surgeons also in low-income countries. It is therefore useful as a training model for gaining experience, but also as a model for refining, testing and evaluating surgical techniques for bilateral lip plasty.
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Affiliation(s)
- Rainer Lutz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany.
| | - Marco Rainer Kesting
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Manuel Weber
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Manuel Olmos
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Deniz Tasyürek
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Tobias Möst
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Jan Bürstner
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
| | - Katja Leonie Schulz
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glückstrasse 11, 91054, Erlangen, Germany
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Patel A, Massand S, Ingraham J. The state of remote learning in plastic surgery: A systematic review of modalities. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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: 5] [Impact Index Per Article: 2.5] [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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Nicholas R, Heinze Z, Papavasiliou T, Fiadeiro R, Atherton D, Timoney N, Echlin K. Educational Impact of a Novel Cleft Palate Surgical Simulator: Improvement in Surgical Trainees’ Knowledge and Confidence. J Plast Reconstr Aesthet Surg 2022; 75:3817-3825. [DOI: 10.1016/j.bjps.2022.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/01/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
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Reply: Response to: Incorporating Cleft Lip Simulation Into a "Bootcamp-Style" Curriculum. Ann Plast Surg 2021; 89:245-246. [PMID: 34670982 DOI: 10.1097/sap.0000000000003012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saldanha FYL, Loan GJ, Calabrese CE, Sideridis GD, Weinstock PH, Rogers-Vizena CR. Incorporating Cleft Lip Simulation Into a "Bootcamp-Style" Curriculum. Ann Plast Surg 2021; 86:210-216. [PMID: 32049760 DOI: 10.1097/sap.0000000000002265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The traditions of surgical education have changed little over the years. However, the increasing focus on patient safety and duty hour restrictions mandates that residents start developing complex skill sets earlier to ensure they graduate with procedural competency. Surgical training is poised to exploit high-fidelity simulation technology to mitigate these pressures. METHODS By revisiting principles of adult learning theory, the authors created a "bootcamp-style" cleft lip curriculum that sought to (1) maximize educational impact and (2) pilot a high-fidelity procedural trainer permitting resident operative autonomy as part of that curriculum. Trainees participated in small group educational sessions comprised of a standard cleft didactic lecture, augmented by instructional video. Participants immediately processed knowledge from the lecture/video by "operating" on the simulator, allowing opportunities for questions and self-reflection, completing the learning cycle. A self-assessment survey was taken before and after each component of the session, including a self-confidence survey to conclude the session. Anthropometric measures of lip/nasal symmetry were assessed. RESULTS Sixteen trainees participated in the program. Little increase in self-assessed knowledge/skill was seen after the lecture, but significant increases in most aspects of cleft lip repair were seen after simulation. The greatest increase in self-assessment was seen for the program as a whole, with significant differences across all aspects of the self-assessment. Higher levels of training were associated with both higher self-assessment scores and better lip symmetry. Regardless of level of training, all participants strongly agreed that simulation helped them actively engage in learning and should be a required aspect of training, whereas 94% (n = 15) thought simulation was much more effective than standard preparation alone. CONCLUSIONS This pilot curriculum illustrates a mechanism to incorporate lessons from adult learning theory into plastic surgery training using a high-fidelity simulator for deliberate practice of cleft lip repair. Further evaluation is warranted to determine whether this didactic model can accelerate the acquisition of the complex skill set required for cleft lip repair and other surgical procedures.
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Affiliation(s)
| | | | - Carly E Calabrese
- From the Department of Plastic and Oral Surgery, Boston Children's Hospital
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Padmanabhan R, Rahman S, Fallico N. A Simple Training Method to Practice Cleft Lip and Palate Markings for Trainee Surgeons. Cleft Palate Craniofac J 2021; 58:1335-1336. [PMID: 33461332 PMCID: PMC8494002 DOI: 10.1177/1055665620980231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Shakeel Rahman
- Department of Plastic Surgery, Guy's and St Thomas' Hospital, London, UK
| | - Nefer Fallico
- The Spires Cleft Centre, Salisbury-Oxford Health NHS Foundation Trust, Salisbury, UK
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Videoscope-Assisted Cleft Palate Surgery: Rationale, Experience, and Technical Implementation. Plast Reconstr Surg 2020; 146:1129-1132. [DOI: 10.1097/prs.0000000000007291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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A Competency Assessment Tool for Unilateral Cleft Lip Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2954. [PMID: 32802652 PMCID: PMC7413813 DOI: 10.1097/gox.0000000000002954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/08/2020] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. Objective evaluation of operative performance is increasingly important in surgical training. Evaluation tools include global rating scales of performance and procedure-specific skills checklists. For unilateral cleft lip repair, the numerous techniques make universal evaluation challenging. Thus, we sought to create a unilateral cleft lip evaluation tool agnostic to specific repair technique.
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Knowledge and Skills Acquisition by Plastic Surgery Residents through Digital Simulation Training. Plast Reconstr Surg 2020; 145:184e-192e. [DOI: 10.1097/prs.0000000000006375] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kantar RS, Alfonso AR, Ramly EP, Diaz-Siso JR, Breugem CC, Flores RL. Simulation in Cleft Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2438. [PMID: 31942398 PMCID: PMC6908384 DOI: 10.1097/gox.0000000000002438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022]
Abstract
A number of digital and haptic simulators have been developed to address challenges facing cleft surgery education. However, to date, a comprehensive review of available simulators has yet to be performed. Our goal is to appraise cleft surgery simulators that have been described to date, their role within a simulation-based educational strategy, the costs associated with their use, and data supporting or refuting their utility.
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Affiliation(s)
- Rami S Kantar
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Allyson R Alfonso
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Elie P Ramly
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - J Rodrigo Diaz-Siso
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
| | - Corstiaan C Breugem
- Department of Plastic and Reconstructive Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roberto L Flores
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, N.Y
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Maximizing Plastic Surgery Education Impact: Lessons from Resident Learning Styles and Experiential Learning Theory. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2252. [PMID: 31942326 PMCID: PMC6952154 DOI: 10.1097/gox.0000000000002252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/15/2019] [Indexed: 11/25/2022]
Abstract
Residents in many surgical disciplines express a strong preference for hands-on learning, but no studies have focused on plastic surgery. This initial study aims to ascertain the learning styles of plastic surgery residents, and identify potential trends that may better guide curriculum development. Methods Kolb Learning Style Index v. 3.1 was administered to plastic surgery residents across all training levels at three residency programs. The Kolb Learning Style Index is a 12-item questionnaire that characterizes an individual's learning style into 1 of 4 major categories: converging; accommodating; assimilating; and diverging. Results The surveyed cohort of plastic surgery residents (n = 45) demonstrated a diverse mix of learning styles: converging (38%, n = 17); accommodating (24%, n = 11); diverging (20%, n = 9); and assimilating (16%, n = 7). One resident was balanced between converging and accommodating (2%, n = 1). Despite varied learning styles, the majority (64%, n = 29) demonstrated a preference for "active experimentation," for example, hands-on learning. Conclusions A preliminary assessment of learning styles among plastic surgery residents suggests that they have mixed learning styles. This contrasts with the existing literature from other surgical specialties where a single learning style dominates. However, like these other specialties, active experimentation is particularly valued. As such, it behooves the plastic surgery educator to continue to strive for balance between book learning and hands-on experience for residents at all levels of training, to engage residents with all learning styles.
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19
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Riedle H, Burkhardt AE, Seitz V, Pachaly B, Reid RR, Lee JC, Franke JE. Design and fabrication of a generic 3D-printed silicone unilateral cleft lip and palate model. J Plast Reconstr Aesthet Surg 2019; 72:1669-1674. [PMID: 31445940 DOI: 10.1016/j.bjps.2019.06.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
The complexity of plastic surgery procedures often requires visualization of the anatomy in three dimensions and therefore demands the development of new and innovative teaching methods. This work describes the development and manufacture of a 3D silicone cleft lip and palate (CLP) model evaluated by surgical residents on its similarity to the biological model. Thirty unilateral CLP models were created and distributed to residents at two different institutions. The model was based on an adult CT scan that was manipulated to resemble an infant with a complete unilateral CLP. This digital model was directly printed in silicone elastomer pieces and later assembled. The residents rated the model based on its realistic value as well as whether or not they felt it improved their surgical technique. Twenty residents used the model to simulate a CLP repair. The structure of the model was rated as fairly realistic while both the material and assembly of the model require improvement in subsequent manufacturing. Post simulation, residents rated the model highly for how accurately it simulated the surgical procedure. An accurate 3D silicone unilateral cleft lip and palate replica was successfully created for educational purposes. This new approach combines a flexible generic design with automated manufacture.
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Affiliation(s)
- Hannah Riedle
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, Egerlandstr. 7-9, 91058 Erlangen, Germany.
| | - Andrea E Burkhardt
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, Egerlandstr. 7-9, 91058 Erlangen, Germany
| | - Vera Seitz
- Wacker Chemie AG, Hanns-Seidel-Platz 4, 81737 Munich, Germany
| | - Bernd Pachaly
- Wacker Chemie AG, Hanns-Seidel-Platz 4, 81737 Munich, Germany
| | - Russell R Reid
- Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637, USA
| | - Justine C Lee
- Division of Plastic and Reconstructive Surgery, University of California Los Angeles, 200 Medical Plaza Driveway 465, Los Angeles, CA 90095, USA
| | - Jörg E Franke
- Institute for Factory Automation and Production Systems, Friedrich-Alexander-Universität Erlangen-Nürnberg, Egerlandstr. 7-9, 91058 Erlangen, Germany
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