Assessing Performance in Simulated Cleft Palate Repair Using a Novel Video Recording Setup

Bilateral Cleft lip Simulation

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.

Evolution of Cleft Lip and Palate Surgical Training in the UK: A Qualitative Study

BACKGROUND

Although the United Kingdom (UK) cleft surgeons follow a similar training pathway, and cleft centers adhere to similar protocols regarding the timing of palate surgery and surgical technique, speech outcomes still vary between centers.

OBJECTIVE

To explore the training experiences of consultant cleft lip and palate (CL/P) surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP) and their approach to teaching others.

DESIGN

An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP and discuss what was important during training and upon qualifying as a consultant.

METHOD

A semi-structured interview schedule was designed, interviews were conducted in-person or via videoconferencing, depending on preference and availability, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis.

RESULTS

Fourteen cleft consultants from the UK participated (3F:11M). Seven of the consultants were trained in plastic surgery and four in maxillofacial surgery. Seven themes were identified from the thematic analysis. Three themes, namely Learning to perform palate repair, Teaching others to perform palate repair, and Ongoing learning as a consultant are discussed.

CONCLUSIONS

Cleft palate repair is clearly a technically challenging procedure to learn and teach with the potential to cause harm if performed incorrectly. Positive changes have been made to improve exposure to palate surgery, encourage practice away from the patient, and increase supervised practical experience. The role of colleagues in providing mentorship and support appears invaluable. We provide some simple recommendations that may improve the training experience and ensure parity for all trainees.

Maintaining technical proficiency in senior surgical fellows during the COVID-19 pandemic through virtual teaching

Objectives

The novel coronavirus (COVID-19) pandemic resulted in a severe reduction in operative opportunities for trainees. We hypothesized that augmenting independent practice with a bench model of vascular anastomoses using regular videoconferences and individual feedback would provide meaningful benefit in maintenance of technical skills in senior lung transplant surgical fellows.

Methods

A lung transplantation virtual technical skills course was developed. Surgical fellows were provided with a bench model and surgical instruments. Using a virtual communication platform, teaching sessions were held twice weekly, and fellows performed an anastomosis on camera. Video recordings were reviewed and critiqued by attending staff. At the end of the 3-month course, participants were surveyed about their experience. Warm ischaemic time was compared between fellows' five most recent cases before and after the pandemic.

Results

Seven senior surgical fellows participated and provided feedback. Fellows had graduated medical school an average of 14 years prior to fellowship, and spent an average of 5 hours (range 1.3 - 15 hours) of home practice. Five of seven (71%) participants reported improvement in their technical skills and increased confidence in performing a lung transplant. No significant difference in warm ischaemic time in procedures performed by fellows was identified (70.3 minutes pre-pandemic vs. 68.3 minutes post pandemic, p = 0.68).

Conclusions

A program of virtual technical skills teaching, individual video coaching, and independent practice provided benefit in maintaining technical skills in lung transplant surgical fellows during the COVID-19 pandemic, when equivalent operative experience was unavailable. Lessons learned from this exceptional time can be used to create simulation curricula for senior trainees.