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Gray T, Boccardi A, Shahwan KT. Simulation-based training in dermatologic surgery: a literature review. Arch Dermatol Res 2023; 315:2227-2232. [PMID: 37024689 DOI: 10.1007/s00403-023-02606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 01/17/2023] [Accepted: 03/09/2023] [Indexed: 04/08/2023]
Abstract
Simulation-based training has been shown to increase confidence and improve technical proficiency in surgical trainees. In this review, we describe the methods of simulation-based training currently being utilized in cutaneous surgery education. PubMed and EMBASE were searched for terms related to dermatologic surgery, education, and simulation. Articles published in English from 2013 onward that discussed simulation-based cutaneous surgery training of dermatology, plastic surgery, or otolaryngology resident physicians were included and summarized. Currently utilized simulation modalities in the training of dermatologic surgeons include skin substitutes, cadavers, and technology-based platforms. While each of these modalities have been shown to enhance trainee confidence and/or skill, head-to-head studies comparing their efficacy and usefulness are limited. Dermatologic surgery training, and therefore patient care, may be enhanced by further incorporation of simulation training. However, further studies are needed to clarify the optimal simulation platforms and delivery.
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Affiliation(s)
- Taylor Gray
- Department of Dermatology, The Ohio State University Medical Center, Columbus, OH, USA
| | - Aleia Boccardi
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | - Kathryn T Shahwan
- Department of Dermatology, The Ohio State University Medical Center, Columbus, OH, USA.
- University of North Dakota Medical School and Altru Health System, Grand Forks, ND, USA.
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Stiff KM, Jellinek NJ, Knackstedt TJ. Hands-On Nail Surgery Workshop Leads to Sustained Improvement in Comfort With Nail Surgery. Dermatol Surg 2021; 47:1670-1671. [PMID: 34743121 DOI: 10.1097/dss.0000000000003282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Nathaniel J Jellinek
- Department of Dermatology, Dermatology Professionals, Inc., East Greenwich, Rhode Island
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Ohio
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas J Knackstedt
- Department of Dermatology, MetroHealth System, Cleveland, Ohio
- Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Tuttle SD, Jin MF, Vidal NY. Survey on the Educational Gap in Dermatologic Procedural Billing and Coding. Dermatol Surg 2021; 47:1177-1178. [PMID: 33481439 DOI: 10.1097/dss.0000000000002860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Scott D Tuttle
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Mauricio F Jin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nahid Y Vidal
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Watchmaker J, Gwinn C, Dover JS. Positive and Negative Impact of the COVID-19 Pandemic on American Society for Dermatologic Surgery Cosmetic Fellowships. Dermatol Surg 2021; 47:1175-1176. [PMID: 34397551 DOI: 10.1097/dss.0000000000003038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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Jefferson IS, Robinson SK, Surprenant D, Whittington A, Arshanapalli A, Tung-Hahn E, Joyce C, Moy L, Lee K, O'Brien E, Tung R, Alam M. Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair. Arch Dermatol Res 2021; 313:793-797. [PMID: 33433713 DOI: 10.1007/s00403-020-02181-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.
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Affiliation(s)
- Itisha S Jefferson
- Stritch School of Medicine, Loyola University, Maywood, IL, USA.
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA.
| | - Shamika Kayo Robinson
- Stritch School of Medicine, Loyola University, Maywood, IL, USA
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - David Surprenant
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Adam Whittington
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Division of Dermatology, Advocate Aurora Health, Fond du Lac, WI, USA
| | - Ashish Arshanapalli
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- United Dermatology Associates, Mansfield, TX, USA
| | - Eleanor Tung-Hahn
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Cara Joyce
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Department of Statistics, Loyola University Medical Center, Maywood, IL, USA
| | - Lauren Moy
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Kristin Lee
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
| | - Ellie O'Brien
- Northwestern Simulation Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Tung
- Division of Dermatology, Loyola University Medical Center, Maywood, IL, USA
- Florida Dermatology and Skin Cancer Centers, Winter Haven, FL, USA
| | - Murad Alam
- Departments of Dermatology, Otolaryngology and Surgery, Feinberg School of Medicine, Northwestern University, 676 N St Clair Suite 1600, Chicago, IL, 60611, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Tracey EH. Surgical dermatoethics for the trainee. Cutis 2019; 103:E41-E43. [PMID: 31233594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Proficiency in performing dermatologic procedures is obtained by practice, and residents practice with real patients. The imperative of training new generations of dermatologists must be achieved while patient autonomy is respected and the highest standards of patient safety are upheld. This article examines ethical considerations that are inherent to the training process in procedural dermatology, including disclosing training status, informing patients of experience level with a particular procedure, and the need for graded responsibility under appropriate supervision.
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Abstract
BACKGROUND: The public and other physicians expect dermatologists to be experts on aesthetic dermatology services. In Canada, current challenges may limit residents from achieving competency in aesthetic dermatology during their training. This may adversely affect patient safety, create medicolegal risks, and deter graduates from offering aesthetic procedures. OBJECTIVES: The objective of this article is to characterize the curriculum, hands-on learning opportunities, and perceptions of aesthetic dermatologic training in Canadian dermatology residency training programs. METHODS: An online survey of faculty and residents within Canadian dermatology residency programs was performed. The main outcome measures were the hours of formal aesthetic dermatology teaching, the frequency of hands-on dermatology resident training with injectables and devices, and comparing faculty and resident perspectives regarding resident aesthetic dermatology training. RESULTS: Thirty-six faculty members (40%) and 47 residents (34%) responded to the survey. Lasers, fillers, neuromodulators, and mole removal were most commonly taught in the 10 hours or fewer of formal instruction. Residents commonly observed rather than performed procedures. High dissatisfaction among residents was reported with the quality and quantity of aesthetic dermatology training. Faculty and resident respondents supported increasing aesthetic dermatology education, and approximately 70% of residents plan to offer aesthetic services. Discounted pricing or resident-led clinics were felt to be ways to increase resident hands-on experience. CONCLUSIONS: The standardization of core competencies in aesthetic dermatologic procedures is essential to ensure patient safety and practitioner competence. At present, formal aesthetic dermatology training in residency may be insufficient for hands-on training. The majority of dermatology faculty and resident respondents support increasing aesthetic dermatology training.
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Affiliation(s)
- Brandon Worley
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
| | - Luvneet Verma
- 2 Faculty of Medicine, University of Ottawa, ON, Canada
| | - Jillian Macdonald
- 1 Division of Dermatology, Department of Medicine, University of Ottawa, ON, Canada
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Wu W, Goldberg L, Rubenzik M, Zelickson B. Clinical pearl: mastering the flexible scalpel blade with the banana practice model. Cutis 2017; 100:169-170. [PMID: 29121123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article describes the various applications of the flexible scalpel blade (FSB), the utility of the banana as a convenient and exceptional training instrument, and the intricacies of mastering the technique for students of different training levels.
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Affiliation(s)
- Wesley Wu
- Department of Dermatology, Houston Methodist Hospital, Texas, USA
| | | | - Marc Rubenzik
- Department of Dermatology, Houston Methodist Hospital, Texas, USA
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Rothenberger J, Seyed Jafari SM, Schnabel KP, Tschumi C, Angermeier S, Shafighi M. Evaluation of Medical Students' Attitudes and Performance of Basic Surgery Skills in a Training Program Using Fresh Human skin, Excised During Body Contouring Surgeries. J Surg Educ 2015; 72:868-874. [PMID: 25891499 DOI: 10.1016/j.jsurg.2015.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/29/2015] [Accepted: 03/08/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Learning surgical skills in the operating room may be a challenge for medical students. Therefore, more approaches using simulation to enable students to develop their practical skills are required. OBJECTIVES We hypothesized that (1) there would be a need for additional surgical training for medical students in the pre-final year, and (2) our basic surgery skills training program using fresh human skin would improve medical students' surgical skills. DESIGN We conducted a preliminary survey of medical students to clarify the need for further training in basic surgery procedures. A new approach using simulation to teach surgical skills on human skin was set up. The procedural skills of 15 randomly selected students were assessed in the operating room before and after participation in the simulation, using Objective Structured Assessment of Technical Skills. Furthermore, subjective assessment was performed based on students' self-evaluation. The data were analyzed using SPSS, version 21 (SPSS, Inc., Chicago, IL). SETTING The study took place at the Inselspital, Bern University Hospital. PARTICIPANTS A total of 186 pre-final-year medical students were enrolled into the preliminary survey; 15 randomly selected medical students participated in the basic surgical skills training course on the fresh human skin operating room. RESULTS The preliminary survey revealed the need for a surgical skills curriculum. The simulation approach we developed showed significant (p < 0.001) improvement for all 12 surgical skills, with mean cumulative precourse and postcourse values of 31.25 ± 5.013 and 45.38 ± 3.557, respectively. The self-evaluation contained positive feedback as well. CONCLUSION Simulation of surgery using human tissue samples could help medical students become more proficient in handling surgical instruments before stepping into a real surgical situation. We suggest further studies evaluating our proposed teaching method and the possibility of integrating this simulation approach into the medical school curriculum.
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Affiliation(s)
- Jens Rothenberger
- University Clinic of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Seyed Morteza Seyed Jafari
- University Clinic of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kai P Schnabel
- Department of Education and the Media, Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Christian Tschumi
- University Clinic of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarina Angermeier
- University Clinic of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maziar Shafighi
- University Clinic of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Kokoschka EM, Schmidt JB, Kopera D. [Austrian Society of Dermatology and Venereology (ÖGDV)]. J Dtsch Dermatol Ges 2014; 12:1068-9. [PMID: 25382578 DOI: 10.1111/ddg.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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de Sena DP, Fabricio DD, Lopes MHI, da Silva VD. Computer-assisted teaching of skin flap surgery: validation of a mobile platform software for medical students. PLoS One 2013; 8:e65833. [PMID: 23935818 PMCID: PMC3720809 DOI: 10.1371/journal.pone.0065833] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/29/2013] [Indexed: 01/22/2023] Open
Abstract
The purpose of this study was to develop and validate a multimedia software application for mobile platforms to assist in the teaching and learning process of design and construction of a skin flap. Traditional training in surgery is based on learning by doing. Initially, the use of cadavers and animal models appeared to be a valid alternative for training. However, many conflicts with these training models prompted progression to synthetic and virtual reality models. Fifty volunteer fifth- and sixth-year medical students completed a pretest and were randomly allocated into two groups of 25 students each. The control group was exposed for 5 minutes to a standard text-based print article, while the test group used multimedia software describing how to fashion a rhomboid flap. Each group then performed a cutaneous flap on a training bench model while being evaluated by three blinded BSPS (Brazilian Society of Plastic Surgery) board-certified surgeons using the OSATS (Objective Structured Assessment of Technical Skill) protocol and answered a post-test. The text-based group was then tested again using the software. The computer-assisted learning (CAL) group had superior performance as confirmed by checklist scores (p<0.002), overall global assessment (p = 0.017) and post-test results (p<0.001). All participants ranked the multimedia method as the best study tool. CAL learners exhibited better subjective and objective performance when fashioning rhomboid flaps as compared to those taught with standard print material. These findings indicate that students preferred to learn using the multimedia method.
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Affiliation(s)
- David P. de Sena
- Postgraduate Program in Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Daniela D. Fabricio
- Department of Otorhinolaryngology, Hospital Sao Lucas, PUCRS, Porto Alegre, Brazil
| | | | - Vinicius D. da Silva
- Department of Pathology and Radiation, Faculdade de Medicina, PUCRS, Porto Alegre, Brazil
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Clarkson B, Telner D. Comprehensive dermatologic procedures pad: innovation in hands-on resident procedural learning. Can Fam Physician 2013; 59:756-757. [PMID: 23851544 PMCID: PMC3710047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Blaise Clarkson
- Department of Family and Community Medicine, University of Toronto, Ontario
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Abbade LPF, Silva F, Guiotoku MM, Miot HA. Banana: a new simulation model to teach surgical techniques for treating ingrown toenails. Dermatol Surg 2013; 39:1274-6. [PMID: 23631629 DOI: 10.1111/dsu.12235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Smith MD, Kishikova L, Stuttaford LH, Norris JM. Synthetic epidermoid cyst simulation. Dermatol Surg 2013; 39:962-4. [PMID: 23551832 DOI: 10.1111/dsu.12211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Halvorson CR. Dermatology at the University of Maryland. Cutis 2012; 89:E1-E2. [PMID: 23961516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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