Use of Simulation in Plastic Surgery Training

Technical skills assessment during simulated cleft lip repair

INTRODUCTION

Cleft lip repair is a challenging procedure with a steep learning curve. A cleft lip simulator can augment the operating experience to shorten the learning curve. This study evaluated the efficacy of a high-fidelity cleft lip simulator using a newly developed cleft lip technical assessment tool.

METHODS

Four plastic surgery residents and 6 fellows performed 3 sequential cleft lip repairs. Three staff surgeons performed 1 cleft lip repair. Each procedure was video recorded and assessed by 3 staff cleft surgeons using a newly developed cleft lip technical assessment scale and a previously developed global rating scale. The reliability (intraclass correlation coefficient [ICC]) of the assessment scores was determined. The first simulation session was compared among participants to determine whether the scales and simulator could distinguish between skill level. Learning curves were determined using successive assessment scores among the trainees.

RESULTS

The average ICC for the cleft lip-specific and global scores were 0.72 (range 0.65-0.82) and 0.70 (range 0.60-0.79), respectively. All scale items demonstrated statistically significant interrater reliability. The staff surgeons significantly outperformed the trainees in the first simulation session for both assessment scores (p < 0.05). The trainees demonstrated improved performance after each session.

CONCLUSIONS

A cleft lip assessment scale was developed and found to be reliable at evaluating technical skill in simulated cleft lip repair. Repeated use of the cleft lip simulator improved performance in simulated cleft lip repair.

Course Review: Surgical Art Hand Fracture Fixation Course August 2024

ABSTRACT

Hand fracture management is an important skill for both plastic and orthopedic surgery, which is often not practiced during early surgical training. Simulation training can be used to supplement clinical practice. The Surgical Art Hand Fracture Fixation course is a 2-day course based in Liverpool that aims to teach the principles of stabilization and fixation of hand fractures. This article provides an evaluation of the August 2024 course. Highlights included the unique animal bone constructs used, the quantity of time for hands-on practice, and the personalized teaching from faculty. Areas for improvement included allocating more time to practice surgical planning and further expansion on surgical approaches. Overall, this course is recommended to surgical trainees with an interest in hand surgery.

A Systematic Review to Explore the Role of Industry and Regulators on Minimally Invasive Aesthetics Education: A Tale of Two Cities

INTRODUCTION

The aesthetic medicine industry has seen significant growth due to technological advancements and increasing demand for minimally invasive procedures. This sector's influence on educational institutions is profound, often shaping curricula to align with industry standards. However, this focus can sometimes narrow educational scope, potentially compromising the broader intellectual and ethical development of medical professionals.

METHODS

This study employs a comprehensive literature review to examine the influence of the aesthetic medicine industry on medical education. A systematic search was conducted across academic databases including PubMed, Google Scholar, and ScienceDirect, focusing on articles published between January 2003 and December 2023. Inclusion criteria encompassed studies examining the impact of industry on medical education, financial relationships, ethical implications, and student outcomes.

RESULTS

Out of 279 studies identified, 21 met the inclusion criteria. The analysis highlighted themes such as the need for a balanced curriculum integrating both theoretical and practical training, the impact of financial incentives on educational integrity, and the importance of ethical guidelines. The literature underscores the necessity for standardised curricula and enhanced regulatory oversight to ensure comprehensive and unbiased education.

CONCLUSION

The aesthetic medicine industry's significant influence on medical education necessitates a balanced approach that integrates industry advancements with ethical and comprehensive educational practices. Addressing these challenges requires collaboration between academic institutions and industry partners, alongside stringent regulatory oversight. By ensuring educational integrity and fostering holistic training, the field can produce well-rounded professionals capable of ethical and effective practice in aesthetic medicine.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Orthopaedic Hand Surgical Simulation Training: A Review

In recent years, new orthopaedic surgical simulation and virtual reality (VR) training models have emerged to provide unlimited education medium to an unlimited number of trainees with no time limit, especially in response to trainee work-hour restrictions. Surgical simulators range from simple wooden boxes to animal and cadaver models to three-dimensional-printed and VR simulators. The coronavirus disease 2019 pandemic further highlighted the need for at-home learning tools for orthopaedic surgical trainees. Advancement in simulating shoulder and knee arthroscopies using VR simulators surpasses the other fields in orthopaedic surgery. Despite the high degree of precision needed to operate at a microscopic level involving vessels, nerves, and the small bones of the hand, the simulation tools have limited advancement in the field of orthopaedic hand surgery. This narrative review summarizes the status of surgical simulation and training techniques available to orthopaedic hand surgical trainees, factors affecting their application, and areas in hand surgery that still lag behind their surgical subspecialty counterparts.

From Augmented to Virtual Reality in Plastic Surgery: Blazing the Trail to a New Frontier

BACKGROUND

 Augmented reality (AR) and virtual reality (VR)-termed mixed reality-have shown promise in the care of operative patients. Currently, AR and VR have well-known applications for craniofacial surgery, specifically in preoperative planning. However, the application of AR/VR technology to other reconstructive challenges has not been widely adopted. Thus, the purpose of this investigation is to outline the current applications of AR and VR in the operative setting.

METHODS

 The literature pertaining to the use of AR/VR technology in the operative setting was examined. Emphasis was placed on the use of mixed reality technology in surgical subspecialities, including plastic surgery, oral and maxillofacial surgery, colorectal surgery, neurosurgery, otolaryngology, neurosurgery, and orthopaedic surgery.

RESULTS

 Presently, mixed reality is widely used in the care of patients requiring complex reconstruction of the craniomaxillofacial skeleton for pre- and intraoperative planning. For upper extremity amputees, there is evidence that VR may be efficacious in the treatment of phantom limb pain. Furthermore, VR has untapped potential as a cost-effective tool for microsurgical education and for training residents on techniques in surgical and nonsurgical aesthetic treatment. There is utility for mixed reality in breast reconstruction for preoperative planning, mapping perforators, and decreasing operative time. VR has well- documented applications in the planning of deep inferior epigastric perforator flaps by creating three-dimensional immersive simulations based on a patient's preoperative computed tomography angiogram.

CONCLUSION

 The benefits of AR and VR are numerous for both patients and surgeons. VR has been shown to increase surgical precision and decrease operative time. Furthermore, it is effective for patient-specific rehearsal which uses the patient's exact anatomical data to rehearse the procedure before performing it on the actual patient. Taken together, AR/VR technology can improve patient outcomes, decrease operative times, and lower the burden of care on both patients and health care institutions.

Building Your Future Holographic Mentor: Can We Use Mixed Reality Holograms for Visual Spatial Motor Skills Acquisition in Surgical Education?

Learning surgical skills require critical visual-spatial motor skills. Current learning methods employ costly and limited in-person teaching in addition to supplementation by videos, textbooks, and cadaveric labs. Increasingly limited healthcare resources and in-person training has led to growing concerns for skills acquisition of trainees. Recent Mixed Reality (MR) devices offer an attractive solution to these resource barriers by providing three-dimensional holographic representations of reality that mimic in-person experiences in a portable, individualized, and cost-effective form. We developed and evaluated two holographic MR models to explore the feasibility of visual-spatial motor skill acquisition from a technical development, learning, and usability perspective. In our first, a pair of holographic hands were created and projected in front of the trainee, and participants were evaluated on their ability to learn complex hand motions in comparison to traditional methods of video and apprenticeship-based learning. The second model displayed a 3D holographic model of the middle and inner ear with labeled anatomical structures which users could explore and user experience feedback was obtained. Our studies demonstrated that scores between MR and apprenticeship learning were comparable. All felt MR was an effective learning tool and most noted that the MR models were better than existing didactic methods of learning. Identified advantages of MR included the ability to provide true 3D spatial representation, improved visualization of smaller structures in detail by upscaling the models, and improved interactivity. Our results demonstrate that holographic learning is able to mimic in-person learning for visual-spatial motor skills and could be a new effective form of self-directed apprenticeship learning.

Blue-Blood Pig Thorax Model Increases Residents' Confidence in Internal Mammary Dissection

BACKGROUND

 Preparation of the recipient vessels is a crucial step in autologous breast reconstruction, with limited opportunity for resident training intraoperatively. The Blue-Blood-infused porcine chest wall-a cadaveric pig thorax embedded in a mannequin shell, connected to a saline perfusion system-is a novel, cost-effective ($55) simulator of internal mammary artery (IMA) dissection and anastomosis intended to improve resident's comfort, safety, and expertise with all steps of this procedure. The purpose of this study was to assess the effect of the use of this chest wall model on resident's confidence in performing dissection and anastomosis of the IMA, as well as obtain resident's and faculty's perspectives on model realism and utility.

METHODS

 Plastic surgery residents and microsurgery faculty at the University of Wisconsin were invited to participate. One expert microsurgeon led individual training sessions and performed as the microsurgical assistant. Participants anonymously completed surveys prior to and immediately following their training session to assess their change in confidence performing the procedure, as well as their perception of model realism and utility as a formal microsurgical training tool on a five-point scale.

RESULTS

 Every participant saw improvement in confidence after their training session in a minimum of one of seven key procedural steps identified. Of participants who had experience with this procedure in humans, the majority rated model anatomy and performance of key procedural steps as "very" or "extremely" realistic as compared with humans. 100% of participants believed practice with this model would improve residents' ability to perform this operation in the operating room and 100% of participants would recommend this model be incorporated into the microsurgical training curriculum.

CONCLUSION

 The Blue-Blood porcine chest wall simulator increases trainee confidence in performing key steps of IMA dissection and anastomosis and is perceived as valuable to residents and faculty alike.

Two cleft palate simulators of Furlow double-opposing Z- palatoplasty: a comparative study

PURPOSE

This study aimed to evaluate the efficiency of the porcine tongue for palatoplasty simulation compared to 3D-printed simulators and their surgical education role.

MATERIALS AND METHODS

A total of 18 senior cleft surgeons participated in a palatoplasty simulation-based workshop conducted using porcine tongue simulators and 3D-printed simulators. This workshop consisted of a didactic session followed by a hands-on simulation session. Each participant independently used both simulators to perform Furlow double-opposing Z-plasty, which was assessed and scored by senior cleft surgeons using a scoring system including organizational flexibility and ductility, anatomical design simulation, proper incision, proper suturing, and convenience of operation. A paired t test was used for data statistical analysis and a P value < 0.05 was regarded as a statistically significant difference.

RESULTS

All senior cleft surgeons strongly agreed that the simulation-based workshop was a valuable learning experience, and both simulators were useful and easy to manipulate (P = 1.00). The results of this comparative study showed that a porcine tongue palatoplasty simulator had an effectively significant difference in terms of organizational flexibility and ductility (P = 0.04), and suturing was better than the 3D-printed palatoplasty simulator (P < 0.01). There were no significant differences between the simulators regarding anatomical design simulation (P = 0.76) and incision simulation (P = 0.65).

CONCLUSION

Both porcine tongue simulator and 3D-printed simulator have their unique strengths in surgical education for palatoplasty. Thus, the combined use of a porcine tongue and a 3D-printed cleft palate simulators are efficient as an educational model to practice Furlow double-opposing Z- palatoplasty. The porcine tongue simulators are superior in terms of organizational flexibility, ductility, and suturing simulators, while with the 3D-printed simulator, various palatoplasty techniques can be repeatedly practiced with better-simulated face and oral cavity.

Feasibility of High-Fidelity Simulator Models for Minimally Invasive Spine Surgery in a Resource-Limited Setting: Experience From East Africa

BACKGROUND

Spine surgery is a rapidly evolving specialty with a continuous need to learn new skills. In resource-limited settings such as Africa, the need for training is greater. The use of simulation-based training is important in different stages of skill acquisition, especially for high-stake procedures such as spine surgery. Among the available methods of simulation, the use of synthetic models has gained popularity among trainers.

METHOD

Twenty participants of a neurosurgery training course, most of whom (65%) were neurosurgery residents and fellows, were recruited. They had hands-on training sessions using a high-fidelity lumbar degenerative spine simulation model and hands-on theater experience. After this, they completed a survey to compare their experience and assess the effectiveness of the lumbar spine model in stimulating real patient and surgery experiences.

RESULTS

The participants were from four African countries, and the majority were neurosurgery residents. There were varying levels of experience among the participants in minimally invasive spine surgery, with the majority either having no experience or having only observed the procedure. All the participants said that the high-fidelity lumbar spine model effectively simulated real minimally invasive spine setup and real bone haptics and was effective in learning new techniques. Most of the participants agreed that the model effectively simulated real dura and nerve roots (95%), real muscle (90%), real bleeding from bones and muscles (95%), and real cerbrospinal fluid in the subarachnoid space. Among them, 95% agreed that the model is effective in lumbar minimally invasive spine training in resource-limited settings.

CONCLUSION

With the development of new and better surgical techniques, the use of high-fidelity models provides a good opportunity for learning and training, especially in resource-poor settings where there is a paucity of training facilities and personnel.

Making Headway in Surgical Education at Home and Abroad: Use of an Inexpensive Three-Dimensional Learning Model to Improve Plastic Surgery Resident Confidence in Mohs Defect Assessment and Closure Planning

BACKGROUND

The development of simulation, particularly low-cost models, has become a focus of interest within plastic surgery education. Current simulators for Mohs reconstruction are either expensive or not reusable. The authors hypothesize that using a Styrofoam head model during an interactive teaching session will positively affect plastic surgery trainee comfort in designing Mohs reconstructive options.

METHODS

A cohort of integrated plastic surgery residents at a single institution performed a preactivity questionnaire to obtain baseline comfort in defect assessment and design for five Mohs defects. They subsequently underwent an interactive learning session and were instructed to design flaps on life-size Styrofoam heads with feedback from the senior author (M.L.B.). A postactivity questionnaire was completed to assess improvement in comfort in defect assessment and flap design. Three attending surgeons then compared trainee designs with the senior author's design to assess accuracy. All surveys were based on a five-point Likert scale.

RESULTS

When analyzing all defects, average postactivity scores increased by 0.63 (SD, ±0.24) ( P = 0.008). Junior residents ( n = 8) had a greater increase in average score responses [mean, 1.07 (0.5 to 1.75)] compared with senior residents ( n = 9) [mean, 0.27 (0 to 1)] ( P < 0.001). When assessed by senior-level surgeons, senior residents had significantly greater accuracy in design for each defect ( P < 0.05) except cheek advancement flap ( P = 0.08).

CONCLUSION

Participation in an interactive educational activity using a Styrofoam head model demonstrated significant improvements in trainee assessment and design of reconstructive options for Mohs defects.

Fundamentals of Microsurgery: A Novel Simulation Curriculum Based on Validated Laparoscopic Education Approaches

BACKGROUND

 Microsurgical techniques have a steep learning curve. We adapted validated surgical approaches to develop a novel, competency-based microsurgical simulation curriculum called Fundamentals of Microsurgery (FMS). The purpose of this study is to present our experience with FMS and quantify the effect of the curriculum on resident performance in the operating room.

METHODS

 Trainees underwent the FMS curriculum requiring task progression: (1) rubber band transfer, (2) coupler tine grasping, (3) glove laceration repair, (4) synthetic vessel anastomosis, and (5) vessel anastomosis in a deep cavity. Resident anastomoses were also evaluated in the operative room with the Stanford Microsurgery and Resident Training (SMaRT) tool to evaluate technical performance. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) and Short-Form Spielberger State-Trait Anxiety Inventory (STAI-6) quantified learner anxiety and workload.

RESULTS

 A total of 62 anastomoses were performed by residents in the operating room during patient care. Higher FMS task completion showed an increased mean SMaRT score (p = 0.05), and a lower mean STAI-6 score (performance anxiety) (p = 0.03). Regression analysis demonstrated residents with higher SMaRT score had lower NASA-TLX score (mental workload) (p < 0.01) and STAI-6 scores (p < 0.01).

CONCLUSION

 A novel microsurgical simulation program FMS was implemented. We found progression of trainees through the program translated to better technique (higher SMaRT scores) in the operating room and lower performance anxiety on STAI-6 surveys. This suggests that the FMS curriculum improves proficiency in basic microsurgical skills, reduces trainee mental workload, anxiety, and improves intraoperative clinical proficiency.

Using Virtual Reality for Deep Inferior Epigastric Perforator Flap Preoperative Planning

This study was designed to compare VR stereoscopical three-dimensional (3D) imaging with two-dimensional computed tomography angiography (CTA) images for evaluating the abdominal vascular anatomy before autologous breast reconstruction.

Methods

This prospective case series feasibility study was conducted in two tertiary medical centers. Participants were women slated to undergo free transverse rectus abdominis muscle, unilateral or bilateral deep inferior epigastric perforator flap immediate breast reconstruction. Based on a routine CTA, a 3D VR model was generated. Before each procedure, the surgeons examined the CTA and then the VR model. Any new information provided by the VR imaging was submitted to a radiologist for confirmation before surgery. Following each procedure, the surgeons completed a questionnaire comparing the two methods.

Results

Thirty women between 34 and 68 years of age were included in the study; except for one, all breast reconstructions were successful. The surgeons ranked VR higher than CTA in terms of better anatomical understanding and operative anatomical findings. In 72.4% of cases, VR models were rated having maximum similarity to reality, with no significant difference between the type of perforator anatomical course or complexity. In more than 70% of the cases, VR was considered to have contributed to determining the surgical approach. In four cases, VR imaging modified the surgical strategy, without any complications.

Conclusions

VR imaging was well-accepted by the surgeons who commented on its importance and ease compared with the standard CTA presentation. Further studies are needed to determine whether VR should become an integral part of preoperative deep inferior epigastric perforator surgery planning.

The Role of Augmented Reality in the Next Phase of Surgical Education

Concomitant with such a shift toward competency-based curricula, there has been increasing adoption of surgical simulation coupled with virtual, mixed, and augmented reality. These technologies have become more commonplace across multiple surgical disciplines, in domains such as preoperative planning, surgical education, and intraoperative navigation. However, there is a relative paucity of literature pertaining to the application of this technology to plastic surgery education. This review outlines the advantages of mixed and augmented reality in the pursuit of an ideal simulation environment, their benefits for the education of plastic surgery trainees, and their role in standardized assessments. In addition, we offer practical solutions to commonly encountered problems with this technology. Augmented reality has tremendous untapped potential in the next phase of plastic surgery education, and we outline steps toward broader implementation to enhance the learning environment for our trainees and to improve patient outcomes.

Simulation in plastic and reconstructive surgery: a scoping review

Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery.

A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes.

Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery.

Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool.

This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.

The Accreditation Council for Graduate Medical Education Milestones in Integrated Plastic Surgery Programs: How Competency-Based Assessment Has Been Implemented

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.

A Systematic Review of Aesthetic Surgery Training Within Plastic Surgery Training Programs in the USA: An In-Depth Analysis and Practical Reference

BACKGROUND

The importance of aesthetic surgery exposure for plastic and reconstructive trainees has been recently validated by the expansion of case requirements for aesthetic procedures from 50 to 150, as well as resident-driven desire for increased cosmetic exposure throughout training. We aim to systematically review the literature at a national level to report on overall trends in aesthetic surgery training within PRS residencies.

METHODS

A literature search of PubMed, Embase, and Scopus identified all English articles published in the USA between 2000 and 2020, using a combination of "aesthetic surgery", "cosmetic surgery", "plastic surgery", "residency and internship", "education", and "training."

RESULTS

Our initial search resulted in 415 articles. After review of inclusion and exclusion criteria, in addition to cross-referencing, 41 studies remained, including 15 studies discussing resident and/or program director surveys, eight studies discussing teaching methods, sixteen studies discussing dedicated resident clinics, four studies discussing cosmetic/aesthetic fellowships, three studies discussing cosmetic practice patterns, and eleven studies discussing patient outcomes.

CONCLUSION

Current literature demonstrates that there are gaps in aesthetic surgery training for PRS residents in the USA, including facial and neck surgeries and non-surgical interventions. Resident clinics have clear benefits for resident education, without sacrificing patient outcomes. Residency programs should consider the development of a resident cosmetic clinic and/or dedicated cosmetic center to increase surgical exposure and increase trainee comfort in providing this subset of procedures. Published literature is limited in consistency of methods of evaluation, and further in-depth analysis of case volume and diversity at training programs within the USA and internationally is indicated.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Utilisation of a 3D printed ex vivo flexor tendon model to improve surgical training

BACKGROUND

Surgery for hand trauma accounts for a significant proportion of the plastic surgery trainee activity. The aim of this article is to create a standardised simulation training module for flexor tendon repair techniques for residents prior to their first encounter in the clinical setting.

METHODS

A step-ladder approach flexor tendon repair training with four levels of difficulty was conducted using a three-dimensional (3D) printed anatomical simulation model and a silicone tendon rod on a cohort of 28 plastic surgery Senior House Officers (SHOs) of various stages in their training (n=28). Assessment of knowledge (online questionnaire) and practical skills using validated score systems (global rating scale and task specific score) was performed at the beginning and end of the module by hand experts of our unit.

RESULTS

The overall average knowledge-based scores of the cohort pre- and post-assessment were 1.48/5 (29.6%) and 3.56/5 (71.5%), respectively. The overall average skills-based scores of the cohort pre- and post-assessments were 3.05/5 (61%) and 4.12/5 (82.5%), respectively. Significant (p<0.01) difference of improvement of knowledge and skills was noted on all trainees. All trainees confirmed that the training module improved their confidence with flexor tendon repair.

CONCLUSION

We demonstrate a standardised simulation training framework that employs a 3D printed flexor tendon simulation model proven to improve the skills of residents especially during their early learning curve and which paves the way to a more universal, standardised and validated training across hand surgery.

Investigation of Objectivity in Scoring and Evaluating Microvascular Anastomosis Simulation Training

The increase in minimally invasive surgery has led to a decrease in surgical experience. To date, there is only limited research examining whether skills are evaluated objectively and equally in simulation training, especially in microsurgery. The purpose of this study was to analyze the objectivity and equality of simulation evaluation results conducted in a contest format. A nationwide recruitment process was conducted to select study participants. Participants were recruited from a pool of qualified physicians with less than 10 years of experience. In this study, the simulation procedure consisted of incising a 1 mm thick blood vessel and suturing it with a 10-0 thread using a microscope. Initially, we planned to have the neurosurgical supervisors score the simulation procedure by direct observation. However, due to COVID-19, some study participants were unable to attend. Thus requiring some simulation procedures to be scored by video review. A total of 14 trainees participated in the study. The Cronbach’s alpha coefficient among the scorers was 0.99, indicating a strong correlation. There was no statistically significant difference between the scores from the video review and direct observation judgments. There was a statistically significant difference (p <0.001) between the scores for some criteria. For the eight criteria, individual scorers assigned scores in a consistent pattern. However, this pattern differed between scorers indicating that some scorers were more lenient than others. The results indicate that both video review and direct observation methods are highly objective techniques evaluate simulation procedures.

Mind the Gap: a Competency-Based Scoping Review of Aesthetic and Reconstructive Reported Simulation Training Models

BACKGROUND

Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide.

METHODS

Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models.

RESULTS

A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%.

CONCLUSIONS

This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Crisis Management Simulation: Review of Current Experience

Crisis management simulation is important in training the next generation of surgeons. In this review, we highlight our experiences with the cavernous carotid injury model. We then delve into other crisis simulation models available for the neurosurgical specialty. The discussion focuses upon how these trainings can continue to evolve. Much work is yet to be done in this exciting arena and we present several avenues for future discovery. Simulation continues to be an important training tool for the surgical learner.