Frozen-thawed Abdominal Flap Remnant as an education material for a Medium Group Surgical Skills Education Workshop

A Systematic Review of Simulation-Based Training Tools in Plastic Surgery

OBJECTIVES

The recent shift from traditional surgical teaching to the incorporation of simulation training in plastic surgery has resulted in the development of a variety of simulation models and tools. We aimed to assess the validity and establish the effectiveness of all currently available simulators and tools for plastic surgery.

DESIGN

Systematic review.

METHODS

The PRISMA 2020 checklist was followed. The review protocol was prospectively registered in PROSPERO (CRD42021231546). Published and unpublished literature databases were searched to the 29th of October 2023. Each model was appraised in accordance with the Messick validity framework, and a rating was given for each section. To determine the effectiveness of each model, the McGaghie model of translational outcomes was used.

RESULTS

On screening 1794 articles, 116 were identified to discuss validity and effectiveness of simulation models in plastic surgery. These were hand surgery (6 studies), breast surgery (12 studies), facial surgery (25 studies), cleft lip and palate surgery (29 studies), rhinoplasty (4 studies), hair transplant surgery (1 study), surgery for burns (10 studies), and general skills in plastic surgery (29 studies). Only 1 model achieved an effectiveness level > 3, and no model had a rating > 2 in all aspects of the Messick validity framework.

CONCLUSION

There are limited models enabling the transfer of skills to clinical practice. No models achieved reductions in surgical complications or costs. There must be more validity studies conducted using updated validity frameworks, with an increased emphasis on the applicability of these simulators to improve patient outcomes and surgical technique. More training tools evaluating both technical and non-technical surgical skills are recommended.

Intraoperative “Spare Parts”: A Novel High-fidelity Suturing Model for Trainees

Many models exist to help the medical student learn how to suture at a competency level required to progress to suturing on patients. However, these models do not readily simulate the qualities of live human tissue. We propose a simple intraoperative high-fidelity model that places the excised autologous patient tissue (eg, panniculectomy and breast reduction) on a sterile side table to allow the trainee to practice their skills alongside the staff surgeon on comparable tissue for the remainder of the case. We believe that the adoption of this practice allows a unique opportunity for medical students to advance their suturing techniques in a low-stress environment with staff surgeon guidance, further preparing them to perform high-quality closures on live patients.

Feasibility and comparative analysis of Dirofilaria immitis microfilaria freezing and fixation for student instruction and assessment of clinical parasitology skills

Background

Detection of D. immitis microfilaria (mf) is an important diagnostic skill in veterinary medicine and is critical to Day 1 veterinarians and technicians. Finding a supply of blood containing mf to teach the technique and formalin’s adverse environmental effects used in the diagnostic microscopic tests present a challenge.

Results

This study evaluated the use of cryopreserved and recently drawn mf-infected blood along with two fixative reagents, acetic acid or formalin for mf detection. The specific aims included determining if veterinary students could 1) detect cryopreserved mf added to fresh blood using routine diagnostic testing and 2) detect morphological differences in the mf. The 236 students were kept blind from the sample status. The ability of the students to identify mf and the mf morphology were compared for the samples and fixatives evaluated. The results demonstrate using a combination of cryopreservation and acetic acid for teaching microfilaria diagnostic techniques is fleasible; however, the quality of the mf morphology is less than optimal when compared to freshly acquired mf containing blood. Compared to reference values, the mf demonstrated a decrease in size with each additional variable evaluated.

Conclusion

A majority (98.3%) of the 236 students correctly identified the presence of mf. Teaching laboratories could utilize cryopreserved mf-spiked donor blood in lieu of freshly collected mf-containing blood from a naturally or experimentally infected dog. Substitution of less hazardous chemicals for the fixative can be used. Finally, the change in size measurements provides a mechanism to ensure students can correctly measure mf as students are required to do verifiable measurements and cannot copy reference values from a text book since the cryopreservation and fixation methods cause the mf to measure smaller than textbook reference values.