title: Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience.
abstract: BACKGROUND
  As interest in surgical simulation grows, plastic surgical educators are pressed to provide realistic surgical experience outside of the operating suite. Simulation models of plastic surgery procedures have been developed, but they are incomparable to the dissection of fresh tissue. We evolved a fresh tissue dissection (FTD) and simulation program with emphasis on surgical technique and simulation of clinical surgery. We hypothesized that resident confidence could be improved by adding FTD to our resident curriculum.
  
  
  METHODS
  Over a 5-year period, FTD was incorporated into the curriculum. Participants included clinical medical students, postgraduate year 1 to 7 residents, and attending surgeons. Participants performed dissections and procedures with structured emphasis on anatomical detail, surgical technique, and rehearsal of operative sequence. Resident confidence was evaluated using retrospective pretest and posttest analysis with a 5-point scale, ranging from 1 (least confident) to 5 (most confident). Confidence was evaluated according to postgraduate year level, anatomical region, and procedure.
  
  
  RESULTS
  A total of 103 dissection days occurred, and a total of 192 dissections were reported, representing 73 different procedures. Overall, resident predissection confidence was 1.90±1.02 and postdissection confidence was 4.20±0.94 (p<0.001). The average increase in confidence correlated with training year, such that senior residents had greater gains. When compared by anatomical region, confidence was lowest for the head and neck region. When compared by procedure, confidence was lowest for rhinoplasty and face-lift, and highest for radial forearm and latissimus flaps.
  
  
  CONCLUSIONS
  A high-volume FTD experience was successfully incorporated into the residency program over 5 years. Training with FTD improves resident confidence, and this effect increases with seniority of training. Although initial data demonstrate that resident confidence is improved with FTD, additional evaluation is needed to establish objective evidence that patient outcomes and surgical quality can be improved with FTD.
authors.affiliation: Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
authors.forename: Clifford C
authors.initials: CC
authors.lastname: Sheckter
authors.forename: Justin T
authors.initials: JT
authors.lastname: Kane
authors.forename: Michael
authors.initials: M
authors.lastname: Minneti
authors.forename: Warren
authors.initials: W
authors.lastname: Garner
authors.forename: Maura
authors.initials: M
authors.lastname: Sullivan
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Randy
authors.initials: R
authors.lastname: Sherman
authors.forename: Mark
authors.initials: M
authors.lastname: Urata
authors.forename: Joseph N
authors.initials: JN
authors.lastname: Carey
mesh_terms: D002102:Cadaver; D002983:Clinical Competence; D003479:Curriculum; D004210:Dissection; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency; D015141:Los Angeles; D008297:Male; D013518:Surgery, Plastic / Q000193:education*