Reconstruction of facial defects with local flaps--a training model for medical students?
BACKGROUND
The lack of surgeons will be a future major problem in patient care for multifaceted reasons. Niche specialties such as OMFS face an additional drawback because of the need for dual qualification. Special surgical training that gives students the opportunity to gain experience in the techniques of plastic-reconstructive surgery (PRS) has therefore been established to promote interest in OMFS.


METHODS
Two hands-on courses with 8 modules of 2 h for 10 students were established. Course modules included surgical techniques of PRS, such as local flaps in a complex facial defect on pig heads, and were supervised by two OMFS surgeons. The identical initial and final tests examined theoretical knowledge and practical skills. Questionnaires concerning basic demographic data, future career goals, and perception of surgical disciplines before and after the completion of the course were handed out.


RESULTS
The 19 participating students (12 female, 7 male; median age 24 ± 2.24) were in their 8.31 ± 1.20 semester. Results of the tests showed improvement in knowledge following the courses (before 52.68 ± 12.64 vs. after 77.89 ± 11.37; p < 0.05). Based on the Likert scale, an increase in interest in a career in OFMS was observed (3.90 ± 1.18 vs. 2.72 ± 1.33; p < 0.05), but this was not so marked with regard to a career in a surgical discipline in general (1.93 ± 1.30 vs. 1.62 ± 1.19; p > 0.05). Perception of OMFS as a surgical discipline changed (3.68 ± 1.09 vs. 1.80 ± 0.64; p < 0.05). The following values also changed: students´ perception of PRS in OMFS (14 (74.68%) vs. 5 (25.32%); 19 (100%) vs. 0 (0%)), evaluation of PRS as a study subject for medical students (7 (36.84%) vs. 12 (63.16%); 19 (100%) vs. 0 (0%)), and the interest in an OMFS elective subject (6 (31.58%) vs. 13 (68.42%); 18 (94.74%) vs. 1 (5.26%)) and as a final clinical year subject (4 (21.05%) vs. 15 (78.95%); 14 (73.68%) vs. 5 (26.32%)).


CONCLUSIONS
Hands-on courses with complex facial defects can be used to gain new professionals, even in niche specialties such as OMFS. Moreover, a hands-on course design, including innovative teaching methods and structured objective tests combined with a close student-teacher relationship and motivated instructors, is able to promote complex surgical skills in PRS.
Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany. florian.jm.bauer@tum.de.
Florian
F
Bauer
Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany. koerdt@mkg.med.tum.de.
Steffen
S
Koerdt
Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany. rommel@mkg.med.tum.de.
Niklas
N
Rommel
Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany. wolff@mkg.med.tum.de.
Klaus-Dietrich
KD
Wolff
Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany. kesting@mkg.med.tum.de.
Marco R
MR
Kesting
Department of Oral and Maxillofacial Surgery at the Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany. weitz@mkg.med.tum.de.
Jochen
J
Weitz
D000328:Adult; D000818:Animals; D002983:Clinical Competence; D005145:Face / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D019651:Plastic Surgery Procedures / Q000193:education* / Q000379:methods; D013337:Students, Medical; D013515:Surgery, Oral / Q000193:education*; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013552:Swine