Computer Simulation and Digital Resources for Plastic Surgery Psychomotor Education.
Contemporary plastic surgery residents are increasingly challenged to learn a greater number of complex surgical techniques within a limited period. Surgical simulation and digital education resources have the potential to address some limitations of the traditional training model, and have been shown to accelerate knowledge and skills acquisition. Although animal, cadaver, and bench models are widely used for skills and procedure-specific training, digital simulation has not been fully embraced within plastic surgery. Digital educational resources may play a future role in a multistage strategy for skills and procedures training. The authors present two virtual surgical simulators addressing procedural cognition for cleft repair and craniofacial surgery. Furthermore, the authors describe how partnerships among surgical educators, industry, and philanthropy can be a successful strategy for the development and maintenance of digital simulators and educational resources relevant to plastic surgery training. It is our responsibility as surgical educators not only to create these resources, but to demonstrate their utility for enhanced trainee knowledge and technical skills development. Currently available digital resources should be evaluated in partnership with plastic surgery educational societies to guide trainees and practitioners toward effective digital content.
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
J Rodrigo
JR
Diaz-Siso
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Natalie M
NM
Plana
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
John T
JT
Stranix
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Court B
CB
Cutting
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Joseph G
JG
McCarthy
New York, N.Y.|From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Roberto L
RL
Flores
D002972:Cleft Palate / Q000601:surgery*; D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008953:Models, Anatomic; D056948:Orthognathic Surgical Procedures / Q000193:education*; D011597:Psychomotor Performance; D000066908:Simulation Training / Q000379:methods*; D013518:Surgery, Plastic / Q000193:education*; D014481:United States; D014584:User-Computer Interface
Phitayakorn R, Nick MW, Alseidi A, et al. WISE-MD usage among millennial medical students. Am J Surg. 2015;209:152157.
Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: A modelling strategy based on available data. Lancet 2008;372:139144.
Selzer DJ, Dunnington GL. Surgical skills simulation: A shift in the conversation. Ann Surg. 2013;257:594595.
Dutta S, Dunnington G, Blanchard MC, Spielman B, DaRosa D, Joehl RJ. “And doctor, no residents please!”. J Am Coll Surg. 2003;197:10121017.
Bell RH Jr, Biester TW, Tabuenca A, et al. Operative experience of residents in US general surgery programs: A gap between expectation and experience. Ann Surg. 2009;249:719724.
Dunnington G. Uneven operative experience in surgical training: A call for action. Ann Surg. 2009;249:725726.
Reznick RK, MacRae H. Teaching surgical skills: Changes in the wind. N Engl J Med. 2006;355:26642669.
Rosen JM, Long SA, McGrath DM, Greer SE. Simulation in plastic surgery training and education: The path forward. Plast Reconstr Surg. 2009;123:729738; discussion 739.
Gardner AK, Scott DJ, Pedowitz RA, et al. Best practices across surgical specialties relating to simulation-based training. Surgery 2015;158:13951402.
Collicott PE, Hughes I. Training in advanced trauma life support. JAMA 1980;243:11561159.
Esposito C, Escolino M, Draghici I, et al. Training models in pediatric minimally invasive surgery: Rabbit model versus porcine model: A comparative study. J Laparoendosc Adv Surg Tech A 2016;26:7984.
Saifi J, Chang BB, Paty PS, Kaufman J, Leather RP, Shah DM. An animal model for instructing and the study of in situ arterial bypass. J Vasc Surg. 1990;12:538540.
Swindle MM. Swine as replacements for dogs in the surgical teaching and research laboratory. Lab Anim Sci. 1984;34:383385.
Steinig D, Mentha G, Lecoultre C, et al. Experimental porcine orthotopic liver transplantation: A training protocol for transplantation in humans. Helv Chir Acta 1990;57:177186.
de Klerk DJ, Ploncard P. Laboratory training in microsurgical techniques for neurosurgery. S Afr Med J. 1972;46:17401742.
Austin GT, Hammond FW, Schaberg SJ, Scharpf HO. A laboratory model for vascular microsurgery. J Oral Maxillofac Surg. 1983;41:450455.
Dumestre D, Yeung JK, Temple-Oberle C. Evidence-based microsurgical skill-acquisition series part 1: Validated microsurgical models. A systematic review. J Surg Educ. 2014;71:329338.
Lohse CL. The dog as an instruction model for surgical correction of mandibular prognathism. J Oral Surg. 1977;35:1720.
Anders KH, Goldstein BG, Lesher JL Jr, Shimp RG, Chalker DK. The use of live pigs in the surgical training of dermatology residents. J Dermatol Surg Oncol. 1989;15:734736.
Anastakis DJ, Regehr G, Reznick RK, et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg. 1999;177:167170.
Ghosh SK. Human cadaveric dissection: A historical account from ancient Greece to the modern era. Anat Cell Biol. 2015;48:153169.
Brattebø G, Seim SH. Teaching and training of invasive procedures on cadavers. Lancet 1988;2:10781079.
Sharma M, Horgan A. Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training. World J Surg. 2012;36:17321737.
Reed AB, Crafton C, Giglia JS, Hutto JD. Back to basics: Use of fresh cadavers in vascular surgery training. Surgery 2009;146:757762; discussion 762.
Khoo LS. Course Review: The Aberdeen Cadaveric Hand Trauma Course. Ann Plast Surg. 2015;75:364.
Chaput B, Herlin C, Dast S, Sinna R. 4th Amiens’ perforator flap course. 2nd Duplex ultrasound workshop for plastic surgeon (in French). Ann Chir Plast Esthet. 2015;60:540541.
Dunne JA. Course review: The 4th Bob Huffstadt upper and lower limb flap dissection course. Ann Plast Surg. 2014;73:625626.
Rossi SH, Mestak O, Stampolidis N, Vasconcelos I. The Institute of Surgery and Innovation trunk flap dissection course. Ann Plast Surg. 2015;75:491492.
Willis RE, Curry E, Gomez PP. Practice schedules for surgical skills: The role of task characteristics and proactive interference on psychomotor skills acquisition. J Surg Educ. 2013;70:789795.
Huang E, Chern H, O’Sullivan P, et al. A better way to teach knot tying: A randomized controlled trial comparing the kinesthetic and traditional methods. Am J Surg. 2014;208:690694.
Zikria BA. Exercise and drill boards for surgical training: 10 year experience with a knot-tying board. Am J Surg. 1981;141:612613.
Denadai R, Kirylko L. Teaching basic plastic surgical skills on an alternative synthetic bench model. Aesthet Surg J. 2013;33:458461.
Denadai R, Oshiiwa M, Saad-Hossne R. Teaching elliptical excision skills to novice medical students: A randomized controlled study comparing low- and high-fidelity bench models. Indian J Dermatol. 2014;59:169175.
Awwad AM. A training card for microsurgery. Microsurgery 1984;5:160.
Steffens K, Koob E, Hong G. Training in basic microsurgical techniques without experiments involving animals. Arch Orthop Trauma Surg. 1992;111:198203.
Kim DC, Hayward PG, Morrison WA. Training model for microvessel anastomosis. Microsurgery 1994;15:820821.
Grober ED, Hamstra SJ, Wanzel KR, et al. The educational impact of bench model fidelity on the acquisition of technical skill: The use of clinically relevant outcome measures. Ann Surg. 2004;240:374381.
Tsuda S, Scott D, Doyle J, Jones DB. Surgical skills training and simulation. Curr Probl Surg. 2009;46:271370.
Pieper SD, Laub DR Jr, Rosen JM. A finite-element facial model for simulating plastic surgery. Plast Reconstr Surg. 1995;96:11001105.
Lange T, Indelicato DJ, Rosen JM. Virtual reality in surgical training. Surg Oncol Clin N Am. 2000;9:6179, vii.
Hüsken N, Schuppe O, Sismanidis E, Beier F. MicroSim: A microsurgical training simulator. Stud Health Technol Inform. 2013;184:205209.
Scott DJ, Dunnington GL. The new ACS/APDS Skills Curriculum: Moving the learning curve out of the operating room. J Gastrointest Surg. 2008;12:213221.
Fitts PM, Posner MJ. Human Performance. 1967.Belmont, Calif: Brooks/Cole.
Oliker A, Napier Z, Deluccia N, et al. Step-based cognitive virtual surgery simulation: An innovative approach to surgical education. Stud Health Technol Inform. 2012;173:325327.
Flores RL, Oliker A, McCarthy JG. An Internet-based surgical simulator for craniofacial surgery. Plast Reconstr Surg. 2015;136(Suppl):8.
Qualter J, Sculli F, Oliker A, et al. The biodigital human: A web-based 3D platform for medical visualization and education. Stud Health Technol Inform. 2012;173:359361.
Demoss P, Murage KP, Tholpady S, Friel M, Havlik RJ, Flores RL. Low-cost, high-definition video documentation of corrective cleft surgeries using a fixed laparoscope. J Plast Reconstr Aesthet Surg. 2014;67:e58e59.
Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet 2010;376:19231958.
Waltzman JT, Tadisina KK, Zins JE. The rise of technology in plastic surgery education: Is the textbook dead on arrival (DOA)? Aesthet Surg J. 2016;36:237243.
Kalet AL, Coady SH, Hopkins MA, Hochberg MS, Riles TS. Preliminary evaluation of the Web Initiative for Surgical Education (WISE-MD). Am J Surg. 2007;194:8993.
Stern C, Oliker A, Napier Z, et al. Integration of surgical simulation in plastic surgery residency training. Stud Health Technol Inform. 2012;173:497499.
Flores RL, Murage K, Tholpady SS. Incidence of concomitant airway anomalies when using the university of California, Los Angeles, protocol for neonatal mandibular distraction. Plast Reconstr Surg. 2013;132:1071e1072e.
Flores RL, Havlik RJ, Choi M, Heidelman JF, Bennett JD, Tholpady S. Measuring surgical competency in facial trauma: The Arch Bar Placement Assessment Scale. Ann Plast Surg. 2014;73:299303.
Temple CL, Ross DC. A new, validated instrument to evaluate competency in microsurgery: The University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument. Plast Reconstr Surg. 2011;127:215222.
Satterwhite T, Son J, Carey J, et al. The Stanford Microsurgery and Resident Training (SMaRT) Scale: Validation of an on-line global rating scale for technical assessment. Ann Plast Surg. 2014;72(Suppl 1):S84S88.
Ghanem AM, Al Omran Y, Shatta B, Kim E, Myers S. Anastomosis Lapse Index (ALI): A validated end product assessment tool for simulation microsurgery training. J Reconstr Microsurg. 2016;32:233241.
Dumestre D, Yeung JK, Temple-Oberle C. Evidence-based microsurgical skills acquisition series part 2: Validated assessment instruments: A systematic review. J Surg Educ. 2015;72:8089.
Shippey S, Handa VL, Chen TL, Chou B, Bowen CW. Validation of an instrument for evaluation of subcuticular suturing using a plastic tissue model. J Surg Educ. 2009;66:3134.
Bentz ML, Ahmad J, Rohrich RJ. Fundraising and philanthropy in plastic surgery: An essential tool for academic excellence. Plast Reconstr Surg. 2011;127:21082112.
Flores R. Innovative cleft palate repair. Sound Medicine: National Public Radio; November 3, 2013.
Miller T. App’s map of the human body also charts next generation of surgical training. New York Daily News. January 10, 2014.
Teaching a man to fish: A sustainable model for helping cleft patients. Atlantic. April 22, 2014.
Heskin L, Mansour E, Lane B, et al. The impact of a surgical boot camp on early acquisition of technical and nontechnical skills by novice surgical trainees. Am J Surg. 2015;210:570577.
Krajewski A, Filippa D, Staff I, Singh R, Kirton OC. Implementation of an intern boot camp curriculum to address clinical competencies under the new Accreditation Council for Graduate Medical Education supervision requirements and duty hour restrictions. JAMA Surg. 2013;148:727732.