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An Evaluation of a Novel Craniofacial Skills Laboratory Curriculum: An Aid to Plastic Surgery Resident Milestone Achievement in Technical Skills and Instrument Knowledge
Nicole J. Jarrett, M.D.1, Samir Shakir, B.S.2, Anand R. Kumar, M.D.3.
1Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA, 2Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA, 3Department of Plastic Surgery, University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
PURPOSE: Plastic Surgery Graduate Medical Education has transitioned to a model of milestones. The objective measurement of surgical skills and technical knowledge remains understudied. Surgical skills curricula have been created for microsurgery, but an educational model for training the unique technical skills for craniofacial surgery has not been defined or validated. The aims of this study are to present and validate a novel educational craniofacial skills laboratory and compare outcomes between traditional on-patient training and simulated laboratory training.
METHODS: A prospective IRB approved study was designed to evaluate 1) instrument identification, 2) time/accuracy of burr hole placement, 3) time/accuracy of craniotomy (square) resection, and 4) time/accuracy of 4 hole plating across the nasomaxillary buttress using Saw BonesTM Craniofacial Models before and after the skills laboratory. Accuracy was measured using a 1-4 scale with 4 representing best score. Minimal classroom training (30 minutes) and extensive laboratory training (7 hours 30 minutes) was provided regarding monobloc, bipartition, Lefort III, Lefort I, mandible osteotomy (BSSO) on fresh cadaver specimens but no direct training with the defined tasks was provided. The R4 group had not yet rotated on the craniofacial service, whilst the R5 group had during the previous year.
RESULTS: The R4 (n=3) group mean time in seconds pre/post-task 1, 2, 3, 4 was 117/28, 6.33/4.33, 77.3/27, and 133/98.6 respectively. Percent improvement for task 1, 2, 3, 4 was 76%, 31%, 65%, and 26% respectively. The R5 (n=6) group mean time in seconds pre/post-task 1, 2, 3, 4 was 62/44, 6/4, 32/22, and 108/82 respectively. Percent improvement for task 1, 2, 3, 4 was 29%, 33%, 30%, and 23% respectively. R4 group post-training times were not significantly different than R5 pre-training times for each of the tasks recorded (p=0.131, 0.597, 0.597, 0.790) respectively. Accuracy testing with instrument recognition demonstrated the greatest improvement from 82% to 100% (p=0.05) for the entire cohort. Accuracy changes in skills tests 2,3,4 pre/post were 2.7/3, 2.5/2.3, and 2.2/2.61(p=0.25, 0.58, 0.17) respectively.
CONCLUSIONS: A single day craniofacial skills laboratory with instruction in standard facial osteotomies measurably improved residents performance on specific tasks by indirect training. Most importantly, R4 residents after the curriculum surpassed the pre-lab R5 residents who had already performed these tasks in the traditional training environment of the operating room. Craniofacial related skills tasks may be used to assess a trainee’s readiness for performing them in the operating room and may aid in proper identification of milestone attainment.
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