Plastic Surgery Research Council

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Cleft Surgery Knowledge and Skills Acquisition by Plastic Surgery Residents: A Simulation-Based Prospective Randomized Blinded Trial
Rami S. Kantar, MD, Allyson R. Alfonso, BS, BA, Elie P. Ramly, MD, Marina Gonchar, DMD, MS, Samantha G. Maliha, BA, Oriana Cohen, MD, J. Rodrigo Diaz-Siso, MD, Bradley S. Eisemann, MD, Pierre B. Saadeh, MD, Roberto L. Flores, MD.
Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA.

Purpose: Simulation is a standard component of residency training in many surgical subspecialties, yet its impact on knowledge and skills acquisition in cleft surgery training remains poorly defined. We evaluated cleft surgery knowledge and skills acquisition by plastic surgery residents through a simulation-based prospective, randomized, blinded trial.
Methods: Thirteen plastic surgery residents were randomized to a digital simulator or textbook demonstrating unilateral cleft lip (UCL) repair. Performance on the following tasks before (pre-intervention) and after (post-intervention) studying were evaluated: knowledge of surgical steps, lip markings on a three-dimensional (3D) stone model, and lip repair using a hands-on/high-fidelity 3D haptic model. Participant procedural confidence and satisfaction with each educational tool were also evaluated. Two expert reviewers blindly graded markings and surgical performance. Intra-class correlation coefficients (ICC) were calculated. Wilcoxon signed-rank and Mann-Whitney U tests were used.
Results: Interrater reliability was strong for pre-intervention and post-intervention grading of markings (ICC=0.97; p<0.001 and ICC=0.96; p<0.001) and surgical performance (ICC=0.76; p=0.01 and ICC=0.85; p=0.001). Compared to pre-intervention, post-intervention marking performance (8.0±2.5 vs. 2.9±3.1; p=0.03), procedural confidence (24.0±7.0 vs. 14.7±2.3; p=0.03), knowledge (40.3±4.4 vs. 33.5±3.7; p=0.03), and performance (20.3±3.6 vs. 15.3±3.1; p=0.04) significantly improved in the digital simulation group, but not in the textbook group. All participants were more satisfied with the digital simulator as an educational tool (27.7±2.5 vs. 14.4±4.4; p<0.001).
Conclusions: We present level I evidence suggesting that digital cognitive simulators lead to significant improvement in cleft surgery markings, as well as procedural confidence, knowledge and performance.


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