Craniofacial Skills: A Two-Site Validation of Assessments to Aid Plastic Surgery Resident Milestone Achievement in Technical Skills and Instrument Knowledge.
Katherine A. Grunzweig, MD, Ji Son, MD, Anand Kumar, MD.
University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
PURPOSE: Plastic surgery evaluates residents on milestones. This study defined a model of education including pre and post-test assessments based around a single day of lab training, intended for evaluating residents in the unique technical skills of craniofacial surgery. This study aimed to validate this task-based assessment first with cadavers, and subsequently using Saw Bones (TM) models with brief instructor education on common technical pitfalls of craniofacial surgery.
METHODS: At the first institution, instrument identification, and time/accuracy of burr hole placement, craniotomy, and plating on Saw BonesTM Craniofacial Models were tested before and after a 7.5 hour craniofacial orthognathic surgery workshop. At the second institution, this was shortened and refined to three tasks: instrument identification (channel retractor, lamina spreader, double guarded nasal osteotome, Obwegesser in tow retractor, J inferior border mandible stripper), accuracy of burr hole placement, and accuracy of square craniotomy evaluated before and after a short teaching simulation by the craniofacial faculty on standard osteotomies, instrument names, and pitfalls of craniofacial surgery. The study population consisted of junior, mid-level, and senior residents with different levels of experience on two different University craniofacial services.
RESULTS: Participant performance was analyzed for each post-graduate year, and was grouped by level of training: junior, midlevel and senior resident. In the first iteration, resident times improved significantly for all four tasks (p=0.008, 0.035, 0.035, 0.016). Resident accuracy improved significantly for instrument naming (p=0.003). Except for instrument naming, resident year did not impact improvement. In the second iteration, resident accuracy improved for all tasks (instrument naming p=0.00002, burr holes p=0.0031, craniotomy p=0.08). There was no difference in rate of improvement between resident years.
CONCLUSIONS: The task-based assessment with resident education on basic craniofacial surgery skills, standard osteotomies, and instrument names directed resident learning and assessed resident knowledge. With the removal of time as a metric, all tasks improved in accuracy. The craniofacial skills task-assessment successfully evaluated milestone attainment.
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