Current status of simulation training in plastic surgery residency programs: A review

 

 Permissions and Reprints

Increased emphasis on competency-based learning modules and widespread departure from traditional models of Halstedian apprenticeship have made surgical simulation an increasingly appealing component of medical education. Surgical simulators are available in numerous modalities, including virtual, synthetic, animal, and non-living models. The ideal surgical simulator would facilitate the acquisition and refinement of surgical skills prior to clinical application, by mimicking the size, color, texture, recoil, and environment of the operating room. Simulation training has proven helpful for advancing specific surgical skills and techniques, aiding in early and late resident learning curves. In this review, the current applications and potential benefits of incorporating simulation-based surgical training into residency curriculum are explored in depth, specifically in the context of plastic surgery. Despite the prevalence of simulation-based training models, there is a paucity of research on integration into resident programs. Current curriculums emphasize the ability to identify anatomical landmarks and procedural steps through virtual simulation. Although transfer of these skills to the operating room is promising, careful attention must be paid to mastery versus memorization. In the authors’ opinions, curriculums should involve step-wise employment of diverse models in different stages of training to assess milestones. To date, the simulation of tactile experience that is reminiscent of real-time clinical scenarios remains challenging, and a sophisticated model has yet to be established.

Publication History

Received: 27 October 2017

Accepted: 03 February 2018

Article published online:
03 April 2022

© 2019. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• REFERENCES

• 1 Lawrence WT. Simulation in plastic surgery training and education: the path forward. Plast Reconstr Surg 2009; 123: 739-40
  CrossrefGoogle Scholar
• 2 Grober ED, Hamstra SJ, Wanzel KR. et al. Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill. J Urol 2004; 172: 378-81
  CrossrefPubMedGoogle Scholar
• 3 Sidhu RS, Park J, Brydges R. et al. Laboratory-based vascular anastomosis training: a randomized controlled trial evaluating the effects of bench model fidelity and level of training on skill acquisition. J Vasc Surg 2007; 45: 343-9
  CrossrefPubMedGoogle Scholar
• 4 Ghanem AM, Hachach-Haram N, Leung CC. et al. A systematic review of evidence for education and training interventions in microsurgery. Arch Plast Surg 2013; 40: 312-9
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Agha RA, Fowler AJ. The role and validity of surgical simulation. Int Surg 2015; 100: 350-7
  CrossrefPubMedGoogle Scholar
• 6 Fonseca AL, Evans LV, Gusberg RJ. Open surgical simulation in residency training: a review of its status and a case for its incorporation. J Surg Educ 2013; 70: 129-37
  CrossrefPubMedGoogle Scholar
• 7 Liebert CA, Mazer L, Bereknyei Merrell S. et al. Student perceptions of a simulation-based flipped classroom for the surgery clerkship: a mixed-methods study. Surgery 2016; 160: 591-8
  CrossrefPubMedGoogle Scholar
• 8 Grober ED, Hamstra SJ, Wanzel KR. et al. Validation of novel and objective measures of microsurgical skill: hand-motion analysis and stereoscopic visual acuity. Microsurgery 2003; 23: 317-22
  CrossrefPubMedGoogle Scholar
• 9 Chan WY, Matteucci P, Southern SJ. Validation of microsurgical models in microsurgery training and competence: a review. Microsurgery 2007; 27: 494-9
  CrossrefPubMedGoogle Scholar
• 10 Guerreschi P, Qassemyar A, Thevenet J. et al. Reducing the number of animals used for microsurgery training programs by using a task-trainer simulator. Lab Anim 2014; 48: 72-7
  CrossrefPubMedGoogle Scholar
• 11 Seymour NE, Gallagher AG, Roman SA. et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 2002; 236: 458-63
  CrossrefPubMedGoogle Scholar
• 12 Grantcharov TP, Kristiansen VB, Bendix J. et al. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 2004; 91: 146-50
  PubMedGoogle Scholar
• 13 Larsen CR, Soerensen JL, Grantcharov TP. et al. Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ 2009; 338: b1802
  CrossrefPubMedGoogle Scholar
• 14 Issenberg SB, McGaghie WC, Petrusa ER. et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27: 10-28
  CrossrefPubMedGoogle Scholar
• 15 Fann JI, Caffarelli AD, Georgette G. et al. Improvement in coronary anastomosis with cardiac surgery simulation. J Thorac Cardiovasc Surg 2008; 136: 1486-91
  CrossrefPubMedGoogle Scholar
• 16 Theman TA, Labow BI. Is there bias against simulation in microsurgery training?. J Reconstr Microsurg 2016; 32: 540-5
  Article in Thieme ConnectPubMedGoogle Scholar
• 17 Immenroth M, Burger T, Brenner J. et al. Mental training in surgical education: a randomized controlled trial. Ann Surg 2007; 245: 385-91
  CrossrefPubMedGoogle Scholar
• 18 Al-Bustani S, Halvorson EG. Status of microsurgical simulation training in plastic surgery: a survey of United States program directors. Ann Plast Surg 2016; 76: 713-6
  CrossrefPubMedGoogle Scholar
• 19 Black SA, Nestel DF, Kneebone RL. et al. Assessment of surgical competence at carotid endarterectomy under local anaesthesia in a simulated operating theatre. Br J Surg 2010; 97: 511-6
  CrossrefPubMedGoogle Scholar
• 20 Clarke DB, Kureshi N, Hong M. et al. Simulation-based training for burr hole surgery instrument recognition. BMC Med Educ 2016; 16: 153
  CrossrefPubMedGoogle Scholar
• 21 da Cruz JS, Dos Reis ST, Cunha Frati RM. et al. Does warmup training in a virtual reality simulator improve surgical performance? A prospective randomized analysis. J Surg Educ 2016; 73: 974-8
  CrossrefPubMedGoogle Scholar
• 22 Schendel S, Montgomery K, Sorokin A. et al. A surgical simulator for planning and performing repair of cleft lips. J Craniomaxillofac Surg 2005; 33: 223-8
  CrossrefPubMedGoogle Scholar
• 23 Stern C, Oliker A, Napier Z. et al. Integration of surgical simulation in plastic surgery residency training. Stud Health Technol Inform 2012; 173: 497-9
  PubMedGoogle Scholar
• 24 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: 325-7
  PubMedGoogle Scholar
• 25 Linke R, Leichtle A, Sheikh F. et al. Assessment of skills using a virtual reality temporal bone surgery simulator. Acta Otorhinolaryngol Ital 2013; 33: 273-81
  PubMedGoogle Scholar
• 26 Mitchell NM, Cutting CB, King TW. et al. A real-time local flaps surgical simulator based on advances in computational algorithms for finite element models. Plast Reconstr Surg 2016; 137: 445e-452e
  CrossrefPubMedGoogle Scholar
• 27 Zheng Y, Lu B, Zhang J. et al. CAD/CAM silicone simulator for teaching cheiloplasty: description of the technique. Br J Oral Maxillofac Surg 2015; 53: 194-6
  CrossrefPubMedGoogle Scholar
• 28 Kazan R, Courteau B, Cyr S. et al. A novel mammoplasty part-task trainer for simulation of breast augmentation: description and evaluation. Simul Healthc 2016; 11: 60-4
  CrossrefPubMedGoogle Scholar
• 29 Lausada NR, Escudero E, Lamonega R. et al. Use of cryopreserved rat arteries for microsurgical training. Microsurgery 2005; 25: 500-1
  CrossrefPubMedGoogle Scholar
• 30 Ghanem AM, Al Omran Y, Shatta B. et al. Anastomosis Lapse Index (ALI): a validated end product assessment tool for simulation microsurgery training. J Reconstr Microsurg 2016; 32: 233-41
  PubMedGoogle Scholar
• 31 Kligman BE, Haddock NT, Garfein ES. et al. Microsurgery trainer with quantitative feedback: a novel training tool for microvascular anastomosis and suggested training exercise. Plast Reconstr Surg 2010; 126: 328e-330e
  CrossrefPubMedGoogle Scholar
• 32 Carey JN, Rommer E, Sheckter C. et al. Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthet Surg 2014; 67: e42-e48
  CrossrefPubMedGoogle Scholar
• 33 Sheckter CC, Kane JT, Minneti M. et al. Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. J Surg Educ 2013; 70: 466-74
  CrossrefPubMedGoogle Scholar
• 34 Singh M, Ziolkowski N, Ramachandran S. et al. Development of a five-day basic microsurgery simulation training course: a cost analysis. Arch Plast Surg 2014; 41: 213-7
  Article in Thieme ConnectPubMedGoogle Scholar
• 35 Chang CH. Medical simulation is needed in anesthesia training to achieve patient’s safety. Korean J Anesthesiol 2013; 64: 204-11
  CrossrefPubMedGoogle Scholar
• 36 Stephenson LS, Gorsuch A, Hersh WR. et al. Participation in EHR based simulation improves recognition of patient safety issues. BMC Med Educ 2014; 14: 224
  CrossrefPubMedGoogle Scholar
• 37 Denadai R, Kirylko L. Teaching basic plastic surgical skills on an alternative synthetic bench model. Aesthet Surg J 2013; 33: 458-61
  CrossrefPubMedGoogle Scholar
• 38 Hamilton EC, Scott DJ, Kapoor A. et al. Improving operative performance using a laparoscopic hernia simulator. Am J Surg 2001; 182: 725-8
  CrossrefPubMedGoogle Scholar
• 39 Scott DJ, Bergen PC, Rege RV. et al. Laparoscopic training on bench models: better and more cost effective than operating room experience?. J Am Coll Surg 2000; 191: 272-83
  CrossrefPubMedGoogle Scholar
• 40 Scott DJ, Dunnington GL. The new ACS/APDS skills curriculum: moving the learning curve out of the operating room. J Gastrointest Surg 2008; 12: 213-21
  CrossrefPubMedGoogle Scholar
• 41 Sturm LP, Windsor JA, Cosman PH. et al. A systematic review of skills transfer after surgical simulation training. Ann Surg 2008; 248: 166-79
  CrossrefPubMedGoogle Scholar
• 42 Cotin S, Delingette H, Ayache N. A hybrid elastic model allowing real-time cutting, deformations and force feedback for surgery training and simulation. Visual Comput 2000; 16: 437-52
  CrossrefGoogle Scholar
• 43 Vadodaria S, Watkin N, Thiessen F. et al. The first cleft palate simulator. Plast Reconstr Surg 2007; 120: 259-61
  CrossrefPubMedGoogle Scholar
• 44 Rosen JM, Long SA, McGrath DM. et al. Simulation in plastic surgery training and education: the path forward. Plast Reconstr Surg 2009; 123: 729-38
  CrossrefPubMedGoogle Scholar
• 45 Palter VN, Grantcharov TP. Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial. Ann Surg 2012; 256: 25-32
  CrossrefPubMedGoogle Scholar
• 46 Aboud E, Al-Mefty O, Yasargil MG. New laboratory model for neurosurgical training that simulates live surgery. J Neurosurg 2002; 97: 1367-72
  CrossrefPubMedGoogle Scholar
• 47 Aboud ET, Krisht AF, O’Keeffe T. et al. Novel simulation for training trauma surgeons. J Trauma 2011; 71: 1484-90
  CrossrefPubMedGoogle Scholar
• 48 Garrett Jr HE. A human cadaveric circulation model. J Vasc Surg 2001; 33: 1128-30
  CrossrefPubMedGoogle Scholar
• 49 Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004; 79 (10 Suppl) S70-81
  PubMedGoogle Scholar
• 50 Accreditation Council for Graduate Medical Education. The plastic surgery milestone project [Internet]. Chicago, IL: ACGME; c2015 [cited 2018 Feb 5]. Available from https://www.acgme.org/Portals/0/PDFs/Milestones/PlasticSurgeryMilestones.pdf
• 51 Gosman A, Mann K, Reid CM. et al. Implementing assessment methods in plastic surgery. Plast Reconstr Surg 2016; 137: 617e-623e
  CrossrefPubMedGoogle Scholar