American Council of Academic Plastic Surgeons
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Making Headway in Surgical Education at Home and Abroad: Use of an Inexpensive Novel 3-D Learning Model for Plastic Surgery Education
Ellen C. Shaffrey, MD1, Ava G. Grotting, BS2, Brett F. Michelotti, MD1, John W. Siebert, MD1, Jeffrey D. Larson, MD1, Michael L. Bentz, MD1
1Division of Plastic and Reconstructive Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin 2University of Wisconsin-Madison, Madison, Wisconsin

Background: Simulation enhances trainee preparation for operative experiences. The development of cost-effective simulations is an area of interest amongst surgical specialties and is superimposed on a critical time in global surgery training as the COVID-19 pandemic has halted international travel for education. The aim of this study is to present a low-cost, interactive educational model, and describe the impact on resident assessment of reconstructive options for Mohs defects for use in both domestic and global surgery educational settings.
Methods: Seventeen residents in an integrated plastic surgery program performed a pre-activity questionnaire to assess their baseline ability to plan reconstructive flaps for five Mohs defects. They subsequently underwent an interactive learning session and were instructed to design flaps on life-sized Styrofoam heads with feedback from a senior surgeon. The residents completed a post-activity questionnaire to assess improvement in: analysis of the defect, identifying multiple reconstructive options, confidence in selecting the optimal reconstructive option, and ability to draw the final operative design. Three additional attending surgeons anonymously reviewed each resident’s designs for accuracy and estimated the resident’s postgraduate year (PGY).
Results: When analyzing all defects, participant-reported average post-activity scores increased by 0.63 [0.06 – 1.12]. Junior residents (PGY 1-3) had a greater increase in average score responses (mean: 1.07 [0.5-1.75]) compared to senior residents (PGY 4-6) (mean: 0.27 [0-1]) (p<0.001). A large majority of participants stated that this study “moderately” or “highly” improved their ability to assess Mohs defects for reconstruction (nasal alae: 30% (72% from 42%), nasal dorsum: 13% (59% from 46%), nasal tip: 20% (69% from 49%), cheek: 25% (68% from 43%), and upper lip: 15% (53% from 38%)). When anonymously assessed by senior-level surgeons, senior residents were significantly more accurate in design across the index cases compared to junior residents. However, junior residents were more likely to be estimated above their PGY training level compared to senior residents.
Conclusion: Beneficial improvements in assessing reconstructive options for Mohs defects are demonstrated, particularly by junior trainees, after participating in this low-cost, interactive educational model. The development of cost-effective models is critical for continued domestic and global surgery education.

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