American Council of Academic Plastic Surgeons
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Surgical simulation for metacarpal fracture fixation improves satisfaction, confidence and skill
Rajiv Iyengar, MD1; Albert Woo, MD2; Adnan Prsic, MD1
1Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, 2Division of Plastic and Reconstructive Surgery, Warren Alpert School of Medicine, Brown University

Introduction: Surgical education has long touted the value of high fidelity simulations in the modern training paradigm. The senior authors of this study have therefore created a low-cost model of a human hand using 3D printing and silicone molding to facilitate at-home practice sessions for K-wiring. Materials and Methods: Following IRB review and approval, 11 plastic surgery residents (PGY 1-6) were recruited for this study. All residents watched a presentation from the senior author (A.P.), which outlined 10 steps to K-wire fixation; the task at hand was placement of two K wires diagonally across a simulated metacarpal fracture. These trials were timed. Residents were divided into two groups in which Group A performed K-wire fixation and Group B observed. The groups then crossed over. The residents performed four practice sessions at home prior to the next assessment. Confidence and satisfaction data in a 15 question survey were recorded using a Likert scale from 1-5, with 5 corresponding to strong agreement. Aggregate scores are represented in parentheses below.
Results: All residents agreed that the model was realistic (4.7), sufficient for fracture identification (4.5) and had appropriate approximation of soft tissue and bony tactile feedback (4.3). Moreover, all residents agreed that they found these sessions stimulating (4.9). All residents would recommend this model to other trainees (4.8) and reported feeling that they had learned valuable skills (4.6). Most residents had scrubbed either 0-5 or 6-10 cases requiring K wiring. All residents felt more confident with K-wiring following the practice sessions when compared to pre-training baselines (2.7 vs. 4.4). Times were stratified by PGY level; PGY 1-4 (n = 8) average times Session 1 was 712 seconds and 433 seconds for Session 2, while PGY 5-6 (n = 3) times were 495 seconds and 247 seconds respectively (p = 0.037).
Conclusions: Our analysis demonstrates that residents universally approved of and benefitted from the K wiring instructional session and practice model. The time improvement was statistically significant. We therefore believe that this is a practical and efficacious model to improve a critical skill in hand surgery across training levels.

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