Resident Needs Assessment And Development Of A High Fidelity Porcine Model For Autologous Breast Reconstruction
Jill P. Stone, MD, FRCSC, George Kokosis, MD, John A. Rose, MD, MPH, Justin M. Sacks, MD, MBA.
Johns Hopkins, Baltimore, MD, USA.
PURPOSE: The ‘learn as you go' approach is a common theme in surgical pedagogy but may leave residents with perceived surgical skills deficiencies. Much of the literature on microsurgical education focuses on the execution of the vessel anastomosis while there is a paucity on flap harvest and recipient vessel preparation. The purpose of this study was to perform a needs assessment and pilot a live porcine microsurgical training model for junior residents
METHODS: Following a didactic lecture given by an experienced microsurgeon, three swine were intubated and prepared according to standard animal ethics protocol at our institution. Five to six plastic surgery residents and a preceptor were assigned to each station. Three surgical objectives were created during this pilot: 1) Prepare the internal mammary vessels (IMVs) 2) Identify perforators to the abdominal tissue 3) Determine if the abdominal tissue should proceed as a pedicled TRAM or free tissue transfer. Eliciting performance while providing real-time feedback was employed to encourage social learning and augment near-peer teaching. Fidelity of the model and utility of the course was tested using an online anonymous survey administered to the resident participants. Self-reported confidence scales were examined for the following skills: IMV preparation, vessel anastomosis, and flap dissection.
RESULTS: Preparation of internal mammary vessels was successfully performed in all three porcine subjects. Bilateral SIEA flaps were performed in Swine #1 and pedicled TRAMs were performed in Swine #2 and #3 due to insufficient deep inferior epigastric vessels. All swine survived the surgical procedures and were euthanized humanely following completion of the training session. Fourteen of the 17 residents responded to the follow-up survey (82.4%). Most residents are ‘very unconfident' in IMV preparation (n=8, 57.1%), vessel anastomosis (n=6, 42.9%), and perforator dissection (n=8, 57.1%). Nearly all residents believed the porcine model simulated human surgery well (n=12, 85.7%), live models are superior to non-live models (n=13, 92.9%), and this porcine training model improved their understanding of flap harvest and IMV preparation (n=12, 85.7%). Near-peer learning was endorsed by most residents (n=12, 85.7%) during this training model.
CONCLUSION: This needs assessment demonstrates that residents lack confidence in the surgical skills required for microsurgical breast reconstruction. The model was well received by the resident learners and incorporates surgical decision-making and technical skills execution. Residents can gain confidence in their surgical technique in this high-fidelity model and thus may improve self-assurance and autonomy in the clinical setting.
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