American Association of Plastic Surgeons

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Digital Simulation in Plastic Surgery Training: A Prospective, Randomized, Blinded Trial of a Surgical Simulator
Natalie M. Plana, BA, William J. Rifkin, BA, Rami S. Kantar, MD, Joshua A. David, BS, Samantha Mahlia, BA, J. Rodrigo Diaz-Siso, MD, Eduardo D. Rodriguez, MD, DDS, Roberto L. Flores, MD.
NYU Langone Health, New York, NY, USA.

Purpose: Simulation is progressively being integrated into surgical training, yet its utility in plastic surgery has not been well described. We present a prospective, randomized, blinded trial comparing digital simulation to a surgical textbook for conceptualization of cleft care techniques.
Methods: Thirty-five medical students were randomized to learning cleft repair using a simulator or textbook. Participants outlined markings for a standard cleft-lip repair before (pre-intervention) and after (post-intervention) 20 minutes of studying their respective resource. An expert reviewer blindly graded student markings according to a 10-point scale, on two separate occasions. Intra-class correlation coefficients were calculated to assess intra-rater reliability. Paired and independent t-tests were performed to compare scoring between the study groups. A validated student satisfaction survey was administered to assess the simulator and textbook sources separately.
Results: Intra-rater grading reliability was excellent for both pre-intervention and post-intervention grading (ICC=0.94 and 0.95, respectively; p<0.001). Mean pre-intervention performances between textbook and simulator groups were comparable (0.821.17 vs. 0.640.95; p=0.31). There was significant improvement from pre-intervention to post-intervention performance in both the textbook (0.821.17 v. 3.501.62; p<0.001) and simulator (0.640.95 vs. 6.442.03; p<0.001) groups. However, the simulator group demonstrated a significantly greater improvement (5.812.01 vs. 2.681.49; p<0.001). Participants of both groups reported the simulator to be more effective (p<0.001) and a clearer tool (p<0.001), that allowed better learning (p<0.001) than textbooks. All participants would recommend the simulator to others.
Conclusions: We present level I evidence supporting online digital simulation as a superior educational resource for novice learners, compared to traditional textbooks.


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