Project description:BackgroundMedical students receive limited exposure to the field of plastic surgery because most students will not rotate in plastic surgery, especially those at schools without dedicated plastic surgery residency programs. This study aimed to create and validate a plastic surgery learning module for medical students to dispel media-propagated myths and misrepresentation of the breadth of plastic surgery and equip students with referral-making capabilities.MethodsThe plastic surgery learning module was created using Articulate Storyline 360 (New York, N.Y.). Student participants were recruited from a single medical school across all four classes. Pre- and postmodule surveys were administered via Qualtrics (Provo, Utah). Scores were computed for the general surgical knowledge section and for each specialty referral question.ResultsTwelve students completed usability testing and edits were subsequently made to optimize the module. The module took on average 66 minutes to complete. Sixty-five students (19 MS1, 16 MS2, 15 MS3, 15 MS4) completed efficacy testing. In the premodule survey, students were nearly 100% accurate in identifying breast-related referrals, unlike pediatric/craniofacial (avg: 68%), reconstruction/microsurgery (avg: 64%), and hand/upper extremity (avg: 30%) referrals. Students of all classes exhibited significant improvement in all testing categories except for the breast category, with the most improvement in the hand referrals category. Prior exposure to plastic surgery (57%) correlated with higher premodule hand (P = 0.003) and breast/cosmetic (P = 0.01) referral scores.ConclusionThe plastic surgery learning module shows promise to be a comprehensive yet affordable and time-efficient tool for medical students to learn about basic surgical principles and the scope of plastic surgery.
Project description:BackgroundTo continue education during the COVID-19 pandemic, we implemented a Virtual Education Platform (VEP) and Virtual Visiting Professorship (VVP) in March 2020 into our plastic surgery residency curriculum. This study investigated resident and guest speaker perceptions of the VEP since the start of the pandemic.MethodsThe VEP consists of weekly VVP lectures and usual conferences held over Zoom. In May 2020, residents and speakers completed surveys that assessed the perceptions of the VEP using a 5-point Likert scale and open-ended responses. In August 2021, residents also completed follow-up surveys.ResultsA total of 19 (100%) residents and 10 (100%) speakers responded to the 2020 surveys and 15 (88.2%) residents responded to the 2021 follow-up survey. Speakers represented nine academic institutions, one international. 74% of residents responded that they learned a lot or a great deal from the VVP. In 2021, 100% of residents agreed that virtual conferences should remain a core component in PRS residency education, even after social distancing requirements subside. The VVP lectures were mentioned as the most helpful lectures in both years. Easy accessibility without travel time was the most mentioned advantage of the VEP in both years, with significantly more residents citing this benefit in 2021 (p = 0.0076). The most reported disadvantage for residents was the lack of social interaction and community in both years, with significantly more residents in 2021 citing this as a disadvantage (p = 0.0307). Residents' attitudes also shifted such that significantly more residents liked and were satisfied with the VVP lectures from 2020 to 2021 (p = 0.04).ConclusionOver a year into the COVID-19 pandemic, resident perceptions of a virtual education platform and virtual visiting professorship were very positive. The quick development, implementation, and high efficacy of these educational experiences underscore that learning is possible in alternative forms in unprecedented times.
Project description:The complex three-dimensional anatomy of the craniofacial skeleton creates a formidable challenge for surgical reconstruction. Advances in computer-aided design and computer-aided manufacturing technology have created increasing applications for virtual surgical planning in craniofacial surgery, such as preoperative planning, fabrication of cutting guides, and stereolithographic models and fabrication of custom implants. In this review, the authors describe current and evolving uses of virtual surgical planning in craniofacial surgery.
Project description:BackgroundWith increasing public awareness of and greater coverage for gender-confirming surgery by insurers, more transgender patients are likely to seek surgical transition. The degree to which plastic surgery and urology trainees are prepared to treat transgender patients is unknown.ObjectiveWe assessed the number of hours dedicated to transgender-oriented education in plastic surgery and urology residencies, and the impact of program director (PD) attitudes on provision of such training.MethodsPDs of all Accreditation Council for Graduate Medical Education-accredited plastic surgery (91) and urology (128) programs were invited to participate. Surveys were completed between November 2015 and March 2016; responses were collected and analyzed.ResultsIn total, 154 PDs (70%) responded, and 145 (66%) completed the survey, reporting a yearly median of 1 didactic hour and 2 clinical hours of transgender content. Eighteen percent (13 of 71) of plastic surgery and 42% (31 of 74) of urology programs offered no didactic education, and 34% (24 of 71) and 30% (22 of 74) provided no clinical exposure, respectively. PDs of programs located in the southern United States were more likely to rate transgender education as unimportant or neutral (23 of 37 [62%] versus 39 of 105 [37%]; P = .017). PDs who rated transgender education as important provided more hours of didactic content (median, 1 versus 0.75 hours; P = .001) and clinical content (median, 5 versus 0 hours; P < .001).ConclusionsA substantial proportion of plastic surgery and urology residencies provide no education on transgender health topics, and those that do, provide variable content. PD attitudes toward transgender-specific education appear to influence provision of training.
Project description:BACKGROUND:In-service training examinations (ITEs) are used to assess residents across specialties. However, it is not clear how they are integrated with the Accreditation Council for Graduate Medical Education Milestones and competencies. OBJECTIVE:This study explored the distribution of specialty-specific milestones and competencies in ITEs for plastic surgery and orthopaedic surgery. METHODS:In-service training examinations were publicly available for plastic surgery (PSITE) and orthopaedics (OITE). Questions on the PSITE for 2014-2016 and the OITE for 2013-2015 were mapped to the specialty-specific milestones and the 6 competencies. RESULTS:There was an uneven distribution of milestones and competencies in ITE questions. Nine of the 36 Plastic Surgery Milestones represented 52% (341 of 650) of questions, and 3 were not included in the ITE. Of 41 Orthopaedic Surgery Milestones, 7 represented 51% (201 of 394) of questions, and 5 had no representation on the ITE. Among the competencies, patient care was the most common (PSITE = 62% [403 of 650]; OITE = 59% [233 of 394]), followed by medical knowledge (PSITE = 34% [222 of 650]; OITE = 31% [124 of 394]). Distribution of the remaining competencies differed between the 2 specialties (PSITE = 4% [25 of 650]; OITE = 9% [37 of 394]). CONCLUSIONS:The ITEs tested slightly more than half of the milestones for the 2 specialties, and focused predominantly on patient care and medical knowledge competencies.
Project description:BackgroundCOVID-19 has led to government enforced 'lockdown' in the UK severely limiting face-to-face patient interaction. Virtual consultations present a means for continued patient access to health care. Our aim was to evaluate the use of virtual consultations (VCons) during lockdown and their possible role in the future.MethodsAn anonymous survey was disseminated to UK and European plastic surgeons via social media, email sharing and via the European Association of Societies of Aesthetic Plastic Surgery newsletter. Uptake of VCons, modality, effectiveness, safety and future utility were assessed.ResultsForty-three senior plastic surgeons responded to the survey. The majority of the respondents (97.7%) reported using VCons during COVID-19 lockdown, of which 74.4% had no prior experience. Two-thirds of surgeons utilised commercial platforms such as Zoom, FaceTime and Skype, 38.1% of respondents did not know about or were unsure about adequate encryption for health care use, and just under a half (47.6%) reported they were unaware of or lacking GDPR compliance. Most (97.6%) say they are likely to use virtual consultations after lockdown.ConclusionVirtual consultations have had a crucial role in patient care during UK lockdown. It is clear that they will serve as an adjunct to face-to-face consultation in the future. Further regulation is required to ensure platforms offer adequate safety and security measures and are compliant with relevant data protection laws.Level of evidence ivThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Project description:Interviews for the integrated plastic surgery residency match took place in a virtual format for the 2020-2021 application cycle. Current literature lacks the perspectives of program directors (PDs) on virtual interviews compared with traditional in-person interviews.MethodsFollowing institutional review board approval, an anonymous 17-question survey was distributed by email to 82 program directors of integrated plastic surgery residency programs in the United States. Participants were asked baseline program information, the number of positions and interview invites offered, and their perspectives on various aspects of the virtual interview process.ResultsSixty-two (75.6%) PDs completed the survey. Thirty-seven percent reported increasing the number of interview offers per available residency spot. On a five-point Likert scale (1, not well at all; 5, extremely well), PDs showed no significant differences in their ability judge an applicant's professionalism (3.1 ± 1.1), interpersonal and communication skills (3.2 ± 1.1), and "fit" with their program (2.9 ± 0.9) during virtual interviews (P = 0.360). Sixty-eight percent reported being satisfied (15.3% extremely satisfied, 52.5% somewhat satisfied) with the virtual interview process, though 76.3% preferred in-person interviews.ConclusionsThis study is the first to provide insight into PDs' impressions of virtual residency interviews. Although most reported being satisfied with the virtual interview process, the majority still preferred in-person interviews. Further long-term studies evaluating the pros and cons of each interview modality may provide more information on whether virtual interviews could become a sustainable alternative to the traditional in-person residency interview.
Project description:Minimally invasive glaucoma surgery (MIGS) has been gaining popularity over the last decade. Although there is no strict definition for MIGS, all the new procedures share the common theme of intraocular pressure reduction with minimal tissue destruction, short surgical time, simple instrumentation and fast postoperative recovery. The use of glaucoma drainage implants has long been the traditional treatment for complex glaucoma, but a new wave of glaucoma micro-stents are now being manufactured with various materials designed to increase aqueous outflow via different channels. This review summarises the current published literature on these devices, including Sclemm's canal stents (iStent, Hydrus), Suprachoroidal stents (CyPass, iStent supra), and subconjunctival stents (Xen, Innfocus).
Project description:BackgroundSurgical start time (SST) has demonstrated conflicting effects on perioperative outcomes due to confounding factors, such as increased acuity in later SST cases. This study investigated the effect of SST on blood transfusion after gastric bypass surgery, a complication-prone elective surgical procedure.MethodsThis retrospective cohort study included all patients undergoing gastric bypass surgery at a single academic medical center from 2016 through 2021 (n = 299). The primary independent variable was SST (before vs. after 15:00). The primary outcome was blood transfusion. Secondary outcomes included postoperative respiratory failure, length of stay, acute kidney injury, and mortality. The associations between SST and outcomes were investigated with univariate analyses. Multivariate and receiver operating characteristic (ROC) analyses were applied to the primary outcome, adjusting for demographic and operative characteristics.ResultsOn univariate analysis, 15:00-18:43 SST was associated with an increased risk of blood transfusion (relative risk 4.32, 95% confidence interval 1.27 to 14.63, p = 0.032), but not postoperative respiratory failure, acute kidney injury, length of stay, or mortality. On multivariate analysis, the only independent predictor of postoperative blood transfusion was a 15:00-18:43 SST (adjusted odds ratio 4.32, 95% confidence interval 1.06 to 15.96, c-statistic = 0.638). ROC analysis demonstrated that compared to the 15:00 threshold, a 14:34 threshold predicted postoperative blood transfusion with better accuracy (sensitivity = 70.0%, specificity = 83.0%).ConclusionsDespite having similar demographic and operative characteristics, gastric bypass patients in the late SST cohort had a greater incidence of postoperative blood transfusion in this single-center study.