RESUMO
BACKGROUND: Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal augmentation mammaplasty operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. OBJECTIVES: To perform face, content, and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. METHODS: Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the objective structured assessment of technical skills (OSATS) system consisting of the global rating scale (GRS), mammaplasty objective assessment tool (MOAT), and a surgery-specific Checklist score. RESULTS: Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT, and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs 36.9 (3.1) (P < 0.0001) for GRS score, 30.4 (2.2) vs 40 (3.2) (P < 0.0001) for MOAT scores, and 9.7 (1.5) vs 12 (1) (P < 0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass correlation coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. CONCLUSIONS: This study proves the construct simulator to be valid and the assessment scales to be reliable.
Assuntos
Implante Mamário/educação , Competência Clínica/estatística & dados numéricos , Treinamento com Simulação de Alta Fidelidade/métodos , Internato e Residência/estatística & dados numéricos , Implante Mamário/métodos , Currículo , Avaliação Educacional/estatística & dados numéricos , Feminino , Humanos , Reprodutibilidade dos Testes , Gravação em VídeoAssuntos
Implante Mamário/psicologia , Implantes de Mama/efeitos adversos , Implantes de Mama/psicologia , Cultura , Atitude , Implante Mamário/efeitos adversos , Implante Mamário/economia , Implante Mamário/educação , Implantes de Mama/classificação , Implantes de Mama/economia , Comércio , Falha de Equipamento , Feminino , Fraude/prevenção & controle , Humanos , Reembolso de Seguro de Saúde , Mastectomia/educação , Mastectomia/métodos , Mastectomia/psicologia , Mastectomia/reabilitação , Educação de Pacientes como Assunto , Desenho de Prótese , Falha de Prótese/efeitos adversos , Géis de Silicone/efeitos adversos , Géis de Silicone/economiaRESUMO
Despite popularity, breast augmentation has not advanced significantly in 20 years. The re-operation data for breast augmentation has been excessive at 15% to 20% in every Federal Drug Administration pre-market approval study for the past 15 years. Recently, a more scientific approach to breast augmentation has described a true process approach to this procedure. One element, tissue-based pre-operative planning, has been shown to reduce re-operation rate to less than 3% in published peer-reviewed studies. The High Five process was published in 2005 and codifies the 5 most important pre-operative decisions made during a breast augmentation procedure. Application into clinical practice of this planning system is discussed.
Assuntos
Antropometria , Tamanho Corporal , Implante Mamário , Implantes de Mama , Tomada de Decisões Assistida por Computador , Cuidados Pré-Operatórios , Adulto , Antropometria/métodos , Imagem Corporal , Implante Mamário/educação , Implante Mamário/instrumentação , Implante Mamário/psicologia , Implantes de Mama/classificação , Implantes de Mama/provisão & distribuição , Comportamento de Escolha , Feminino , Humanos , Planejamento de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto , Participação do Paciente/métodos , Participação do Paciente/psicologia , Seleção de Pacientes , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/psicologia , Reoperação , Cirurgia Assistida por ComputadorRESUMO
This article contains two case reports that illustrate the difficulty two mothers experienced when they mechanically expressed their milk for their very preterm infants. Each of the mothers was enrolled in a separate research study and had previously undergone surgery for breast augmentation. Neither of the mothers was able to provide an adequate milk supply for her preterm infant. Preoperative counseling and informed consent for breast augmentation is vital if the mother desires to exclusively provide mother's milk for the infant.