[Assessment tool's validation study for a simulation-based skin suturing skill]. / Étude de validation d'une grille d'évaluation d'un exercice de suture cutanée en simulation.

CONTEXT: Health simulation is a recognized educational method for teaching and validating surgical procedural skills. The latter requires the development of adapted assessment tools, reaching different validity criteria. The aim of this study was to validate a multimodal assessment tool for a complex skin suturing exercise, combining a manual knot, an intradermal linear suturing and a needle holder tied knot. METHODOLOGY: The suturing exercise was realized on a synthetic skin model by voluntary participants after having obtained their written consent, including 9 postgraduate medical students, 40 surgical residents of different levels of experience, and a group of 9 senior surgeons. The multimodal assessment tool (MAT) combined a checklist, a speed score and a global rating scale. Each exercise was scored by two evaluators. Medical students' performances were filmed anonymously so that they could be scored iteratively. Content validity was tested through a satisfaction questionnaire randomly completed by participants. RESULTS: The MAT was considered relevant or very relevant by 98% of the participants, with a better appreciation for the checklist than for the global rating scale. Internal consistency was strong with a Cronbach α coefficient at 0.78, and a good correlation between the results of the checklist and the global rating scale (r=0.79, P<0.0001). The MAT showed continuous improvement in mean scores from 34.4±3.6 for novices to 47.4±2.5/50 points for experts, passing through three intermediate levels groups, and allowed for significant discrimination between groups. The MAT was reliable, with a coefficient of correlation set at 0.88 for intra-observer reliability, and 0.72 for inter-observer reliability. On sub score analysis, the global rating scale and the speed score better discriminated between groups than the checklist, the latter moreover showing slightly lower reliability than the global rating scale. CONCLUSION: Despite its banality in any surgeon's practice and the fact that it is taught from the 2nd cycle of medical studies, suturing and its technical components have rarely been the subject of publications dedicated to the validation of specific assessment tools. Hence, this work on the MAT and its sub scores made it possible to validate them on many validity and reliability criteria. They can therefore be proposed to surgical teachers for evaluating a complex suturing exercise, with a checklist that is easier to use even for novices and a global rating scale showing better discrimination capacity.

Simulation-based training in dermatologic surgery: a literature review.

Simulation-based training has been shown to increase confidence and improve technical proficiency in surgical trainees. In this review, we describe the methods of simulation-based training currently being utilized in cutaneous surgery education. PubMed and EMBASE were searched for terms related to dermatologic surgery, education, and simulation. Articles published in English from 2013 onward that discussed simulation-based cutaneous surgery training of dermatology, plastic surgery, or otolaryngology resident physicians were included and summarized. Currently utilized simulation modalities in the training of dermatologic surgeons include skin substitutes, cadavers, and technology-based platforms. While each of these modalities have been shown to enhance trainee confidence and/or skill, head-to-head studies comparing their efficacy and usefulness are limited. Dermatologic surgery training, and therefore patient care, may be enhanced by further incorporation of simulation training. However, further studies are needed to clarify the optimal simulation platforms and delivery.

Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair.

Since dermatologists routinely perform surgery in an outpatient setting, ensuring that dermatology trainees are provided with opportunities to develop sufficient proficiency in excisional surgery and suture technique is paramount. The objectives of this study are to assess trainee preference for silicone-based synthetic skin compared with porcine skin as a surgical training medium and to assess the ability of trainees to successfully demonstrate basic surgical skills using the simulated skin model. Participants were a convenience sample of dermatology residents from the greater Chicago area, who were asked to perform an elliptical excision and bilayered repair on a silicone-based synthetic skin model. Residents were then surveyed regarding their satisfaction with the model. Four blinded dermatologist raters evaluated digital photographs obtained during the performance of the procedures and graded the execution of each maneuver using a surgical task checklist. Nineteen residents were enrolled. Residents were more likely to prefer pig skin to simulated skin for overall use (p = 0.040) and tissue repair (p = 0.018), but the nominal preference for tissue handling was nonsignificant (p = 0.086). There was no significant difference between satisfaction with pig skin versus synthetic skin with regard to excision experience (p = 0.82). The majority of residents (10/19) performed all surgical checklist tasks correctly. Of those residents who did not perform all steps correctly, many had difficulty obtaining adequate dermal eversion and wound approximation. Synthetic skin may be conveniently and safely utilized for hands-on surgical practice. Further refinement may be necessary to make synthetic skin comparable in feel and use to animal skin.

Surgical dermatoethics for the trainee.

Proficiency in performing dermatologic procedures is obtained by practice, and residents practice with real patients. The imperative of training new generations of dermatologists must be achieved while patient autonomy is respected and the highest standards of patient safety are upheld. This article examines ethical considerations that are inherent to the training process in procedural dermatology, including disclosing training status, informing patients of experience level with a particular procedure, and the need for graded responsibility under appropriate supervision.

A video-based, flipped classroom, simulation curriculum for dermatologic surgery: A prospective, multi-institution study.

BACKGROUND: Medical education is evolving to emphasize trainee engagement. The impact of a flipped classroom curriculum and surgical simulation on dermatology resident education has not been evaluated. OBJECTIVE: To assess the impact of video education and surgical simulation on dermatology resident procedural skills. METHODS: We created a curriculum on foundational surgical skills for 31 first- and second-year dermatology residents at 3 institutions. The flipped classroom approach replaces traditional in-person lectures with at-home viewing of instructional videos. After this self-directed learning, trainees had 3 hands-on sessions using simulated skin models. The Objective Structured Assessment of Technical Skills (OSATS) instrument was used to assess residents performing a simulated elliptical excision with intermediate repair before and after the curriculum. Residents completed precurriculum and postcurriculum surveys evaluating operative confidence and perceived value of the curriculum. RESULTS: Residents' total OSATS score increased from a median of 27 (interquartile range, 22-38.5) before the curriculum to 46 (interquartile range, 39.5-51.5) after the curriculum (P < .001). Self-reported confidence in surgical performance significantly improved, and residents were highly satisfied. LIMITATIONS: Limitations include the small sample size and potential influence from concurrent learning on surgical rotations. CONCLUSIONS: Video education and simulation are effective for improving dermatology residents' procedural skills. We hope to serve as a template for other institutions and nondermatology trainees hoping to improve procedural skills.

Aesthetic Dermatologic Surgery Training in Canadian Residency Programs.

BACKGROUND:: The public and other physicians expect dermatologists to be experts on aesthetic dermatology services. In Canada, current challenges may limit residents from achieving competency in aesthetic dermatology during their training. This may adversely affect patient safety, create medicolegal risks, and deter graduates from offering aesthetic procedures. OBJECTIVES:: The objective of this article is to characterize the curriculum, hands-on learning opportunities, and perceptions of aesthetic dermatologic training in Canadian dermatology residency training programs. METHODS:: An online survey of faculty and residents within Canadian dermatology residency programs was performed. The main outcome measures were the hours of formal aesthetic dermatology teaching, the frequency of hands-on dermatology resident training with injectables and devices, and comparing faculty and resident perspectives regarding resident aesthetic dermatology training. RESULTS:: Thirty-six faculty members (40%) and 47 residents (34%) responded to the survey. Lasers, fillers, neuromodulators, and mole removal were most commonly taught in the 10 hours or fewer of formal instruction. Residents commonly observed rather than performed procedures. High dissatisfaction among residents was reported with the quality and quantity of aesthetic dermatology training. Faculty and resident respondents supported increasing aesthetic dermatology education, and approximately 70% of residents plan to offer aesthetic services. Discounted pricing or resident-led clinics were felt to be ways to increase resident hands-on experience. CONCLUSIONS:: The standardization of core competencies in aesthetic dermatologic procedures is essential to ensure patient safety and practitioner competence. At present, formal aesthetic dermatology training in residency may be insufficient for hands-on training. The majority of dermatology faculty and resident respondents support increasing aesthetic dermatology training.

Computer-Based Video Instruction for Training Medical Students on Skin Biopsies.

BACKGROUND: The development of procedural skills is necessary for medical students. Computer-based video instruction (CBVI) increases knowledge and procedural skills. OBJECTIVE: This pilot study's aim was to investigate the usefulness of CBVI in dermatologic procedure training for medical students and secondarily assess students' overall perception of the field of dermatology. METHODS: Twenty-nine first- and second-year medical students were randomly assigned to the CVBI group or control group, in addition to in-person instructor demonstration of shave and punch biopsies using fresh cadaver tissue. Blinded evaluators graded student performances using a five-point Likert scale immediately after demonstration, and 1 week later to assess knowledge retention. RESULTS: In overall performance, the CBVI group demonstrated higher scores both in shave (3.54 vs 2.59, p = .01) and punch biopsies (3.63 vs 2.88, p = .01) at immediate recall and knowledge retention (3.68 vs 2.67, p = .01; 4.00 vs 2.99, p < .001, respectively). Approximately 33.3% of the students stated that the experience increased their interest in the field of dermatology. CONCLUSION: Incorporation of CBVI into the dermatology curriculum augments medical students' procedural skills. The CBVI group performed significantly better in all 7 grading categories for shave biopsy and in 5 of 7 categories for punch biopsy. Integration of procedural laboratory tests raises students' interest in dermatology.