A systematic review of facial plastic surgery simulation training models

Introduction

In traditional surgical training, the trainee acts as an apprentice to a senior surgeon. In the UK, surgical training competencies are now more explicitly laid out. Working hours are also limited by the European Working Time Directive,¹ potentially leading to reduced exposure to surgical procedures.

The coronavirus disease 2019 (Covid-19) pandemic has led to a reduction in operative exposure, particularly for facial plastics. In the UK, all non-essential elective surgery stopped, and most facial plastic surgery has ceased. Indeed, only skin cancer operations are regarded as sufficiently high priority.² Following commencement of elective activity, facial plastics operative numbers are likely to be reduced because of extra precautions in the operating theatre and patients wishing to avoid elective surgery in a ‘high Covid risk’ environment. In addition, workforce mobilisation and redeployment are likely to continue, impacting surgical training.³

The concept of the ‘learning curve’ in surgery is familiar to every practising surgeon.^4,5 For example, Yeolekar and Qadri reported a mean of 76.66 open septorhinoplasties required to achieve proficiency.⁶ Surgical performance improves with experience.

Human cadaveric dissection offers the most effective method of training without real patient exposure; however, this is not always available. Surgical simulation is a way to help address this skills gap, particularly in the context of reduced operative numbers. In view of this, we conducted a systematic review to evaluate current facial plastics themed simulation models by assessing their validity and level of effectiveness. Human cadaveric dissection was outside the scope of this review. It is hoped that this systematic review will assist readers to choose simulators to ensure skill maintenance and provide alternative training.

Methods

Protocol

A review protocol was developed (available online at the following website: https://osf.io/qyvkf/?view_only=a1436d90c8b94b16a875aa5c5e45f93c).

Literature search

Literature searches were conducted independently by two authors (MAMS and RH), using PubMed, Embase, Cochrane, Google Scholar and Web of Science databases, between 1 April 2020 and 10 May 2020. Searches were performed using the combination of Boolean logic ‘AND’ and ‘OR’ with the following key word search terms: ‘simulation’, ‘simulations’, ‘reconstruction’, ‘auricle’, ‘pinna’, ‘ear’, ‘blepharoplasty’, ‘facial nerve’, ‘facial’, ‘nerve’, ‘resurfacing’, ‘plastic’, ‘facial plastic’, ‘animation’, ‘reanimation’, ‘re-animation’, ‘lip’, ‘malar’, ‘augmentation’, ‘chin’, ‘mentoplasty’, ‘nose’, ‘pinnaplasty’, ‘otoplasty’, ‘rhinoplasty’, ‘septoplasty’, ‘septorhinoplasty’, ‘rhytidoplasty’, ‘rhytidectomy’, ‘lift’, ‘flap’ and ‘flaps’. References were...