Plastic and Reconstructive Surgery

Skip Navigation LinksHome > Blogs > PRSonally Speaking > Models and simulators used to practice surgical skills in pl...
PRSonally Speaking
Friday, October 4, 2013
Models and simulators used to practice surgical skills in plastic surgery
by Arturo Prado, MD
One of the most important objectives of plastic surgery residents is to practice skills in a safe environment before going into the operating room.

As surgical judgment relies on cognitive and professional skills, it can be better supervised in a simulated operating scenario, enabling trainees to receive feedback about their technical and nontechnical performance.

There are different types of simulators used in plastic surgery:
1. Bench models that are cheap, portable, reusable and have minimal risks with best use in training of basic skills for novice plastic surgeons and that can only measure discrete skills.

2. Live animals that permits practice of hemostasis and models of operations (microsurgery, vascular, nerves, flaps, muscular transpositions, blood flow, etc.) and can measure advanced procedural knowledge and dissection skills.

3. Cadavers, they are the only true anatomy simulator and where we can practice entire operations, with best use for continuing medical education.

4. Human performance simulators that permit three-dimension simulation, data capture, interactivity, team training, crisis management, feed back.

5. Virtual reality surgical simulators with minimal setup time, data capture, three dimension not well simulated (laparoscopic skills laboratory, endoscopic and transcutaneous procedural skills, robotics).
These models follow the Fitts-Posner three stage theory of motor skill acquisition and that has a:
1. Cognitive stage in which the trainee intellectualizes the task, with a performance that is erratic in its distinct steps; the best example is with tying a knot, in which the learner must understand the mechanics of the skill, how to hold the tie, how to place the throws, and how to move the hands.

2. Integrative stage in which with practice and feedback, knowledge is translated into appropriate motor behavior; the learner is still thinking about how to move the hands and hold the tie but is able to execute the task more fluidly and with fewer interruptions.

3. Autonomous stage in which practice gradually results in smooth performance; the learner no longer needs to think about how to execute this particular task and can concentrate on other aspects of the procedure.
With these tools we can address the increasingly limited opportunities for technical training and assessment that are offered to residents and fellows, not only during training but also throughout their careers.

It is no longer necessary to educate in a system that relies on chance opportunities for learning new skills.

Simulation allows for risk-free training in technical skills. For the first time, a proficiency-based curriculum can make the actual level of skill rather than a predetermined period of time the primary factor in plastic surgery resident progression up the training ladder, ensuring that patients are cared with expertise in the procedures they perform.

Although simulations alone cannot improve the quality of health care, they do significantly advance clinical education, especially when combined with enriched curricular and educational environments such as virtual operating rooms and lead to enhance clinical reasoning and professionalism.
Arturo Prado is an associate professor of plastic and general surgery at the University of Chile School of Medicine.
About the Blog

Plastic and Reconstructive Surgery

PRSonally Speaking is the official blog of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. Visit our blog for exclusive previews of and discussions on hot topics in plastic surgery as well as insider-tips on open access content. PRSonally Speaking is now powered by frequent contributions from the American Society of Plastic Surgeons’ Young Plastic Surgeons Forum (YPS); these practicing plastic surgeons provide the personal side of the plastic surgery story, from daily challenges to unique insights. PRSonally Speaking is home to lively, civil debate on hot topics and great discussions pertaining to our field. So, bookmark us, subscribe to the RSS feed and join in the on-going conversation with Plastic and Reconstructive Surgery. This is your Journal; have fun, be respectful, get engaged and interact with the PRS community.

The views and recommendations of guest contributors do not necessarily indicate official endorsements or opinions of the Journal, PRS, or the ASPS. All views are those of the authors and the authors alone.


Anureet K. Bajaj, MD is a practicing plastic surgeon in Oklahoma City. She completed residency and fellowship in 2004, had a brief stint in academia at the University of Cincinnati, and then chose to join her father (Paramjit Bajaj MD, also a practicing plastic surgeon) in private practice in OKC, where she focuses on breast reconstruction and general cosmetic surgeries.

Devra B. Becker, MD, FACS, is an Assistant Professor of Plastic Surgery in the Department of Plastic Surgery at University Hospitals/Case Western Reserve University School of Medicine in Cleveland, Ohio. She completed Plastic Surgery residency at Washington University School of Medicine in St. Louis, and completed fellowships with Daniel Marchac and with Bahman Guyuron. She currently has a primarily reconstructive practice.

Henry C. Hsia, MD, FACS is at Robert Wood Johnson Medical School of Rutgers University in New Brunswick, New Jersey and also holds an appointment at Princeton University.  When he’s not working hard trying to be a good father and husband, he runs a practice focused on reconstructive surgery and wound care as well as a research lab focused on wound biology and regenerative medicine.

Stephanie K. Rowen, MD is a senior physician at The Permanente Medical Group in San Jose, California.  She joined TPMG upon finishing residency and a hand surgery fellowship in 2005.  She has a primarily reconstructive practice, about 50% hand surgery.  Outside of work she enjoys participating in triathlons and spending time with her family.

Jon Ver Halen, MD is currently Chief of plastic surgery, Baptist Cancer Center; Research member, Vanderbilt- Ingram Cancer Center; Adjunct clinical faculty, St. Jude Children's Research Hospital. He also acts as Program Director for the plastic surgery microvascular surgery fellowship. His practice focuses on oncologic reconstruction.

Tech Talk Bloggers

Adrian Murphy is a plastic surgery trainee in London, England. He studied medicine in Dublin, Ireland and has trained in Ireland, Boston, MA and the United Kingdom. He is a self-confessed geek and gadget aficionado.

Ash Patel, MD is Assistant Professor of Plastic Surgery and Associate Program Director at Albany Medical College, in Albany NY. His practice is primarily reconstructive.