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doi: 10.1097/SCS.0000000000005412
Original Article: PDF Only

Background: Plastic surgery evaluates residents on milestones. This study defines a model of education including pre and post-test assessments paired with didactics intended for evaluating residents in the unique technical skills of craniofacial surgery.

Methods: At the first institution, instrument identification, and time/accuracy of burr hole placement, craniotomy, and plating on Saw Bones Craniofacial Models were tested before and after a 7.5-hour craniofacial orthognathic surgery workshop. At the second institution, this was refined, removing plating, eliminating assessment of timing, and shortening didactics to standard osteotomies, instrument names, and common surgical approaches. The study population consisted of junior, mid-level, and senior residents on 2 different University craniofacial services.

Results: Participant performance was analyzed by level of training: junior, midlevel and senior resident. In the first iteration, resident times improved significantly for all 4 tasks (P = 0.008, 0.035, 0.035, 0.016). Resident accuracy improved significantly for instrument naming (P = 0.003). Except for instrument naming, resident year did not impact improvement (timing: P = 0.062, 0.310, 0.125, 0.334; accuracy: P = 0.029, 0.664, 0.717, 0.306). In the second iteration, resident accuracy improved for all tasks (instrument naming P = 0.00002, burr holes P = 0.0031, craniotomy P = 0.08). There was no difference in rate of improvement between resident cohorts.

Conclusion: The task-based assessment with resident education on basic craniofacial surgery skills, standard osteotomies, and instrument names directed resident learning and assessed resident knowledge. With the removal of time as a metric, all tasks improved in accuracy. The craniofacial skills task-assessment successfully evaluated milestone attainment in a reproducible model.

University Hospitals Cleveland Medical Center, Department of Plastic & Reconstructive Surgery, Cleveland, OH.

Address correspondence and reprint requests to Katherine A. Grunzweig, MD, University Hospitals Cleveland Medical Center, Department of Plastic & Reconstructive Surgery, 11100 Euclid Avenue, LKSD suite 5206 mailstop 5044, Cleveland, OH 44106-5068; E-mail:

Received 2 October, 2018

Accepted 15 January, 2019

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data from the original curriculum was presented the senior resident research day by Dr NJ Jarrett, 2014. The listed authors KG and JS did significant and detailed statistical re-evaluations of the original raw data and drew new conclusions of the original curricula independently. Conception of the 2-site study and development of the revised curriculum was independently performed by the listed authors KG and JS. All conclusions drawn are new and original by KG and JS with the assistance of the senior author ARK.

The development or design of the work, or acquisition, analysis, or interpretation of the data of the work, the drafting of the work and revising intellectual content and final approval of submitted work (KG, JS, and ARK).

ARK is a consultant for Polarity TE. The authors have no other conflicts of interest to disclose.

© 2019 by Mutaz B. Habal, MD.