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A Prospective, Randomized, Blinded Trial Comparing Digital Simulation to Textbook for Cleft Surgery Education

Plana, Natalie M., B.A.; Rifkin, William J., B.A.; Kantar, Rami S., M.D.; David, Joshua A., B.S.; Maliha, Samantha G., B.A.; Farber, Scott J., M.D.; Staffenberg, David A., M.D.; Grayson, Barry H., D.D.S.; Diaz-Siso, J. Rodrigo, M.D.; Flores, Roberto L., M.D.

Plastic and Reconstructive Surgery: January 2019 - Volume 143 - Issue 1 - p 202-209
doi: 10.1097/PRS.0000000000005093
Pediatric/Craniofacial: Original Articles

Background: Simulation is progressively being integrated into surgical training; however, its utility in plastic surgery has not been well described. The authors present a prospective, randomized, blinded trial comparing digital simulation to a surgical textbook for conceptualization of cleft lip repair.

Methods: Thirty-five medical students were randomized to learning cleft repair using a simulator or a textbook. Participants outlined markings for a standard cleft lip repair before (preintervention) and after (postintervention) 20 minutes of studying their respective resource. Two expert reviewers blindly graded markings according to a 10-point scale, on two separate occasions. Intrarater and interrater reliability were calculated using intraclass correlation coefficients. Paired and independent t tests were performed to compare scoring between study groups. A validated student satisfaction survey was administered to assess the two resources separately.

Results: Intrarater grading reliability was excellent for both raters for preintervention and postintervention grading (rater 1, intraclass correlation coefficient = 0.94 and 0.95, respectively; rater 2, intraclass correlation coefficient = 0.60 and 0.92, respectively; p < 0.001). Mean preintervention performances for both groups were comparable (0.82 ± 1.17 versus 0.64 ± 0.95; p = 0.31). Significant improvement from preintervention to postintervention performance was observed in the textbook (0.82 ± 1.17 versus 3.50 ± 1.62; p < 0.001) and simulator (0.64 ± 0.95 versus 6.44 ± 2.03; p < 0.001) groups. However, the simulator group demonstrated a significantly greater improvement (5.81 ± 2.01 versus 2.68 ± 1.49; p < 0.001). Participants reported the simulator to be more effective (p < 0.001) and a clearer tool (p < 0.001), that allowed better learning (p < 0.001) than textbooks. All participants would recommend the simulator to others.

Conclusion: The authors present evidence from a prospective, randomized, blinded trial supporting online digital simulation as a superior educational resource for novice learners, compared with traditional textbooks.

New York, N.Y.

From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health.

Received for publication January 26, 2018; accepted May 30, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Roberto L. Flores, M.D., Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 307 East 33rd Street, New York, N.Y. 10016,

Copyright © 2018 by the American Society of Plastic Surgeons