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Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review

Abi-Rafeh, Jad H.B.Sc., M.Sc.; Zammit, Dino H.B.Sc., M.D., C.M.; Mojtahed Jaberi, Mehrad B.Sc., M.D., C.M.; Al-Halabi, Becher B.Med.Sc., B.M.B.Ch., M.H.P.E.; Thibaudeau, Stephanie C.M., F.R.C.S.C.

Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 496e-507e
doi: 10.1097/PRS.0000000000005990
Plastic Surgery Focus: Special Topics

Background: Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model’s complexity, characteristics, advantages, disadvantages, and validation measures taken.

Methods: A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria.

Results: Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators.

Conclusions: A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today’s training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.

Montreal, Quebec, Canada

From the Faculty of Medicine, McGill University; and the Division of Plastic and Reconstructive Surgery, McGill University Health Center.

Received for publication September 7, 2018; accepted February 13, 2019.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

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Dino Zammit, H.B.Sc., M.D., C.M., Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada,, Instagram: @mcgillprs, @drdinoz_n_rs3

Copyright © 2019 by the American Society of Plastic Surgeons