Validation of an in vivo porcine simulation model of pedicled latissimus dorsi myocutaneous flap elevation
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ORIGINAL PAPER
Validation of an in vivo porcine simulation model of pedicled latissimus dorsi myocutaneous flap elevation Maha Wagdy Hamada 1 & Giorgios Pafitanis 2 & Alex Nistor 3 & Youn Hwan Kim 4 & Simon Myers 2 & Ali Ghanem 2 Received: 14 February 2020 / Accepted: 19 August 2020 # The Author(s) 2020
Abstract Background In vivo and ex vivo simulation training workshops can contribute to surgical skill acquisition but require validation before becoming incorporated within curricula. Ideally, that validation should include the following: face, content, construct, concurrent, and predictive validity. Methods During two in vivo porcine surgical training workshops, 27 participants completed questionnaires relating to face and content validity of porcine in vivo flap elevation. Six participants’ performances raising a pedicled myocutaneous latissimus dorsi (LD) flap in the pig (2 experts and 4 trainees) were sequentially and objectively assessed for construct validity with hand motion analysis (HMA), a performance checklist, a blinded randomized procedure-specific rating scale of standardized video recordings, and flap viability by fluorescence imaging. Results Face and content validity were demonstrated straightforwardly. Construct validity was demonstrated for average procedure time by HMA between trainees and experts (p = 0.036). Skill acquisition was demonstrated by trainees’ HMA average number of hand movements (p = 0.046) and fluorescence flap viability (p = 0.034). Conclusion Face and content validity for in vivo porcine flap elevation simulation training were established. Construct validity was established for an in vivo porcine latissimus dorsi flap elevation simulation specifically. Predictive validity will prove more challenging to establish. Level of evidence: Not ratable . Keywords Microsurgery . Training . Validation . Live pig model
Introduction Trainee surgeons are increasingly expected to complete a variety of competency-based surgical courses during specialty training. Surgical courses on high fidelity simulation models provide students and junior trainees with key practical skills placing them at the center of the educational experience as opposed to the clinical setting [1]. Surgical simulation is * Ali Ghanem [email protected] 1
Imperial College University, London, UK
2
Academic Plastic Surgery Group, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
3
Pius Branzeu Center, Timisoara, Romania
4
Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
increasingly presented as a solution to improving patient safety despite truncation of training schemes. It has particular relevance to technically challenging sub-specialty areas including microvascular flap reconstruction [2]. Microsurgical simulation training courses generally extend over a number of consecutive days aiming to provide a bundle of skills within a patient safe and non-threatening training environment for trainees [3, 4].
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