Biological Simulator for Training in Cleft Lip Surgery. Validation of the Instrument for the Evaluation of Surgical Competencies in Cleft Lip Surgery with Tennison Randall Queiloplasty

Purpose: The evaluation of surgical skill acquisition in plastic surgery has traditionally relied on subjective opinions of senior faculty. Currently, is shifting toward early competency-based training using validated models. No objective assessment of dexterity, movement skills, and ability exist on the evaluation of surgical techniques for cleft lip cheiloplasty with biological simulators.

 Objective: To develop and validate the Instrument for the Evaluation of Surgical Competencies in Cleft Lip Surgery with Tennison Randall type Cheiloplasty.This instrument consists on a three-module scale that assess 13 basic surgical parameters during the procedure.  

Method: In order to validate this assessment instrument, 20 clinical cases of cheiloplasty in rabbits using Tennison Randall technique were perform by second and third year plastic surgery residents, guided by an expert consultant plastic surgeon faculty. The procedures were recorded on videos using a video camera. The videos were unedited and evaluated by 3 blinded expert plastic surgeons in cheiloplasty technique, using the Instrument for the Evaluation of Surgical Competencies in Cleft Lip surgery with Tennison Randall type Cheiloplasty. All residents performed the same surgical technique to standardize the assessment as much as possible.  

Results: A total summary score was calculated from the sum of the three modules from the Instrument. Mean scores were compared among the three evaluators using analysis of variance. Significant differences were found among the rating scores for the 10 residents but not among the 3 evaluators. Inter-rater reliability was determined using Cronbach’s alpha coefficient (0.89) and task module-specific (0.93) scores suggested high internal consistency for each module.

 Conclusion: The Instrument for the Evaluation of Surgical Competencies in Cleft Lip Surgery with Tennison Randall type Cheiloplasty is the first validated instrument for assessing surgical competencies in cleft lip surgery. Proficiency in cleft lip surgery can be achieved over a relatively limited number of practice sessions. Standardized evaluation and systematic learning of conventional surgical techniques is necessary, and is the foundation of competency-based training, which itself is the future of surgical education.