Evaluation of 3D Printed Cleft Lip and Palate Models in Plastic Surgery Education

Background: Modern plastic surgical education is challenged with increasing work hours restrictions, attainment of milestones for graduated responsibility, and a general decrease in operative independence.  These challenges require residency programs to define new methods for delivery of education efficiently and preoperatively to augment the intraoperative surgical experience.  We evaluated an approach using a three-dimensional printed cleft lip and palate silicone model for haptic simulation surgery in a laboratory setting.

Methods: Three-dimensional modeling and printing of a unilateral complete cleft lip and palate model was performed and tested at two accredited plastic and reconstructive surgery residency programs. A standardized modified Millard cleft lip repair course was developed for model surgery and proctored by a craniofacial surgery faculty member at each institution.  Pre-test and post-test evaluations were used for self-assessment of the understanding and confidence in performing the operation as well as an objective evaluation of knowledge.

Results: 27 trainees from two institutions completed the cleft lip model surgery session. Improvement of pre-test to post-test self-assessed understanding of the surgery steps (mean 5.6±1.6 to 6.3±1.7) and confidence in performing the surgery (mean 4.9±2.1 to 5.8±2.6) were statistically significant (p=0.02, p<0.001, respectively). Additionally, the improvement of objective knowledge from pre-test to post-test (mean 13.7±3.4 to 16.2±1.7) was also statistically significant (p<0.001).

To differentiate between the improvement between differing levels of training, trainees were separated into three levels based on post-graduate years (PGY) with low corresponding to <2 years, medium 3-4 years, and high >5 years. For both subjective measures of self-assessed understanding and confidence, post-test scores were elevated in higher level trainees while objective knowledge scores were not significantly different. When grouped by the number of primary cleft lip surgeries performed, again, self-assessed understanding and confidence post-test scores were higher in trainees who had previously performed more cleft lip repairs. Objective knowledge pre-test scores were also higher in trainees who had performed a larger number of cleft lip repairs (p=0.005), while no difference in knowledge scores were found post-test.

Conclusions: Transforming the classic “one-to-one” to a “one-to-many” apprenticeship model using simulation laboratories maximizes and efficiently delivers technical surgical education. A three-dimensional printed, standardized unilateral complete cleft lip and palate model for haptic surgical simulation demonstrated an improvement in subjective understanding and confidence in trainees for performing surgery. Furthermore, a curriculum incorporating haptic surgical simulation for cleft lip surgery demonstrated equalization of objective knowledge between trainees who have performed fewer repairs when compared to those who have performed greater number of repairs.