TEACHING/LEARNING AESTHTIC RHINOPLASTY:



Teaching Learning Rhinoplasty: The Booster Method

Patricio F. Jacovella M.D. Ph.D.

Aesthetic surgery of the nose implies high stakes to good results and narrow margin of errors. Due to reduced surgical field, can be considered as " surgery of sensations"

Despite of considering that experience is still the best teacher, the objective is to present a simple pedagogical booster method based in a step by step development of specific surgical skills.

Material and Methods:

The study was carried out in the University of Buenos Aires, Argentina, School of Medicine, Plastic Surgery Training Program, with 25 plastic surgery residents with no previous experience in aesthetic rhinoplasty.

The teaching / learning method was divided in three main steps:

1. Anatomical dissections of the nose in fresh cadavers, in order to get the knowledge of the different nasal structures.

2. Specific surgical maneuvers performed in "open nose" fresh cadavers, in order to achieve and develop hand sensations.

3. Measurement of the same specific maneuvers during the first real rhinoplasty, performed by each resident assisted by a staff surgeon.

The whole training program took 40 hours and was developed in 2 weeks.

[pic] [pic]

Fig.1 Lateral cartilages Fig.2 Nasal valve

The following pedagogical parameters were evaluated: knowledge, attitudes and specific skills.

Thru an observable video assisted behavioral scale, residents performances in accuracy an number of attempts were considered as very good (VG), good (G), acceptable (A) and non acceptable (NA).

[pic] [pic]

Fig.3 Dorsum resection Fig.4 Lateral osteotomy

Results:

The results were compared with other population of 25 plastic surgery residents who did not participate in this training program.

Differences between the two groups are shown in the following table.

Table 1: Residents performances comparison

VG G A NA

n % n % n % n %

Study group 19 76 4 16 2 8 - -

Control group 1 4 8 32 12 48 4 16

Discussion:

Even though touch provides approximately 5 % of the overall sensory input, this sense plays a crucial role for specific skills in rhinoplasty.

The feasibility of using Data glove, a simulator that allows touching and receiving sensations, thru a three dimensional computer-aided program, is very expensive and different than being in touch with real anatomic tissue. With this method, errors can be made without detrimental consequences to patients. Is a good opportunity for residents to feel sensations with force feedback like in real surgery and be used to similar skills.

Conclusions:

1.The booster method allows hand sensation achievement and skill development.

2.Cost benefit ratio analysis in medical education suggests this training as an economic issue to be considered.

References

1.Constantin MB, Epheresis C and Sheen JH: The Expert Teaching System: A New Method for Learning Rhinoplasty using Interactive Computer Graphics. Plast Reconstr Surg, 79:278-281, 1987.

2.Cutting C, Grayson B, Mc Carthy JG, Thorne C, Khorramabadi D, Haddad B and Taylor R :A Virtual Reality System for Bone Fragment Positioning in Multisegment Craniofacial Surgical Procedures. Plast Reconstr Surg,102: 2436-2443, 1998.

3.Dingman RO and Natvig P: Surgical Anatomy in Aesthetic and Corrective Rhinoplasty. Clin Plast Surg, 4:111-114, 1997.

4.Haluck RS, Marshall RL, Krummel TM and Melkonian MG : Are Surgery Training Programs Ready for Virtual Reality ?

J Am Coll Surg, 193(6): 660-665, 2001

5.Jacovella PF : Introduccion a la Docencia en Medicina. Buenos Aires, Lopez Libreros Editores,1991.Pages 59-72

6.Meier AH, Rawn CI, Krummel TM: Virtual Reality: Surgical Application-Challenge for the New Milleniium.

J Am Coll Surg, 192(3):372-284, 2001

7.Pieper SD, Laub DR, Rosen JM: Afinite Element Facial Model for Simulating Plastic Surgery. Plast Reconstr Surg, 96: 1100-1105,1995.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download