Background Rhinoplasty is a complex procedure that requires meticulous planning and precise execution. Plastic surgeons involved in teaching residents must balance a trainee’s hands-on experience while ensuring appropriate execution of difficult maneuvers. Surgical simulation, a field of growing importance with the shift towards competency-based education, may aid in trainee skill development. Through the concept of deliberate practice, the authors looked to explore the utility and economics of 3-dimensional (3D) printing technology to develop a step-specific rhinoplasty simulator. Objectives The main objective of this study was to address rhinoplasty skills previously identified as “learning areas of weakness” and develop a low-cost, step-specific simulator to help rhinoplasty teaching. Methods A patient’s facial bones, upper and lower lateral cartilages, and septum were segmented from a computed tomography scan and rendered in 3D format. This was 3D printed utilizing Ultimaker Polylactic filament with a polyvinyl acetate dissolvable support for bone, a mixture of Rigur 450 and Tango plus polyjet material for cartilage, and Smooth-On Dragon Skin for skin. Results A modular simulator was developed with 3 separate, interchangeable components with a perfect fit design. The simulator allowed for deliberate practice of the 5 rhinoplasty learning areas of weakness, with a maximal recurring cost of $75 CAD. Conclusions Through the employment of 3D printing, a low-cost, maneuver-specific rhinoplasty simulator reinforcing deliberate practice was developed. This concept of simulation-based deliberate practice may be of increasing interest when considering the implementation of competency-based curricular standards in plastic surgery education.
Background: Rhinoplasty is known for its complexity in planning and execution. For trainees, knowledge acquisition is often adequately attained. The mastery of skills, however, occurs by means of hands-on exposure, which continues to be a challenge. This article discusses the positive progress made in rhinoplasty training, and objectively demonstrates a need for more hands-on rhinoplasty exposure for residents. Methods: A systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Concurrently, an online survey was developed, assessing resident comfort and training in rhinoplasty, and e-mailed to Canadian and U.S. plastic surgery training programs. Results: One hundred thirty-eight residents completed the survey, 62 junior (first- to third-year residents) and 76 senior residents (fourth- to sixth-year residents). Seventy-two percent of senior residents (95 percent of sixth-year residents) reported adequate rhinoplasty exposure, as opposed to 13 percent of junior residents. Seventy-five percent of senior residents most often participated as observers or first assistants, 25 percent participated as co-surgeons, and 73.9 percent did not perform a key rhinoplasty step more than five times. Residents felt the three most difficult steps of rhinoplasty were nasal osteotomy (76.1 percent), caudal septum/anterior nasal spine manipulation (65.2 percent), and nasal tip sutures (55.8 percent), and 73.9 percent felt that simulator training would substantially improve confidence. Conclusions: Despite sufficient exposure to rhinoplasties, residents were least confident in performing rhinoplasties relative to other aesthetic procedures, likely because of the high proportion of rhinoplasty exposure that is observational as opposed to hands-on acquisition of surgical maneuvers in the operating room. The survey established the maneuvers residents find the most difficult, and as programs adopt competency-based training, developing rhinoplasty simulators targeting specific identified steps may help improve competence for rhinoplasty skills.
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