Letter to the Editor: Comment on Ngaage LM, et al. Global Burn Registry Perspective on Head and Neck Burns (Ann Plast Surg 2021;87:33-38)

Abstract

Regarding follow-up studies, one arm of our current work focuses on more rigorously evaluating simulator construct validity to determine its utility for assessing surgeon competence. This is a critical step before incorporating it into training or using it to measuring surgeons' ability. A second arm of current research is determining whether improvements gained through simulation are maintained over time. This is a particularly important focus as a high-fidelity cleft simulator not only enables technical skills acquisition but also allows residents to think through steps of an operation, manage intraoperative challenges, and experience consequences of their mistakes, theoretically lessening a steep intraoperative learning curve without risk to patients. It also begins to marry the concepts of technical and nontechnical skills into a comprehensive simulation program.The authors make an important point about evaluating impact of simulation on actual intraoperative performance. Although our ultimate goal, it is logistically challenging given that trainees do not experience operative autonomy for cleft lip repair until later stages of their career after considerable experience assisting with the procedure. This is where simulating a complex multistep operation like cleft lip repair diverges from a procedure-like cystoscopy as the authors described. Within the subspecialty of urology, it more closely compares to simulating proximal hypospadias correction in terms of the challenges in teaching/learning, ramifications of giving autonomy to relative novices, and long duration over which outcomes manifest (but with the emergence of hypospadias simulators, we will certainly look out for work in this area). Regardless, we fully agree that improving actual performance in the operating room is the ultimate goal and measuring that effect a holy grail of surgical simulation.