Reevaluating the Current Model of Rhinoplasty Training and Future Directions: A Role for Focused, Maneuver-Specific Simulation

Abstract

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.

Use of Simulation in Plastic Surgery Training

“…This has at least partially been reflected through resident surveys. For example, Zammit et al 55 found that residents express the least confidence with rhinoplasty procedures and desire increased availability of simulators to improve these skills. Additionally, one study has demonstrated that residents lack hands-on training in bilateral breast augmentation despite it being the second most common esthetic procedure performed in the United States.…”

“…Additionally, one study has demonstrated that residents lack hands-on training in bilateral breast augmentation despite it being the second most common esthetic procedure performed in the United States. 55 The authors attributed these findings to the fact that the majority of esthetic training is observation-based as opposed to hands-on. As a result, the demand for simulation in esthetic training is quite high and has been proved to be helpful.…”

Aesthetic Training in Plastic Surgery Residency

“…Likewise, there are many opportunities for simulation-based training in aesthetic surgery. For example, a study by Zammit et al 35 showed that residents feel the least confident performing rhinoplasty procedures and desire increased availability of simulators to practice and improve their skills. Another study showed that simulation training resulted in improved surgical performance of Botox administration when compared with video training.…”

Surgical Training Simulators for Rhinoplasty: A Systematic Review

“…the procedure, with no residents reporting experience as the primary surgeon, performing 100% of the procedure. 1 Moreover, 53.9% of senior residents did not perform any rhinoplasty step more than five times. 1 A lack of direct hands-on training directly translates to a lack of confidence 1,[3][4][5] and autonomy 6 in performing the procedure.…”

“…73.9% of junior and senior residents felt a surgical simulator could improve their confidence by a minimum of 60%. 1 While there are published examples of rhinoplasty simulators, there is no collective understanding of the strengths and limitations of available rhinoplasty simulators as a whole for rhinoplasty education. The purpose of this paper is to amalgamate the literature on rhinoplasty surgical simulators and understand their Extracted data were then taken from Covidence and downloaded in a Microsoft Excel (version 16.59) file.…”