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Standardized Schematics for Facial Trauma Planning: A Clinical Education Tool
Brandon J. De Ruiter, BS1; Robert P. Lesko, BA1; Edward H. Davidson, MD2
1Albert Einstein College of Medicine
2Case Western Reserve University
2020-01-30
Presenter: Brandon J De Ruiter
Affidavit:
I certify that the submitted work is original content created by the members identified on the author chain. All work has been discussed and reviewed by each author to ensure accuracy of the enclosed information.
Director Name: Edward H. Davidson
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
BACKGROUND
Learning facial fracture management principles can be challenging for surgical trainees. Residents must assimilate nuanced information on fixation techniques, skeletal biomechanics, and hardware use while managing acute work-flow limitations. The aim of this study was to design a standardized schematic for teaching facial fracture management and evaluate its performance improving resident operative planning.
METHODS
Printable schematics of the facial skeleton with soft-tissue overlay were developed. Instructions on depicting fracture pattern, incisions, plating sequence, load-bearing/sharing plates, locking/non-locking screws, and mono/bicortical screws were given. Senior residents (n=5) evaluated computed tomography of three mandibular fractures and submitted three operative plans per case: first without guidance, then with written instruction, and finally using the schematic (total n=45). Performance in each trial was graded on content and conceptual correctness. Likert-scale surveys were given assessing understanding, communication, and operative planning.
RESULTS
Schematic use improved operative plan content and facilitated communication of resident operative schemes. Of seven content domains spanning approach, plating strategy, and screw selection, a mean of 2.3, 3.7, and 6.5 were included with no guidance, written instruction, and schematic use respectively. Information on approach (p=0.001), plating type (p=0.02), screw location (p<0.000), monocortical/bicortical screw type (p=0.000), and screw locking status (p=0.000) were significantly improved when comparing pre- and post-intervention plans. All subjects "agreed" (n=2) or "strongly agreed" (n=3) that schematic use aided operative planning and communication.
CONCLUSIONS
Simple, guided interventions can enhance surgical training by identifying knowledge gaps, improving visuospatial conceptualization, and facilitating targeted discussions with attendings.
