A systematic review of simulation-based training tools in plastic surgery

Abstract

Objectives: The recent shift from traditional surgical teaching to the incorporation of simulation training in plastic surgery has resulted in the development of a variety of simulation models and tools. We aimed to assess the validity and establish the effectiveness of all currently available simulators and tools for plastic surgery. Design: Systematic review. Methods: The PRISMA 2020 checklist was followed. The review protocol was prospectively registered in PROSPERO (CRD42021231546). Published and unpublished literature databases were searched to the 29th of October 2023. Each model was appraised in accordance with the Messick validity framework, and a rating was given for each section. To determine the effectiveness of each model, the McGaghie model of translational outcomes was used. Results: On screening 1794 articles, 116 were identified to discuss validity and effectiveness of simulation models in plastic surgery. These were hand surgery (6 studies), breast surgery (12 studies), facial surgery (25 studies), cleft lip and palate surgery (29 studies), rhinoplasty (4 studies), hair transplant surgery (1 study), surgery for burns (10 studies), and general skills in plastic surgery (29 studies). Only 1 model achieved an effectiveness level > 3, and no model had a rating > 2 in all aspects of the Messick validity framework. Conclusion: There are limited models enabling the transfer of skills to clinical practice. No models achieved reductions in surgical complications or costs. There must be more validity studies conducted using updated validity frameworks, with an increased emphasis on the applicability of these simulators to improve patient outcomes and surgical technique. More training tools evaluating both technical and non-technical surgical skills are recommended.