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  • Keoni Nguyen, DOLake Erie College of Osteopathic Medicine

    Aultman Hospital/ Tri-County Dermatology

    April 24, 2015

    Experiential Learning in Dermatologic

    Surgery: Evaluating an Interactive

    Surgical Manikin

  • Disclosure

    Inventor of U.S. Patent US8814573B2

    Interactive Surgical Manikin

  • Objectives

    1. Why create an interactive surgical manikin (ISM)?

    2. Fabrication of the ISM.

    3. Evaluating the efficacy of the ISM.

    4. Who is using ISM?

    5. Conclusion

  • Increasing Trends in Dermatologic Procedures

    Tromovitch TA, Stegman SJ, golgau RG. A survey of dermatologic surgery procedures. J Dermatol Surg Oncol 13:763-766, 1987.

    Hanke WC, Bailin PL. Current Trends in the Practice of Dermatologic Surgery. J Dermatol Surg Oncol 1990;16:130-131.

    Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, Coldiron BM. Incidence Estimatted of Nonmelanoma Skin Cancer in the United States, 2006.. Arch

    Dermatol. 2010;146(3):283-287.

  • Todd MM, Miller JJ, Ammirati CT. Dermatologic Surgery Training in Residency. Dermatol Surg 2002;28:547-550.

    Disparity in Surgical Training Programs

  • Low-fidelity Surgical Models Published in

    Dermatology Literature

    Altinyazar HC, Hosnuter M, Unalacak M, et al. A Training Model for Cutaneous Surgery. Dermatol Surg 2003;29:1122-1124.

    2003: Altinyazar et al.

    Biosynthetic

    Dressing

    Rat

    SkinLatex-free Elastic

    Bandage

    Garcia C, Haque R, Poletti E. Surgical Pearl: Artificial skin model for simulation of flap mechanics. J Am Acad Dermatol 2005;53:144-6.

    Ian A. Maher, MD, Monica Boyle, MD, and Mark abdelmalek, MD. A Use of Latex-free Bandage to Simulate Flap Mechanics. Dermatol Surg 2010;36: 113-114.

    2005: Garcia et al. 2010: Maher et al.

  • Low-fidelity Surgical Models Used in

    Dermatology Residency Programs

    Pigs feet (84%)

    Synthetic (12%)

    Live animals (3%)

    Virtual reality (Computer based) (3%)

    Reichel JL, Peirson PR, Berg D. Teaching and Evaluation of Surgical Skills in Dermatology. Arch Dermatol 2004;140:1365-

    1369.

    Low/High-fidelity Surgical Model

    Cadavers (9%)

    - Low-fidelity = Dated cadavers in formaldehyde

    - High-fidelity = Fresh cadavers

  • Objectives

    1. Why create an interactive surgical manikin (ISM)?

    2. Fabrication of the ISM.

    3. Evaluating the efficacy of the ISM.

    4. Who is using ISM?

    5. Conclusion

  • ISM Skin-Simulant Testing

    Instron E 3000 testing at Dayton Community Tissue Biomechanics Laboratory, 2009 2010.

    Instron E 3000

  • ISM Skin-Simulant Testing

    Gallagher AJ, Anniadh AN, and Bruyere K. et al. Dynamic Tensile Properties of Human Skin. IRC-12-59. IRCOBI Conference 2012.

    Instron E 3000 testing at Dayton Community Tissue Biomechanics Laboratory, 2009 2010.

    Edwards E, Marks R. Evaluation of Biomechanical Properties of Human Skin. Clinics in Dermatology;1995;13:375-380

    Comparison of Mechanical Skin Properties of Fresh

    Cadavers vs. Interactive Surgical Manikin

    Per

    cen

    t /

    MP

    a

    Fresh Human Cadaver (FHC)

    Interactive Surgical Manikin (ISM)

  • Interactive Surgical Manikin

    Danger Zone

  • Interactive Surgical Manikin

    Anatomy Dissection Video

  • Interactive Surgical Manikin

    Flap Design Concept Video

  • Interactive Surgical Manikin

    Basic Model Tumor free Margin Concept

  • Interactive Surgical Manikin

    Advance Model Pentagonal Wedge Resection

  • Interactive Surgical Manikin

    Estlander Flap

  • Interactive Surgical Manikin

    Paramedian Forehead Flap

  • Objectives

    1. Why create an interactive surgical manikin (ISM)?

    2. Fabrication of the ISM.

    3. Evaluating the efficacy of the ISM.

    4. Who is using ISM?

    5. Conclusion

  • ISM Surgical Workshop

  • 12 ACGME Dermatology Programs

    7 AOCD/AOA Dermatology Programs

    35 Residents

    Columbia Hospital

    Dartmouth-Hitchcock Medical Center

    Genesys Regional Medical Center

    Indiana University

    Loyola University

    St. Joseph Mercy Health System

    MWU/Arizona College of Osteopathic Medicine

    National Naval Medical Center

    Barnabas Hospital

    Northwestern University

    Ohio University

    Ohio State University

    Rush University Medical Center

    Stanford University COM

    TUCOM/Valley Hospital Medical Center

    University of Chicago

    University of TN Health Science Center

    University of Wisconsin

    West Virginia University

    Dermatology Programs

    ISM Surgical Workshop

  • Surgical Lectures: 1hr

    Surgical Lab: 4hrs

    Flap demonstrations: 10 mins

    Resident closures: 30 mins- Advancement flap

    - Rotation flap

    - Transposition flap

    - Z-plasty

    ISM Surgical Workshop

  • ISM Surgical Workshop

  • Results of Workshop

    4.38SD + 2.24

    5.29SD + 3.85

    7.96SD + 1.97

    8.06SD + 1.52

    8.67SD + 1.92

    Rating Scale: 1= Weak and 10 = Strong

  • 26 50%

    Pe

    rce

    nt

    Residents Rating of Surgical Skill Improvementand ISM Supplementing Their Surgical Curriculum

    30.21%SD + 18.24

    80%SD + 1.59

    Results of Workshop

  • Objectives

    1. Why create an interactive surgical manikin (ISM)?

    2. Fabrication of the ISM.

    3. Evaluating the efficacy of the ISM.

    4. Who is using ISM?

    5. Conclusion

  • Australia Surgical Workshop

    *

  • Australia Surgical Workshop

  • Australia Surgical Workshop 2012

    Dr. Anthony Dixon

  • Australia Surgical Workshop

  • Australia Surgical Workshop

  • Great Barrier Reef

  • Great Barrier Reef

  • Italy Surgical Workshop

  • Pisa, Italy Surgical Workshop

  • Italy Surgical Workshop

  • Italy Surgical Workshop

  • Objectives

    1. Why create an interactive surgical manikin (ISM)?

    2. Fabrication of the ISM.

    3. Evaluating the efficacy of the ISM.

    4. Who is using ISM?

    5. Conclusion

  • Conclusion

    The Efficacy of the ISM

    Applications: Facial Anatomy, Mohs Surgery Layers,

    Advanced Reconstruction

    A standardized method of ensuring surgical competency

  • Acknowledgements

    Thomas G. Olsen, MD

    Heidi Donnelly, MD

    Joseph W. McGowan, MD

    Thomas Lewis, MD

    David Roy, DO

    Thi T. Tran, DO

    Anthony Dixon, MD

    Gian Marco Vezzoni, MD

    Maurizio Biagioli, MD

    Willy Pagani, MD

    Giampaolo Vezzoni, MD

  • Thank You!