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

Pig’s 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

Resident’s 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!