Skip to main content

Advertisement

Log in

Simulation-based training in dermatologic surgery: a literature review

  • REVIEW
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Simulation-based training has been shown to increase confidence and improve technical proficiency in surgical trainees. In this review, we describe the methods of simulation-based training currently being utilized in cutaneous surgery education. PubMed and EMBASE were searched for terms related to dermatologic surgery, education, and simulation. Articles published in English from 2013 onward that discussed simulation-based cutaneous surgery training of dermatology, plastic surgery, or otolaryngology resident physicians were included and summarized. Currently utilized simulation modalities in the training of dermatologic surgeons include skin substitutes, cadavers, and technology-based platforms. While each of these modalities have been shown to enhance trainee confidence and/or skill, head-to-head studies comparing their efficacy and usefulness are limited. Dermatologic surgery training, and therefore patient care, may be enhanced by further incorporation of simulation training. However, further studies are needed to clarify the optimal simulation platforms and delivery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Data availability

Not applicable (literature review, no data generated or analyzed).

References

  1. Adams CC, Marquart JD, Nicholas LL, Sperling LC et al (2014) Survey of medical student preference for simulation models for basic dermatologic surgery skills: simulation platforms in medical education. Dermatol Surg 40(4):427–435. https://doi.org/10.1111/dsu.12445

    Article  CAS  PubMed  Google Scholar 

  2. Alam M, Nodzenski M, Yoo S, Poon E et al (2014) Objective structured assessment of technical skills in elliptical excision repair of senior dermatology residents: a multirater, blinded study of operating room video recordings. JAMA Dermatol 150(6):608–612. https://doi.org/10.1001/jamadermatol.2013.6858

    Article  PubMed  Google Scholar 

  3. Altinyazar HC, Hosnuter M, Unalacack M, Koca R et al (2003) A training model for cutaneous surgery. Dermatol Surg 29(11):1122–1124. https://doi.org/10.1046/j.1524-4725.2003.29350.x

    Article  PubMed  Google Scholar 

  4. Carey JN, Rommer E, Sheckter C, Minneti M et al (2014) Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers. J Plast Reconstr Aesthet Surg 67(2):e42–e48. https://doi.org/10.1016/j.bjps.2013.09.026

    Article  PubMed  Google Scholar 

  5. Cervantes JA, Costello CM, Maarouf M, McCrary HC et al (2017) The use of a fresh-tissue cadaver model for the instruction of dermatological procedures: a laboratory study for training medical students. Dermatol Surg 43(9):1150–1156. https://doi.org/10.1097/DSS.0000000000001179

    Article  CAS  PubMed  Google Scholar 

  6. Chitgopeker P, Sidey K, Aronson A, Chung J et al (2020) Surgical skills video-based assessment tool for dermatology residents: A prospective pilot study. J Am Acad Dermatol 83(2):614–616. https://doi.org/10.1016/j.jaad.2019.08.048

    Article  PubMed  Google Scholar 

  7. Clark MA, Yoo SS, Kundu RV (2016) Nail surgery techniques: a single center survey study on the effect of a cadaveric hand practicum in dermatology resident education. Dermatol Surg 42(5):696–698. https://doi.org/10.1097/DSS.0000000000000676

    Article  CAS  PubMed  Google Scholar 

  8. Dai J, Bordeaux JS, Miller CJ, Sobanko JF (2016) Assessing surgical training and deliberate practice methods in dermatology residency: a survey of dermatology program directors. Dermatol Surg 42(8):977–984. https://doi.org/10.1097/DSS.0000000000000802

    Article  CAS  PubMed  Google Scholar 

  9. Dawe SR, Windsor JA, Broeders JA, Cregan PC et al (2014) A systematic review of surgical skills transfer after simulation-based training: laparoscopic cholecystectomy and endoscopy. Ann Surg 259(2):236–248. https://doi.org/10.1097/SLA.0000000000000245

    Article  PubMed  Google Scholar 

  10. Denadai R, Oshiiwa M, Saad-Hossne R (2014) Teaching elliptical excision skills to novice medical students: a randomized controlled study comparing low- and high-fidelity bench models. Indian J Dermatol 59(2):169–175. https://doi.org/10.4103/0019-5154.127679

    Article  PubMed  PubMed Central  Google Scholar 

  11. Denadai R, Saad-Hossne R, Martinhao Souto LR (2013) Simulation-based cutaneous surgical-skill training on a chicken-skin bench model in a medical undergraduate program. Indian J Dermatol 58(3):200–207. https://doi.org/10.4103/0019-5154.110829

    Article  PubMed  PubMed Central  Google Scholar 

  12. Denadai R, Saad-Hossne R, Raposo-Amaral CE (2014) Simulation-based rhomboid flap skills training during medical education: comparing low- and high-fidelity bench models. J Craniofac Surg 25(6):2134–2138. https://doi.org/10.1097/SCS.0000000000001094

    Article  PubMed  Google Scholar 

  13. Dunkin B, Adrales GL, Apelgren K, Mellinger JD (2007) Surgical simulation: a current review. Surg Endosc 21(3):357–366. https://doi.org/10.1007/s00464-006-9072-0

    Article  CAS  PubMed  Google Scholar 

  14. Ericsson KA, Smith J (1991) Toward a general theory of expertise: prospects and limits. Cambridge University Press, Cambridge

    Google Scholar 

  15. Faizer R, Singal A, Ojo C, Reed AB (2020) Development of a pulsatile cadaver-based simulation for training of open abdominal vascular surgery skills. J Vasc Surg 72(3):1076–1086. https://doi.org/10.1016/j.jvs.2019.11.043

    Article  PubMed  Google Scholar 

  16. Gallagher JJ, Goldin IM, O’Sullivan GM, Silverman EL et al (2015) Simulation of tangential excision: a test for construct validity. J Burn Care Res 36(5):558–564. https://doi.org/10.1097/BCR.0000000000000166

    Article  PubMed  Google Scholar 

  17. Gladstone HB, Raugi GJ, Berg D, Berkley J et al (2000) Virtual reality for dermatologic surgery: virtually a reality in the 21st century. J Am Acad Dermatol 42(1):106–112. https://doi.org/10.1016/s0190-9622(00)90017-3

    Article  CAS  PubMed  Google Scholar 

  18. Grantcharov TP, Reznick RK (2008) Teaching procedural skills. BMJ 336(7653):1129–1131. https://doi.org/10.1136/bmj.39517.686956.47

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gutierrez-Mendoza D, Narro-Llorente R, Contreras-Barrera ME, Fonte-Avalos V et al (2011) Ethylene vinyl acetate (foam): an inexpensive and useful tool for teaching suture techniques in dermatologic surgery. Dermatol Surg 37(9):1353–1357. https://doi.org/10.1111/j.1524-4725.2011.02033.x

    Article  CAS  PubMed  Google Scholar 

  20. Hazan E, Torbeck R, Connolly D, Wang JV, et al (2018) Cadaveric simulation for improving surgical training in dermatology. Dermatol Online J 24(6).

  21. Isaacson DS, Edmonds PR, Isaacson G (2014) The galliform (Turkey thigh) model for resident training in facial plastic surgery. Laryngoscope 124(4):866–868. https://doi.org/10.1002/lary.24350

    Article  PubMed  Google Scholar 

  22. Jefferson IS, Robinson SK, Surprenant D, Whittington A et al (2021) Surgical training tools for dermatology trainees: porcine vs. synthetic skin for excision and repair. Arch Dermatol Res 313(9):793–797. https://doi.org/10.1007/s00403-020-02181-z

    Article  CAS  PubMed  Google Scholar 

  23. Kent S, Belcher M, Potter K (2021) Cadaveric simulation for dermatologic surgery training. Dermatol Surg 47(9):1289–1290. https://doi.org/10.1097/DSS.0000000000003031

    Article  CAS  PubMed  Google Scholar 

  24. Khan MS, Bann SD, Darzi AW, Butler PEM (2007) Assessing surgical skill using bench station models. Plast Reconstr Surg 120(3):793–800. https://doi.org/10.1097/01.prs.0000271072.48594.fe

    Article  CAS  PubMed  Google Scholar 

  25. Kneebone RL (2009) Practice, rehearsal, and performance; an approach for simulation-based surgical and procedure training. JAMA 302(12):1336–13338. https://doi.org/10.1001/jama.2009.1392

    Article  CAS  PubMed  Google Scholar 

  26. Kostusiak M, Hart M, Barone DG, Hofmann R et al (2017) Methodological shortcomings in the literature evaluating the role and applications of 3D training for surgical trainees. Med Teach 39(11):1168–1173. https://doi.org/10.1080/0142159X.2017.1362102

    Article  PubMed  Google Scholar 

  27. Liu KJ, Tkachenko E, Waldman A, Boskovski MT et al (2019) A video-based, flipped classroom, simulation curriculum for dermatologic surgery: A prospective, multi-institution study. J Am Acad Dermatol 81(6):1271–1276. https://doi.org/10.1016/j.jaad.2019.03.078

    Article  PubMed  Google Scholar 

  28. Loh CYY, Wang AYL, Tiong VTY, Athanassopoulos T et al (2018) Animal models in plastic and reconstructive surgery simulation-a review. J Surg Res 221:232–245. https://doi.org/10.1016/j.jss.2017.08.052

    Article  PubMed  Google Scholar 

  29. McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH et al (2011) Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 86(6):706–711. https://doi.org/10.1097/ACM.0b013e318217e119

    Article  PubMed  PubMed Central  Google Scholar 

  30. McNeil E, Reich H, Hurliman E (2020) Educational video improves dermatology residents’ understanding of Mohs micrographic surgery: a survey-based matched cohort study. J Am Acad Dermatol 83(3):926–927. https://doi.org/10.1016/j.jaad.2020.01.013

    Article  PubMed  Google Scholar 

  31. Mitchell NM, Cutting CB, King TW, Oliker A et al (2016) A real-time local flaps surgical simulator based on advances in computational algorithms for finite element models. Plast Reconstr Surg 137(2):445e-e452. https://doi.org/10.1097/01.prs.0000475793.38984.7e

    Article  CAS  PubMed  Google Scholar 

  32. Mitkov MV, Thomas CS, Cochuyt JJ, Forte AJ et al (2018) Simulation: an effective method of teaching cosmetic botulinum toxin injection technique. Aesthet Surg J 38(12):NP207–NP12. https://doi.org/10.1093/asj/sjy159

    Article  Google Scholar 

  33. Muzic JG, Schmitt AR, Wright AC, Alniemi DT et al (2017) Incidence and trends of basal cell carcinoma and cutaneous squamous cell carcinoma: a population-based study in Olmsted County, Minnesota, 2000 to 2010. Mayo Clin Proc 92(6):890–898. https://doi.org/10.1016/j.mayocp.2017.02.015

    Article  PubMed  Google Scholar 

  34. Nicholas L, Toren K, Bingham J, Marquart J (2013) Simulation in dermatologic surgery: a new paradigm in training. Dermatol Surg 39(1):76–81. https://doi.org/10.1111/dsu.12032

    Article  CAS  PubMed  Google Scholar 

  35. OCEBM Levels of Evidence Working Group The Oxford 2011 Levels of Evidence. Oxford Centre for Evidence-Based Medicine. http://www.cebm.net/index.aspx?o=5653

  36. Ojevwe C, Rana J, Burgin S (2018) Teaching & Learning Tips 11: Teaching a procedure. Int J Dermatol 57(9):1114–1117. https://doi.org/10.1111/ijd.13780

    Article  PubMed  Google Scholar 

  37. Okuda Y, Bryson EO, DeMaria S, Jacobson L et al (2009) The utility of simulation in medical education: what is the evidence? Mt Sinai J Med 76(4):330–343. https://doi.org/10.1002/msj.20127

    Article  PubMed  Google Scholar 

  38. Palter VN, Grantcharov TP (2014) Individualized deliberate practice on a virtual reality simulator improves technical performance of surgical novices in the operating room: a randomized controlled trial. Ann Surg 259(3):443–448. https://doi.org/10.1097/SLA.0000000000000254

    Article  PubMed  Google Scholar 

  39. Parra C, Decker A, Minkis K (2016) How to assess dermatology resident surgical training: new techniques. Curr Derm Rep 5(2):115–120. https://doi.org/10.1007/s13671-016-0137-6

    Article  Google Scholar 

  40. Reichel JL, Peirson RP, Berg D (2004) Teaching and evaluation of surgical skills in dermatology. Arch Dermatol 140:1365–1369. https://doi.org/10.1001/archderm.140.11.1365

    Article  PubMed  Google Scholar 

  41. Reznick RK, MacRae H (2006) Teaching surgical skills-changes in the wind. N Engl J Med 355(25):2664–2669. https://doi.org/10.1056/NEJMra054785

    Article  CAS  PubMed  Google Scholar 

  42. Roenigk RK (2008) Dermatologists perform more skin surgery than any other specialist: implications for health care policy, graduate and continuing medical education. Dermatol Surg 34(3):293–300. https://doi.org/10.1111/j.1524-4725.2007.34061.x

    Article  CAS  PubMed  Google Scholar 

  43. Satava RM (2010) Emerging trends that herald the future of surgical simulation. Surg Clin N Am 90(3):623–633. https://doi.org/10.1016/j.suc.2010.02.002

    Article  PubMed  Google Scholar 

  44. Seymour NE, Gallagher AG, Roman SA, O’Brien MK et al (2002) Virtual reality training improves operating room performance: results of a randomized. Double-Blinded Study Ann Surg 236(4):458–464. https://doi.org/10.1097/00000658-200210000-00008

    Article  PubMed  Google Scholar 

  45. Sheckter CC, Kane JT, Minneti M, Garner W et al (2013) Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. J Surg Educ 70(4):466–474. https://doi.org/10.1016/j.jsurg.2013.02.008

    Article  PubMed  Google Scholar 

  46. Shen Z, Yang F, Gao P, Zeng L et al (2018) A novel clinical-simulated suture education for basic surgical skill: suture on the biological tissue fixed on standardized patient evaluated with objective structured assessment of technical skill tools. J Invest Surg 31(4):333–339. https://doi.org/10.1080/08941939.2017.1319994

    Article  PubMed  Google Scholar 

  47. Sturm LP, Windsor JA, Cosman PH, Cregan P et al (2008) A systematic review of skills transfer after surgical simulation training. Ann Surg 248(2):166–179. https://doi.org/10.1097/SLA.0b013e318176bf24

    Article  PubMed  Google Scholar 

  48. Tassavor M, Shah A, Hashim P, Torbeck R (2021) Flipped classroom curriculum for dermatologic surgery during COVID-19: a prospective cohort study. J Am Acad Dermatol 85(5):e297–e298. https://doi.org/10.1016/j.jaad.2021.06.891

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Taylor SR, Chang CW (2016) Gelatin facial skin simulator for cutaneous reconstruction. Otolaryngol Head Neck Surg 154(2):279–281. https://doi.org/10.1177/0194599815618389

    Article  PubMed  Google Scholar 

  50. Williams TP, Snyder CL, Hancock KJ, Iglesias NJ et al (2020) Development of a low-cost, high-fidelity skin model for suturing. J Surg Res 256:618–622. https://doi.org/10.1016/j.jss.2020.07.051

    Article  PubMed  PubMed Central  Google Scholar 

  51. Yang SF, Powell A, Srinivasan S, Kim JC et al (2021) Addressing the pandemic training deficiency: filling the void with simulation in facial reconstruction. Laryngoscope 131(8):E2444–E2448. https://doi.org/10.1002/lary.29490

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

KS developed the idea for this review article and critically revised the work. TG and AB performed the literature search and drafted the manuscript.

Corresponding author

Correspondence to Kathryn T. Shahwan.

Ethics declarations

Conflict of interest

No authors have financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gray, T., Boccardi, A. & Shahwan, K.T. Simulation-based training in dermatologic surgery: a literature review. Arch Dermatol Res 315, 2227–2232 (2023). https://doi.org/10.1007/s00403-023-02606-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-023-02606-5

Keywords

Navigation