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Aesthetic Surgery Journal Nov 2023Developed originally as a tool for resident self-evaluation, the Plastic Surgery Inservice Training Examination (PSITE) has become a standardized tool adopted by Plastic...
BACKGROUND
Developed originally as a tool for resident self-evaluation, the Plastic Surgery Inservice Training Examination (PSITE) has become a standardized tool adopted by Plastic Surgery residency programs. The introduction of large language models (LLMs), such as ChatGPT (OpenAI, San Francisco, CA), has demonstrated the potential to help propel the field of Plastic Surgery.
OBJECTIVES
The authors of this study wanted to assess whether or not ChatGPT could be utilized as a tool in resident education by assessing its accuracy on the PSITE.
METHODS
Questions were obtained from the 2022 PSITE, which was present on the American Council of Academic Plastic Surgeons (ACAPS) website. Questions containing images or tables were carefully inspected and flagged before being inputted into ChatGPT. All responses by ChatGPT were qualified utilizing the properties of natural coherence. Responses that were found to be incorrect were divided into the following categories: logical, informational, or explicit fallacy.
RESULTS
ChatGPT answered a total of 242 questions with an accuracy of 54.96%. The software incorporated logical reasoning in 88.8% of questions, internal information in 95.5% of questions, and external information in 92.1% of questions. When stratified by correct and incorrect responses, we determined that there was a statistically significant difference in ChatGPT's use of external information (P < .05).
CONCLUSIONS
ChatGPT is a versatile tool that has the potential to impact resident education by providing general knowledge, clarifying information, providing case-based learning, and promoting evidence-based medicine. With advancements in LLM and artificial intelligence (AI), it is possible that ChatGPT may be an impactful tool for resident education within Plastic Surgery.
Topics: Humans; Surgery, Plastic; Artificial Intelligence; Plastic Surgery Procedures; Inservice Training; Evidence-Based Medicine
PubMed: 37128784
DOI: 10.1093/asj/sjad128 -
Aesthetic Plastic Surgery Dec 2023Antifibrinolytics, particularly tranexamic acid (TXA), are agents used to reduce bleeding. TXA is a synthetic reversible competitive inhibitor to the lysine receptor... (Review)
Review
Antifibrinolytics, particularly tranexamic acid (TXA), are agents used to reduce bleeding. TXA is a synthetic reversible competitive inhibitor to the lysine receptor found on plasminogen. By reversibly binding to this site, it leads to plasminogen being unable to bind to fibrin and so prevents fibrinolysis, this stabilizes the clot and thus prevents hemorrhage. (Pekrul in Der Anaesth 70:515-521, 2021) It can be used either intravenously or topically but has never entered mainstream use in plastic surgery. (Pekrul in Der Anaesth 70:515-521, 2021) This is most likely due to understandable fears of thromboembolic events. On the other hand, the tempting benefits are reduced bleeding (perioperatively) decreased bruising and swelling, and thus increased aesthetic, important for obvious reasons. A review of the literature was done to go deeper on this issue, examining topical use in aesthetic surgery. Clear benefit was shown in the literature, it could be postulated that it would not be unwise to consider more research on topical use of TXA in certain cases, the benefits could greatly outweigh the risks. Old fears and conceptions, unsupported by the literature at the time of writing, should not hold back further research, and the benefits shown could even potentially justify the topical use of these agents in the near future. Further studies evaluating the utility of TXA in Panniculectomy and Abdominoplasty surgery should be performed especially, since only one was found which reported no significant benefit. Minor complications were present, such as minor delayed post-auricular skin healing, temporary unilateral marginal mandibular neuropraxia and increased cumulative seroma volume. These were novel findings and could warrant further investigation as well. After performing a review of the literature, it was seen that topical TXA generally adds benefit in aesthetic plastic surgery, with no particularly significant complications. We would like to bring more attention to the issue and support more studies on TXA use. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Tranexamic Acid; Surgery, Plastic; Plastic Surgery Procedures; Hemorrhage; Esthetics; Plasminogen
PubMed: 37069351
DOI: 10.1007/s00266-023-03346-7 -
Annals of Plastic Surgery May 2024
Topics: Artificial Intelligence; Surgery, Plastic; Humans; Periodicals as Topic
PubMed: 38685489
DOI: 10.1097/SAP.0000000000003997 -
Annals of Plastic Surgery Jul 2023Microsurgery is an advanced set of techniques that require a high level of skill to be performed safely. Surgical skills courses offer safe environments for practice in...
Microsurgery is an advanced set of techniques that require a high level of skill to be performed safely. Surgical skills courses offer safe environments for practice in such skills and form a fundamental part of surgical training. The Yorkshire Microsurgery Course is a 3-day course at Bradford Royal Infirmary, United Kingdom. Delivered via short lectures followed by supervised practical sessions, the course aims to provide delegates with the essential knowledge and skills required for microsurgery.We detail an outline and critical evaluation of the February 2023 iteration of the course, with recommendations for improvement.Overall, we found the course excellent. It provided delegates with a solid grounding in the fundamentals of microsurgery and the opportunity for personalized practice supervised by experts. We would recommend this course to colleagues interested in a career in plastic surgery.
Topics: Humans; Microsurgery; Plastic Surgery Procedures; Surgery, Plastic; Curriculum; Clinical Competence
PubMed: 37450857
DOI: 10.1097/SAP.0000000000003580 -
Evaluation of a Plastic and Reconstructive Surgery Resident Non-surgical Cosmetic Clinic Experience.The Journal of Surgical Research Jul 2023An important component of plastic surgery residency training is independent cosmetic patient management. A resident cosmetic clinic was created at Oregon Health &...
INTRODUCTION
An important component of plastic surgery residency training is independent cosmetic patient management. A resident cosmetic clinic was created at Oregon Health & Science University in 2007 to expand this experience. The cosmetic clinic has traditionally been most successful in offering nonsurgical facial rejuvenation with neuromodulators and soft tissue fillers. This study focuses on the demographics of the patient population and the treatments provided over a 5-year period and compares this experience to those of the same program's attending cosmetic clinics.
METHODS
A retrospective chart review of all patients seen at Oregon Health & Science University's Plastic and Reconstructive Surgery Resident Cosmetic Clinic between January 1, 2017, and December 31, 2021 was performed. Patient demographics, type of injectable received (neuromodulator versus soft tissue filler), location of injection, and additional cosmetic procedures were evaluated.
RESULTS
Two hundred patients met the study criteria, which included 114 seen in the resident clinic (RC), 31 seen in attending clinic (AC), and 55 patients seen in both. A primary analysis compared the two groups seen in the resident and attending only clinics. The average age of patients seen in the RC was younger, 45 versus 51.5 (P ≤ 0.05). There was a trend toward more patients in the RC being involved in healthcare as compared to those patients seen in the AC, but this difference was not found to be statistically significant. The median number of neuromodulator visits in the RC was 2 (1, 4) versus 1 (1, 2) in the AC (P ≤ 0.05) The most common location for neuromodulator injections in both clinics was the corrugators.
CONCLUSIONS
Patients in the resident cosmetic clinic were younger females, most receiving neuromodulator injections. No statistically significant differences were identified in patient population, injections received, and location of injections between the two clinics, indicating a similar trainee skill set and patient care plan between the two clinics.
Topics: Female; Humans; Surgery, Plastic; Retrospective Studies; Internship and Residency; Plastic Surgery Procedures; Neurotransmitter Agents
PubMed: 36868121
DOI: 10.1016/j.jss.2022.12.006 -
Journal of Plastic, Reconstructive &... Jul 2023Continuing problems with fewer training opportunities and a greater awareness of patient safety have led to a constant search for an alternative technique to bridge the... (Review)
Review
Continuing problems with fewer training opportunities and a greater awareness of patient safety have led to a constant search for an alternative technique to bridge the existing theory-practice gap in plastic surgery training and education. The current COVID-19 epidemic has aggravated the situation, making it urgent to implement breakthrough technological initiatives currently underway to improve surgical education. The cutting edge of technological development, augmented reality (AR), has already been applied in numerous facets of plastic surgery training, and it is capable of realizing the aims of education and training in this field. In this article, we will take a look at some of the most important ways that AR is now being used in plastic surgery education and training, as well as offer an exciting glimpse into the potential future of this field thanks to technological advancements.
Topics: Humans; Augmented Reality; Surgery, Plastic; Virtual Reality; COVID-19; Plastic Surgery Procedures
PubMed: 37207439
DOI: 10.1016/j.bjps.2023.04.033 -
Aesthetic Plastic Surgery Oct 2023This study aims to systematically assess body and facial aesthetic surgery before-and-after photography bias on Instagram.
PURPOSE
This study aims to systematically assess body and facial aesthetic surgery before-and-after photography bias on Instagram.
METHODS
An Instagram search using the term "plastic surgeon" was conducted on October 2020. The top 11 plastic surgeons' accounts were selected, and the first 15 images were selected from these profiles pertaining to different anatomical locations. Each photo was analyzed by a blinded board-certified plastic surgeon utilizing a 5-domain clinical photography bias score. The domains covered: (1) photo quality; (2) photo background; (3) position; (4) exposure/coverage; (5) bias.
RESULTS
The search strategy identified a total of 161 sets of before and after. The most common anatomical site posted was the nose (n=47), followed by breasts (n=37). The most common angles posted were anterior-posterior view (n=61). The majority of images showed bias toward the post-operative image (70.8%). The main culprit with photo characteristics occurred due to there being a different post-operative background which was more flattering for the post-operative result (n=46, p=0.006) and a different view or angle, which again, flattered the post-operative image (n=36, p=0.02). Other factors that influenced the post-operative bias included photos of the patient covered with clothing (n=15, p=0.014) or standing (n=20, p=0.001), compared to a supine pre-operative image.
CONCLUSION
Before-and-after photography conditions in aesthetic surgery is biased toward the post-operative result on Instagram. This observation was noticed across all surgical anatomical areas. Accounts photographer tends to misrepresent the photo background, view of angle, patients pose or position, or covering certain body parts.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Humans; Surgery, Plastic; Esthetics; Nose; Face; Photography
PubMed: 37253847
DOI: 10.1007/s00266-023-03398-9 -
Annals of Plastic Surgery Jul 2023
Topics: Humans; Surgery, Plastic; Plastic Surgery Procedures; Breast
PubMed: 37347162
DOI: 10.1097/SAP.0000000000003566 -
Journal of Plastic, Reconstructive &... Oct 2023The efficacy of virtual visits in converting new patients into established patients undergoing surgical treatment has not been demonstrated. The aim of this study was to...
BACKGROUND
The efficacy of virtual visits in converting new patients into established patients undergoing surgical treatment has not been demonstrated. The aim of this study was to evaluate patient retention and surgical conversion rate after an initial virtual plastic surgery consultation.
METHODS
An IRB-approved retrospective review of all new plastic surgery patients seen between May and August 2020 at a single institution was conducted. The initial encounter type, chief complaint, demographics, treatment recommendation, insurance approval rate, number and modality of pre- and postoperative visits, time to procedure, follow up, and complications were recorded. Patient retention and surgery conversion rate were calculated. Statistical analysis was performed with Chi-squared test, Fisher's exact test, and unpaired t-test.
RESULTS
In total, the records of 1889 new patients were reviewed (1635 in-person, 254 virtual). Virtual patients were younger (44.5 ± 19.0 versus 49.5 ± 20.7 years, p < 0.001), and nearly half resided greater than 50 miles away (42% versus 16%, p < 0.001). Virtual patients more frequently presented for cosmetic surgery (14% versus 7%, p < 0.001), lymphedema (15% versus 3%, p < 0.001), and gender dysphoria (11% versus 2%, p < 0.001). In-person patients presented more often for trauma (18% versus 5%, p < 0.001), elective hand complaints (16% versus 3%, p < 0.001), and breast reconstruction (9% versus 4%, p < 0.01). There were no differences in patient retention (p = 0.45) and procedure conversion rate (p = 0.21) between the groups.
CONCLUSION
Telemedicine provides an opportunity to increase the practice catchment area and is as effective as in-person first encounters for establishing care and transition to surgery.
Topics: Humans; Surgery, Plastic; Telemedicine; Referral and Consultation; Retrospective Studies; Plastic Surgery Procedures
PubMed: 37541046
DOI: 10.1016/j.bjps.2023.07.011 -
The Surgeon : Journal of the Royal... Dec 2023The Covid-19 pandemic has highlighted the importance of remote patient and professional communication. This has been especially important for highly specialised and...
BACKGROUND
The Covid-19 pandemic has highlighted the importance of remote patient and professional communication. This has been especially important for highly specialised and regionally-based specialties such as plastic surgery. The aim of this study was to review how UK plastic surgery units represent themselves online and their phone accessibility.
PATIENTS AND METHODS
UK plastic surgery units were identified using the BAPRAS website and their websites and telephone accessibility assessed.
RESULTS
Whilst a minority of units have clearly invested heavily in ensuring comprehensive webpages, nearly a third have no dedicated webpage at all. We found significant variation in quality and user-friendliness of online resources both for patients and for other healthcare professionals, with less than a quarter of units providing comprehensive contact details, emergency referral guidance, or information about changes to services due to Covid-19, to highlight a few areas. Communication with the BAPRAS website was also poor with less than half of web-links connecting to correct and relevant webpage and only 13.5% of phone numbers connecting directly to a useful plastic surgery number. In the phone component of our study we found that 47% of calls to 'direct' numbers went to voicemail but wait-times were significantly less than going through hospital switchboards and connections were more accurate.
CONCLUSION
In a world where a business' credibility is so heavily based on their online appearance and, in an increasingly online era of medicine, we hope that this study may be a resource for units to improve their web-based resources and prompt further research in enhancing patient experience online.
Topics: Humans; Surgery, Plastic; Pandemics; Plastic Surgery Procedures; COVID-19; Referral and Consultation; Internet
PubMed: 37308375
DOI: 10.1016/j.surge.2023.05.003