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Journal of Plastic, Reconstructive &... Dec 2023Assessment tools for grading technical and nontechnical skills, such as operative technique and professionalism, are well established in general surgery. Less is known... (Review)
Review
Assessment tools for grading technical and nontechnical skills, such as operative technique and professionalism, are well established in general surgery. Less is known regarding the application of these tools in plastic surgery training. This study is a comparative review of the most prevalent assessment tools and rubrics utilized in general and plastic surgery. Two parallel systematic reviews of the literature utilizing PubMed and Cochrane were conducted for articles published between 1990 and 2022. Searches used Boolean operators specific to assessment tools in general and plastic surgery. Fourteen studies met the inclusion criteria for general surgery assessment tools, and 21 studies were included for plastic surgery assessment tools. Seven studies (50%) evaluated technical skills in general surgery, whereas 15 studies (71%) assessed technical skills in plastic surgery with commonality found in the evaluation of principles, such as tissue and instrument handling and operative flow. Task-specific evaluation tools were described for both general and plastic surgeries. Five studies evaluated nontechnical skills, such as communication and leadership in general surgery, whereas no plastic surgery studies solely examined nontechnical assessment tools. Our literature review demonstrates that standardized skill assessments in plastic surgery are lacking compared with those available in general surgery. Plastic surgery programs should consider implementing competency-based assessment tools in surgical coaching and training for technical and nontechnical skills. More research is necessary in plastic surgery to optimize the evaluation of nontechnical skills.
Topics: Humans; Clinical Competence; Surgery, Plastic; Educational Measurement; Curriculum; Education, Medical, Graduate; General Surgery
PubMed: 37922663
DOI: 10.1016/j.bjps.2023.10.055 -
Annals of Plastic Surgery Apr 2024
Topics: Humans; United States; Supreme Court Decisions; Surgery, Plastic; Plastic Surgery Procedures
PubMed: 38421208
DOI: 10.1097/SAP.0000000000003838 -
Plastic and Reconstructive Surgery.... Dec 2023Plastic surgery dates back to 800 BC, where forehead flaps were used to reconstruct noses in India. Today, it is one of the most romanticized fields in medicine. Due to...
BACKGROUND
Plastic surgery dates back to 800 BC, where forehead flaps were used to reconstruct noses in India. Today, it is one of the most romanticized fields in medicine. Due to the influence of social media, there has never been a larger spotlight. Ironically, this spotlight brings a narrowed perception of the scope of plastic surgery. This study aimed to assess the scope through the eyes of the average American to identify gaps in knowledge to better represent the field.
METHODS
A series of questions were developed under survey methodologists and administered by Qualtrics. Responses were gathered, and data were analyzed to assess the public's knowledge of plastic surgery's scope.
RESULTS
Two thousand five hundred responses were obtained, balanced across demographics similar to that of the United States. The US population has a poor understanding of the scope of plastic surgery and how to obtain board certification.
CONCLUSIONS
This survey demonstrates a gap in awareness of plastic surgery as a field and the scope outside aesthetic procedures dramatized by the media. There remains no clear understanding of the qualifications of plastic surgeons or the provider makeup of the field of cosmetic surgery. Subspecialties proved to be overlooked, and knowledge of board certification was sparse. Further effort is needed to educate both the public and patients of the scope of plastic surgery, so that they might seek and gain access to appropriate treatment in the most efficient manner to optimize outcomes regarding the form and function of the body.
PubMed: 38145151
DOI: 10.1097/GOX.0000000000005495 -
Journal of Plastic, Reconstructive &... Dec 2023Harold Gillies, plastic surgeon, and Donald Morton, surgical oncologist, were iconic pioneers in their respective fields. Both of them made their mark by identifying... (Review)
Review
Harold Gillies, plastic surgeon, and Donald Morton, surgical oncologist, were iconic pioneers in their respective fields. Both of them made their mark by identifying crucial practical problems and finding innovative ways of solving them. Gillies grappled with the challenge of restoring form and function to British military personnel injured in World War I, and he set up a dedicated facility for performing this work. He introduced many new reconstructive techniques that became the foundation of the modern specialty of plastic and reconstructive surgery, which he established and nurtured. Morton, in the United States, applied his problem-solving skills to the long-debated question of the best way to manage regional lymph nodes in patients with melanoma. He developed the innovative technique of sentinel lymph node biopsy and initiated large-scale international clinical trials to establish its validity and clinical value. This and other important contributions to the emerging field of surgical oncology earned Morton his reputation as a pioneer and leader of that specialty. The problems that confronted Gillies and Morton were completely different, but both demonstrated remarkable skills as master problem-solvers in their respective fields and made extraordinary contributions to the body of knowledge and welfare of patients. All surgeons must be problem-solvers because every patient who presents for surgical management represents a new problem (or set of problems) to be addressed. As surgeons, we would do well to consider individuals such as Gillies and Morton as role models for our own problem-solving activities in day-to-day clinical practice.
Topics: Male; Humans; Surgery, Plastic; Surgical Oncology; Plastic Surgery Procedures; Sentinel Lymph Node Biopsy; Melanoma
PubMed: 37804644
DOI: 10.1016/j.bjps.2023.09.047 -
Journal of Plastic, Reconstructive &... Oct 2023Patient-reported outcome measures (PROMs) quantify patient perspectives to measure outcomes that matter to patients. The aim of this study was to assess the reporting of... (Review)
Review
BACKGROUND
Patient-reported outcome measures (PROMs) quantify patient perspectives to measure outcomes that matter to patients. The aim of this study was to assess the reporting of appropriateness and quality of PROM selection in plastic surgery randomized controlled trials (RCTs).
METHODS
MEDLINE, Embase, and CENTRAL were searched from January 1, 2000, to June 5, 2022, to identify published RCTs within the plastic surgery literature. Included studies were categorized as follows: 1) a clearly defined patient-reported primary outcome; 2) a primary outcome could be inferred; or 3) no clear or implied primary outcome. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) database was consulted to assess the available literature on the PROMs.
RESULTS
There were 130 plastic surgery RCTs identified. Of the 43 studies with a clear or inferred primary outcome, the percentage of studies that commented with supporting references on the PROM's appropriateness for the population, disease/condition, and outcome were 20.9% (n = 9/43), 18.6% (n = 8/43), and 27.9% (n = 12/43), respectively. The percentage of studies that commented on the PROM's validity, reliability, and responsiveness with supporting references were 34.9% (n = 15/43), 14.0% (n = 6/43), and 11.7% (n = 5/43), respectively. There were 21 unique PROMs identified; 28.6% (n = 6/21) were available in the COSMIN database.
CONCLUSION
The majority of plastic surgery RCTs assessing patient-reported primary outcomes lack transparency surrounding PROM selection and quality. We recommend investigators conducting plastic surgery clinical research report explicitly why they used a particular PROM and support its appropriateness and psychometric properties with supporting references. Finally, they should familiarize themselves with the COSMIN initiative.
Topics: Humans; Surgery, Plastic; Quality of Life; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Patient Reported Outcome Measures
PubMed: 37473643
DOI: 10.1016/j.bjps.2023.06.063 -
Head & Neck Sep 2023Current literature on reconstruction after head and neck cancer (HNC) focusses on short-term patient-reported outcomes (PROs), while there is a need for knowledge on... (Review)
Review
Current literature on reconstruction after head and neck cancer (HNC) focusses on short-term patient-reported outcomes (PROs), while there is a need for knowledge on long-term consequences. Embase, Medline, Web of Science, and Cochrane were searched for studies on health-related quality of life (HRQoL) after HNC reconstruction, using validated PROMs in at least 50 patients, and a follow-up of more than 1 year. Thirty studies were included, comprising 2358 patients with a follow-up between one and 10 years. The most used questionnaire was the UW-QoL v4. Reconstructive surgery was generally followed by diminished oral function, worsened by radiotherapy. Patients experienced anxiety and fear of cancer recurrence. However, there was a progressive decrease in pain over time with some flaps having more favorable HRQoL outcomes. Age and bony tumor involvement were not related to postoperative HRQoL. These results may lead to better patient counseling and expectation management of HNC patients.
Topics: Humans; Quality of Life; Surgery, Plastic; Neoplasm Recurrence, Local; Head and Neck Neoplasms; Patient Reported Outcome Measures
PubMed: 37401563
DOI: 10.1002/hed.27450 -
Annals of Plastic Surgery Jan 2024
Topics: Humans; Surgery, Plastic; Plastic Surgery Procedures; Attitude of Health Personnel
PubMed: 38117042
DOI: 10.1097/SAP.0000000000003746 -
Aesthetic Plastic Surgery Aug 2023According to recent evidence, the use of local tranexamic acid (TXA) during plastic surgery may lessen blood loss. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
According to recent evidence, the use of local tranexamic acid (TXA) during plastic surgery may lessen blood loss.
OBJECTIVES
To comprehensively assess the use of local TXA during plastic surgery through a systematic review and meta-analysis of randomized controlled trials addressing these issues.
METHODS
Four electronic databases, including PubMed, Web of Science, Embase and the Cochrane Library, were searched until December 12, 2022. Following meta-analyses, the mean difference (MD) or standardized mean difference (SMD) for blood loss volume (BLV), ΔHct, ΔHb and operation time were calculated when appropriate.
RESULTS
Eleven randomized controlled trials were included in the qualitative synthesis, while 8 studies were included in the meta-analysis. Compared with the control group, the local TXA group showed a reduction in blood loss volume of -1.05 (p < 0.00001; 95% CI, -1.72 to -0.38). However, local TXA had a limited effect on reducing ΔHct, ΔHb and operation time. A meta-analysis was not performed because of heterogeneity in other outcomes; however, except for 1 study in which no significant difference was observed on POD 1, all studies showed significantly lower rates of postoperative ecchymosis after surgery, 2 studies showed statistically significant reductions in transfusion risk or volume, and 3 studies reported significantly better surgical field quality in operations with local TXA. In the 2 included studies, the researchers concluded that local treatment does not play a role in relieving postoperative pain.
CONCLUSIONS
Local TXA is associated with less blood loss, less ecchymosis and better surgical field in plastic surgery patients.
LEVEL OF EVIDENCE I
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; Antifibrinolytic Agents; Blood Loss, Surgical; Surgery, Plastic; Ecchymosis; Randomized Controlled Trials as Topic
PubMed: 36810834
DOI: 10.1007/s00266-023-03281-7 -
Plastic and Reconstructive Surgery.... Oct 2023Plastic and reconstructive surgery is consistently one of the most competitive medical specialties in the match. The recent United States Medical Licensing Examination...
BACKGROUND
Plastic and reconstructive surgery is consistently one of the most competitive medical specialties in the match. The recent United States Medical Licensing Examination score reporting switch to pass-fail led to a change in metrics by which applicants are evaluated by plastic surgery programs. Applicant research productivity and the demand for plastic surgery mentorship will continue to rise. Given the competitive nature of the residency match and shift in metrics emphasis after the change in STEP 1 scoring, early exposure to plastic surgery and mentoring relationships are paramount to applicant success. However, most medical students are not exposed to plastic surgery until they begin clinical rotations.
METHODS
A literature review of plastic surgery mentorship programs available during preclinical years was conducted to identify preclinical mentorship opportunities in plastic surgery. Sixty-eight references were identified, but only two studies met the inclusion criteria of addressing mentorship programs in preclinical years.
RESULTS
Examination of the included studies indicated that preclinical medical students achieve self-identified goals and generate longitudinal benefits in plastic surgery by participating in early and focused mentorship programs.
CONCLUSIONS
The limited number of studies in this review highlights a lack of available, studied preclinical mentorship programs in plastic surgery and reveals a knowledge gap concerning the creation of successful preclinical mentorship programs. Early exposure to plastic surgery, combined with the development of structured preclinical mentorship programs, can potentially replicate successful outcomes seen in other surgical subspecialties' mentorship programs while addressing the lack of formalized mentorship opportunities for preclinical students in plastic surgery.
PubMed: 37817925
DOI: 10.1097/GOX.0000000000005322 -
Aesthetic Plastic Surgery Apr 2024ChatGPT, an artificial intelligence (AI) chatbot that uses natural language processing (NLP) to interact in a humanlike manner, has made significant contributions to... (Review)
Review
BACKGROUND
ChatGPT, an artificial intelligence (AI) chatbot that uses natural language processing (NLP) to interact in a humanlike manner, has made significant contributions to various healthcare fields, including plastic surgery. However, its widespread use has raised ethical and security concerns. This study examines the presence of ChatGPT, an artificial intelligence (AI) chatbot, in the literature of plastic surgery.
METHODS
A bibliometric analysis and scoping review of the ChatGPT plastic surgery literature were performed. PubMed was queried using the search term "ChatGPT" to identify all biomedical literature on ChatGPT, with only studies related to plastic, reconstructive, or aesthetic surgery topics being considered eligible for inclusion.
RESULTS
The analysis included 30 out of 724 articles retrieved from PubMed, focusing on publications from December 2022 to July 2023. Four key areas of research emerged: applications in research/creation of original work, clinical application, surgical education, and ethics/commentary on previous studies. The versatility of ChatGPT in research, its potential in surgical education, and its role in enhancing patient education were explored. Ethical concerns regarding patient privacy, plagiarism, and the accuracy of information obtained from ChatGPT-generated sources were also highlighted.
CONCLUSION
While ethical concerns persist, the study underscores the potential of ChatGPT in plastic surgery research and practice, emphasizing the need for careful utilization and collaboration to optimize its benefits while minimizing risks.
LEVEL OF EVIDENCE V
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: Bibliometrics; Humans; Surgery, Plastic; Artificial Intelligence; Natural Language Processing; Plastic Surgery Procedures
PubMed: 37853081
DOI: 10.1007/s00266-023-03709-0