Teaching elliptical excision skills to novice medical students: A randomized controlled study comparing low- and high-fidelity bench models

Abstract

Background:The search for alternative and effective forms of training simulation is needed due to ethical and medico-legal aspects involved in training surgical skills on living patients, human cadavers and living animals.Aims:To evaluate if the bench model fidelity interferes in the acquisition of elliptical excision skills by novice medical students.Materials and Methods:Forty novice medical students were randomly assigned to 5 practice conditions with instructor-directed elliptical excision skills’ training (n = 8): didactic materials (control); organic bench model (low-fidelity); ethylene-vinyl acetate bench model (low-fidelity); chicken legs’ skin bench model (high-fidelity); or pig foot skin bench model (high-fidelity). Pre- and post-tests were applied. Global rating scale, effect size, and self-perceived confidence based on Likert scale were used to evaluate all elliptical excision performances.Results:The analysis showed that after training, the students practicing on bench models had better performance based on Global rating scale (all P < 0.0000) and felt more confident to perform elliptical excision skills (all P < 0.0000) when compared to the control. There was no significant difference (all P > 0.05) between the groups that trained on bench models. The magnitude of the effect (basic cutaneous surgery skills’ training) was considered large (>0.80) in all measurements.Conclusion:The acquisition of elliptical excision skills after instructor-directed training on low-fidelity bench models was similar to the training on high-fidelity bench models; and there was a more substantial increase in elliptical excision performances of students that trained on all simulators compared to the learning on didactic materials.

Will SCOBY do? An alternative for teaching basic surgical skills of suturing and skin excision

“…In teaching the skills of suturing and excision to postgraduate medical students, materials used to represent human skin have included vegetables, pads and foam products, chicken legs, pig feet, and other post-mortem animal parts. [1][2][3][4][5][6] The fidelity of these materials to living human tissue can vary significantly and, as shown in the literature, evaluations of model fidelity are often based on authors' opinions rather than research. [7][8][9] The criteria for selection of suture models appear to be based on cost, convenience of use, and degree of skin fidelity.…”

“…[7][8][9] The criteria for selection of suture models appear to be based on cost, convenience of use, and degree of skin fidelity. [1][2][3]7,8 Staff at the Grampians Clinical School -Deakin University (GCS) have used ethylene-vinyl acetate pads (EVA) and pork belly as materials to simulate human skin.…”

Basic Plastic Surgery Skills Training Program on Inanimate Bench Models during Medical Graduation

“…The different inanimate bench models vary in relation to the fidelity level (realism) when compared to a live human being; there are high fidelity models, such as parts of postmortem animals (pig [37, 38, 40, 45, 46], chicken [38, 39, 44], and cattle [48] skins and ox tongue [40–42]) and others of low fidelity, such as plates of ethylene-vinyl acetate [32, 34–38, 47], organic material [33, 49], among others [40, 53]. …”

“…Therefore, since there are studies developed by our group [36–38] and by others [80–83] that demonstrate objectively that the surgical skills learned by novice undergraduate on bench models can result in improved performance in animals, corpses, and also in the operating room, regardless of the fidelity of bench model [9, 38, 39, 80–83], the choice of a specific bench model should not be based on its fidelity. Aspects such as availability, seasonal variability, and costs should be considered for this choice.…”

Endoscopic Interlaminar Discectomy. Use of Swine Cadavers as a Training Model

“…i.e., simulators that offer a high degree of realism for the training that is intended to be imparted. [41][42][43] Although human cadavers continue to be the gold standard in surgical training processes, [44][45][46] their use is linked to extensive infrastructure and logistics requirements, which make it costly and of limited availability. For this reason, experimental model cadavers constitute an interesting alternative that must certainly be used within a framework of ethical and responsible use, recognizing their true potential and analyzing their comparative anatomy.…”