Abstract
Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient safety and quality of care. We aimed to deliver a one-day “hands-on” practical session on basic surgical skills and principles in plastic surgery, and to assess its effectiveness at improving confidence to the specialty among junior trainees. Methods: The one-day practical session covered knot tying, suturing, LA administration, skin lesion excision and local flaps, with short concurrent lectures on principles of plastic surgery. Self-assessment confidence scores were recorded before and after the course on seven domains: a) knowledge: wound assessment and management, suture selection, and concepts of flaps; b) practical skills: Handling of surgical instrument, suturing, LA administration, and skin lesion excision. Results: Thirty-five participants attended: Six core surgical trainees, fifteen foundation doctors, and fourteen medical students. The overall course satisfaction was 9.13/10. Self-assessment confidence scores in all domains significantly improved after the course (p < 0.0001). Suturing (58.6%) and skin lesion excision (74.5%) demonstrated the largest improvement. Qualitative feedback was extremely positive. Conclusions: The hands-on nature of the course offered participants great opportunities to acquire the necessary confidence and practical skills required for in-hospital placements. It is vital for students and doctors interested in a career in plastic surgery to prepare adequately for this diverse specialty, which is covered in limited depth in medical school. The need for more practical skills courses on plastic surgery for this demographic is intuitive.
Highlights
Plastic surgery is a specialty that involves the restoration of form and function, and the reconstruction of tissue defects; it covers a wide spectrum of conditions and pathologies including burns, hand traumas, soft tissue defects, skin oncology, breast reconstructions, and cleft and craniofacial deformities
Medical students and junior doctors are often inadequately prepared for inhospital placements which may impact on patient safety and quality of care
Undergraduate teaching of plastic surgery has declined in recent years; in the 1980s, 78% of medical schools formally taught plastic surgery, this fell to 21% and 13%, in the 1990s and 2000s respectively [2]-[4]
Summary
Plastic surgery is a specialty that involves the restoration of form and function, and the reconstruction of tissue defects; it covers a wide spectrum of conditions and pathologies including burns, hand traumas, soft tissue defects, skin oncology, breast reconstructions, and cleft and craniofacial deformities. The foundations of plastic surgery are based upon anatomical and physiological principles and surgical precision and finesse, which are essential components for medical students and junior doctors to appreciate prior to plastic surgery hospital placements. The curriculum evolved to accommodate the modernisation of medical education which focused on a broader syllabus including patient-centred care and public health, but at the expense of certain specialty components [5]-[7]. Junior doctors and medical students harbour a number of misconceptions about the specialty hampering the opportunity to make informed career choices; this is poignant given the current trend to encourage early specialisation [7]-[9]. The exposure to plastic surgery is predominantly through self-selected modules (SSC) and elective studies for medical students, and “taster-weeks” for junior doctors [10]
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