The Blepharoplasty Teacher: Kirigami Model for Learning Eyelid Anatomy.

Abstract

Blepharoplasty is highly desired for both functional and aesthetic improvements, and it is a common operation performed for patients over the age of 65.1,2 The ability to master the complex periorbital anatomy foundational to blepharoplasty remains challenging for both students and trainees. The three-dimensional understanding of layered structures is hard to obtain through two-dimensional textbooks,3,4 and although the use of technology, including three-dimensional applications, has improved the breadth of anatomy resources, it is hindered by accessibility and cost.5 Therefore, we developed a low-tech, low-cost teaching model, the Blepharoplasty Teacher, that creatively uses the principles of kirigami, the art of paper folding and cutting, to improve education and knowledge retention of the eyelid anatomy critical to the operative approach in blepharoplasty. The Blepharoplasty Teacher device is printed double-sided on 8.5 × 11-inch paper. Figure 1 depicts a representative image. The entire Blepharoplasty Teacher is included as supplemental digital content with instructions for assembly. (See Document, Supplemental Digital Content 1, which demonstrates the Blepharoplasty Teacher, designed by Amy Zhong, M.A., and printed with permission from Mount Sinai Health System. Print on a double-sided sheet of paper and follow the instructions to create a booklet with seven picture panels by cutting and folding along the dotted lines. Cut along the dotted lines on the eyelid to expose each layer, https://links.lww.com/PRS/F444.) A randomized controlled trial was conducted to analyze the efficacy of the Blepharoplasty Teacher in improving education and knowledge retention.Fig. 1.: The Blepharoplasty Teacher, panel 1, printed with permission from Mount Sinai Health System.Study participants comprised 21 first-year and second-year medical students who had previously completed their medical school anatomy course. They completed a 10-question pretest about their knowledge and comfort with blepharoplasty anatomy, and then had 30 minutes to study from either the Blepharoplasty Teacher (n = 11) or a traditional textbook (n = 10). They subsequently completed a 10-question posttest about eyelid anatomy and their comfort level with this anatomy. The surveys contained anatomically based questions adapted from the American Council of Academic Plastic Surgeons in-service examination review material. (See Document, Supplemental Digital Content 2, which shows pretest and posttest questions adapted from the American Council of Academic Plastic Surgeons in-service examination review material, https://links.lww.com/PRS/F445.) Students who used the Blepharoplasty Teacher significantly improved their test scores by an average of 1.4 points out of 10 (p = 0.017), whereas students who used the textbook did not achieve significant improvement (p > 0.05) (Fig. 2). Eight students (73 percent) using the Blepharoplasty Teacher improved their score by at least 1 point as compared to three (30 percent) in the textbook group (p = 0.05). Six students (55 percent) who studied from the Blepharoplasty Teacher felt more comfortable with eyelid anatomy after the study as compared to one student (10 percent) using the textbook (p = 0.031). Nine students (82 percent) who used the Blepharoplasty Teacher would recommend it to a colleague.Fig. 2.: Test score improvement of students who used the Blepharoplasty Teacher compared to students who used textbook pages. *p < 0.05.These findings demonstrate that students who used the Blepharoplasty Teacher achieved significant improvement in their test scores, developed an increased comfort level with eyelid anatomy, and would recommend use of this device to a colleague. Thus, not only was the Blepharoplasty Teacher helpful in knowledge retention, but it was also an enjoyable resource that students believed would benefit the education of their peers. Further research should focus on widespread testing of the Blepharoplasty Teacher among medical students and plastic surgery trainees, as well as on creating similar models for teaching the anatomy of other complex structures.