A Facial Trauma Simulation Course for Evaluation and Treatment of Facial Fractures

Abstract

Importance: Traditional facial trauma laboratories are used for teaching basic concepts of fracture reduction and hardware manipulation. Facial trauma simulation laboratories allow training physicians the opportunity to develop unique treatment plans as they would in real patient encounters.

Objective: To assess the value of a novel facial trauma simulation course requiring residents to practice advanced decision making.

Design, setting, and participants: Data were prospectively collected July 23 and August 23 and 24, 2016, in a survey study during a resident physician trauma simulation course. Fresh frozen cadaver heads were fractured using an impactor that applied a measurable amount of force. Each head was scanned with high-resolution computed tomography. Residents were paired and tasked with evaluating their specimen's imaging findings and developing a treatment plan.

Main outcomes and measures: Before the course, residents were asked their postgraduate year level, number of facial fractures treated as a resident surgeon, and their comfort level based on the Otolaryngology Milestone for Facial Trauma (OMFT; ratings range from 0-5, with 5 indicating equivalent to fellow-level experience). After the course, residents were asked to assess the course's value relative to a theoretical number of actual operative cases, and a posttraining OMFT assessment was obtained.

Results: Thirty resident physicians completed the course at 2 institutions. Residents represented an equivalent distribution of postgraduate year levels. The residents stated that the course was worth a mean (SD) of 6.4 (2.8) operative cases of facial trauma in terms of surgical learning. The mean change in self-reported OMFT rating after the course was 0.87 (95% CI, 0.67-1.07; P < .001, paired t test). On the basis of this change in self-perceived OMFT rating, the course was deemed to be worth 1.5 years of residency training in the management of facial fractures.

Conclusion and relevance: Conducting a facial trauma simulation course increases resident experience with advanced surgical decision making.

Level of evidence: NA.

Figure 1.. Reconstruction and Repair of Facial Fractures

Three-dimensional reconstruction of midface fracture displays the coronal and sagittal views and bicoronal and gingivobuccal approaches.

Figure 2.. Resident Self-assessment Rating by Postgraduate Year and Number of Operative Cases Treated

Self-assessment was performed before the course using the Otolaryngology Milestone for Facial Trauma (OMFT). Higher ratings indicate more experience. Boxes represent data points. For case log, 1 indicates 1 to 5 cases; 2, 6 to 10 cases; 3, 11 to 20 cases; and 4, 21 to 50 cases. Data points overlap and appear to represent fewer points than actually exist.

Figure 3.. Resident Self-assessment by Faculty Rank

Self-assessment and faculty rating were performed before the course using the Otolaryngology Milestone for Facial Trauma (OMFT). Higher ratings indicate more experience. Data points overlap and appear to represent fewer points than actually exist. The Accreditation for Graduate Medical Education Council implemented this competency-based milestone project, the OMFT.