Resident and Faculty Perspectives Toward Plastic Surgery Skills Lab: A Targeted Needs Assessment for Curriculum Development

Introduction
Currently there are no standard guidelines for surgical skills lab curricula in plastic surgery, leaving educators with the significant challenge of determining how to optimize learning in the lab. Though skills labs are becoming increasingly common in plastic surgery programs, we do not fully understand how to maximize resource utilization and how to align skills lab curricula with the specific needs of resident learners. As part of the process of refining our curriculum, we aimed to perform a targeted needs assessment to investigate attitudes toward our current plastic surgery skills lab at UCSF.

Methods
Plastic Surgery residents at UCSF participate in a recurring 2-year longitudinal skills lab curriculum, held once a month with a combination of cadaver labs and other hands-on workshops. We conducted semi-structured interviews with plastic surgery resident learners and faculty facilitators to explore the perceived value of skills lab in resident education, the utility of its content, and the strengths and limitations of the current skills lab curriculum. Two residents involved with this project were excluded. All interviews were de-identified, transcribed verbatim, and then analyzed using a constructivist grounded theory approach. A sub-analysis was performed comparing junior resident (PGY1-3) to senior resident (PGY4-7) responses.

Results
15 of 19 eligible integrated plastic surgery residents and 4 frequent skills lab facilitators among the surgical faculty were interviewed. Regardless of PGY level, all residents cited the skills lab as one of the most valuable educational settings in residency, providing opportunity for 1) low stress, low stakes deliberate practice, 2) detailed anatomical dissection, and 3) practice with "unique procedures," including: procedures for rare pathologies, procedures for urgent indications, and procedures less frequently seen at UCSF specifically (i.e. cosmetic and brachial plexus). All residents experienced a change in the educational environment when learning in mixed-level groups compared to near-peer groups; While both juniors and seniors acknowledged the benefit of practicing teaching skills when in mixed groups, juniors appreciated more hands-on practice and focus on fundamental skills (i.e. preoperative marking, dissection) when in junior resident groups, while senior residents appreciated "struggling together" to troubleshoot more complex dissections in senior resident groups. Both residents and attendings cited instrument, implant and hardware selection as particularly valuable skills to practice in the lab, and an area that could be more represented in future curricular iterations. Attendings strongly believed learners in the lab should focus on practicing fundamental technical skills and improving their understanding of anatomy rather than focusing on specific procedures.

Conclusions
Despite the wide variability in training and exposure to different aspects of plastic surgery across residency programs, our analysis revealed important insights into broad skill categories such as instrument selection and anatomical dissection that are valued by residents and educators alike in the skills lab setting. Additionally, factors that influence the educational climate such as near-peer interactions are critical to consider when designing skills lab curricula.

References
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Research and Technology

PSTM 2024