Cleft Lip Repair Competence Can Be Evaluated with High-fidelity Simulation

Area of Science:

• Surgical Education
• Medical Simulation
• Cleft Lip and Palate Surgery

Background:

• Assessing surgical competency before independent practice is crucial.
• High-fidelity simulators offer a potential solution for objective performance evaluation.
• This study investigated the utility of a cleft lip simulator for assessing procedural competence.

Purpose of the Study:

• To test if a high-fidelity cleft lip simulator can discriminate performance across surgical training levels.
• To evaluate the simulator's utility for assessing procedural competence in cleft lip repair.

Main Methods:

• A prospective cohort study involving 26 participants (postgraduate year 3 to craniofacial fellow).
• Participants performed unilateral cleft lip repair on a high-fidelity simulator.
• Videos were blindly assessed using the Objective Structured Assessment of Technical Skills (OSATS) and the Unilateral Cleft Lip Repair Competency Assessment Tool (UCLR).
• Digital symmetry measurements were taken, and correlations with training level and experience were analyzed.

Main Results:

• Training level showed the strongest correlation with the UCLR (R = 0.4842, P = 0.0122) compared to OSATS (R = 0.3645, P = 0.0671).
• Specific UCLR subscores for performance and result correlated significantly with training level (R = 0.5152, P = 0.0071 and R = 0.4226, P = 0.0315, respectively).
• Cumulative experience had weak correlations with assessment scores, and symmetry measures showed a weak correlation with training level.

Conclusions:

• High-fidelity simulation combined with a procedure-specific tool (UCLR) demonstrates construct validity for evaluating cleft lip repair performance.
• The ability to simply mark the repair or the final symmetry are not accurate independent assessment methods.
• This approach provides a reliable method for assessing surgical trainees' competence in cleft lip repair.