Teaching paradigm for decision making in facial skin defect reconstructions

Objective: To present a decision paradigm for facial defect reconstruction, and test the ability of this paradigm to improve resident performance. Design: A decision paradigm for reconstruction of facial skin defects is proposed and explained, with patient examples. The paradigm's usefulness is the tested with residents. Setting: Otolaryngology residency training program at a tertiary hospital. Study Participants: Otolaryngology residents. Interventions: Twelve residents took a pretest wherin they were presented with drawings of skin defects and asked to choose the 'best' (most aesthetically pleasing) type of reconstruction from a closed set. This paradigm was presented to these residents, and their posttest consisted of choosing again with the same defects and closed set of choices. Main Outcome Measures: Cosmetic outcomes of reconstructive decisions on the pretest and posttest were rated on a scale of 0 to 5 (with 0 indicating poor; 5, excellent). Results: There was a significant improvement in reconstructive choices between the pretest and posttest (P<.001, Student t test). Conclusion: This paradigm can be easily modified to accommodate different surgical approaches preferred by individual surgeons and is thus useful in almost any reconstructive teaching situation.