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Karen H. Calhoun, MD; Hadi Seikaly, MD; Francis B. Quinn, MD

Arch Otolaryngol Head Neck Surg. 1998;124:60-66.

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 then tested with residents.

Setting  Otolaryngology residency training program at a tertiary hospital.

Study Participants  Otolaryngology residents.

Interventions  Twelve residents took a pretest wherein 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.

From the Department of Otolaryngology, University of Texas Medical Branch, Galveston.