TEACHING PARADIGM FOR DECISION-MAKING IN FACIAL SKIN DEFECT RECONSTRUCTIONS

Objective: To present a decision paradigm for facial defect reconstruc tion, and test the ability of this paradigm to improve resident perfor mance. Design: A decision paradigm for reconstruction of facial skin d efects is proposed and explained, with patient examples. The paradigm' s usefulness is then tested with residents. Setting: Otolaryngology re sidency training program at a tertiary hospital. Study Participants: O tolaryngology residents. Interventions: Twelve residents took a pretes t wherein they were presented with drawings of skin defects and asked to choose the ''best'' (most aesthetically pleasing) type of reconstru ction from a closed set. This paradigm was presented to these resident s, and their posttest consisted of choosing again with the same defect s 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: The re was a significant improvement in reconstructive choices between the pretest and posttest (P<.001, Student t test). Conclusion: This parad igm can be easily modified to accommodate different surgical approache s preferred by individual surgeons and is thus useful in almost any re constructive teaching situation.