Matic, Damir B.

Background: Surgeons pursuing improvement in the aesthetic outcomes of their cleft lip repairs may benefit from a granular scale evaluating individual objectives of the repair. Methods: A working group of 9 surgeons convened to develop an assessment scale for nasolabial aesthetics after unilateral cleft lip repair. The group identified objectives of the repair that could be evaluated using two-dimensional facial photographs. Scale items were developed to appraise success or failure in achieving each objective. Scale items were iteratively tested and refined. The scale was subsequently implemented as part of a Continuing Medical Education course that included self-evaluation and peer-to-peer education, culminating in the formation of individual plans for improvement. Results: Twelve distinct objectives of unilateral cleft lip repair were identified, of which 10 could be evaluated using photographs routinely obtained in clinical practice. A comprehensive scale was developed, incorporating these 10 objectives. Each scale item takes the form of a binary (yes/no) question evaluating a specific aesthetic concept, with accompanying reference images. Intrarater reliability for each item ranged from moderate to substantial (kappa value, 0.57 to 0.81). Interrater reliability ranged from fair to substantial (kappa value, 0.27 to 0.81). When implemented in a Continuing Medical Education course, the scale enabled surgeons to identify specific opportunities for improvement in their repair and specific surgical maneuvers to adopt in pursuit of these improvements. Conclusions: A new scale for evaluating outcomes of unilateral cleft lip repair is presented. The scale provides specific, actionable evaluations for individual objectives of the repair.

AbstractBackgroundSoft tissue management (STM) training programs for surgeons are largely tradition based, and substantial differences exist among different surgical specialties. The lack of comprehensive and systematic clinical evidence on how surgical techniques and implants affect soft tissue healing makes it difficult to develop evidence‐based curricula. As a curriculum development group (CDG), we set out to find common grounds in the form of a set of consensus statements to serve as the basis for surgical soft tissue education.MethodsFollowing a backward planning process and Kern's six‐step approach, the group selected 13 topics to build a cross‐specialty STM curriculum. A set of statements based on the curriculum topics were generated by the CDG through discussions and a literature review of three topics. A modified Delphi process including one round of pilot voting through a face‐to‐face CDG meeting and two rounds of web‐based survey involving 22 panelists were utilized for the generation of consensus statements.ResultsSeventy‐one statements were evaluated, and 56 statements reached the 80% consensus for “can be taught as is.”ConclusionsUsing a modified Delphi method, a set of cross‐specialty consensus statements on soft tissue management were generated. These consensus statements can be used as a foundation for multi‐specialty surgical education. Similar methods that combine expert experience and clinical evidence can be used to develop specialty‐specific consensus on soft tissue handling.