N. Nosrati1, W. A. Wooden1, R. L. Flores1, R. Sood1, S. S. Tholpady1 1Indiana University,Plastic Surgery,INDIANAPOLIS, IN, USA
Introduction: One of the key learning opportunities in plastic surgery residency is taking call. The residents are on their own to make the initial diagnosis and plan and to effectively communicate all the data to their attending. One component is accurately reading imaging studies. The maxillofacial computed tomography imaging is among the more complex a plastic surgery resident will encounter on call. In this study, we analyzed the resident’s ability to read and process the films.
Methods: Using the plastic surgery sign out system, images were extracted from the previous 4 months. The images used were identified by the on-call resident as the crucial CT slices to make the diagnosis and plan. The corresponding computed tomography films were identified. Using a Pantech P4100 tablet, these films were video recorded. The images and films were then grouped according to resident year. Individually, each craniofacial attending was first shown the images and asked to decide on a management plan. They were then shown the video and asked if their management changed. Changes in plans were recorded.
Results:A total of 15 films were identified, 6 in the first year independent, 2 in the second year independent, 3 in the fourth year integrated, and 4 in the second year integrated. Image data was missing on 37 sign outs. Attending 1 changed his plan 40% of the time, attending 2 20% of the time, and attending 3 6.7% of the time for an average change of 22.2%. All attendings independently agreed on 7 operative plans.
Conclusion: As resident level progressed, selection of crucial slices of imaging improved. However, even in the more senior years there was some discordance with image selection. While CT is not the sole factor in management of craniofacial trauma, it does play a significant role. All the study participants agreed, having a full CT available improves communication and planning. In areas where information systems do not allow for easy viewing of images, the transmission of video with a full CT provides an alternate method to evaluate and change resident plans leading to improved patient care and resident education.
If feasible, especially in earlier resident years, use of computed tomography video recordings greatly enhances patient management and resident education of craniofacial trauma.