Rib Framework Simulation for Microtia Reconstruction

Abstract

Objective: Costochondral framework creation for microtia reconstruction is difficult to master, given the rarity of cases and scarcity of realistic, affordable simulation. These barriers are amplified in low-resource settings. We evaluated a simulated rib model for auricular framework creation as a training tool in multi-national, multi-specialty cohorts. Methods: Fifty-nine resident physicians from the University of Washington Departments of Otolaryngology-Head & Neck Surgery (UW-O, n=20), University of Washington Department of Plastic Surgery (UW-P, n=17), and University of Health Sciences Cambodia Department of Plastic Surgery (UHS-P, n=22) completed the simulation. Participants rated pre- and post-simulation confidence and skill, model realism and ease of use. Statistical analyses were done to identify intra- and inter-cohort differences. Results: All three cohorts improved significantly in self-reported confidence and skill (all p<.005). UHS-P entered with significantly higher baselines and showed no shift in median scores. Both UW cohorts gained significantly more confidence than UHS-P. UW-O gained significantly more skill than UHS-P (all p<.05). Post-simulation confidence and skill did not differ significantly across cohorts. Cohort did not independently predict post-simulation outcomes. Ratings were favorable for realism (median 4, IQR 3-4), ease of use (median 5, IQR 3.5-5), and satisfaction with the model as a global training tool (median 4, IQR 3-4.75). Conclusion: This accessible rib framework simulator demonstrated face validity and consistent gains in self-reported confidence and skill across otolaryngology and plastic surgery trainees in two countries. These findings support its feasibility as a training tool for microtia reconstruction.