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Correspondence
April 2006

A Model to Teach Elliptical Excision and Basic Suturing Techniques

Arch Dermatol. 2006;142(4):523-533. doi:10.1001/archderm.142.4.526

This model, which is used in our programs to teach elliptical excision and basic suturing techniques to dermatology residents, consists of face diagrams, a skin substitute pad, a checklist, and a global rating scale. The face diagrams are premarked with three 1-cm circles representing lesions on the forehead, cheek, and nasolabial fold. The skin substitute pad (Limbs and Things, Bristol, England) is a 3-layered model made of foam and vinyl.

Initially, residents undergo a 1- to 2-hour training session to learn the design and execution of elliptical excision, undermining, and various suturing techniques, including cutaneous simple interrupted and running, vertical mattress, and subcutaneous buried. Two weeks later, they perform the tasks again while the attending dermatologic surgeon grades their performance using a checklist and a global rating scale. The checklist describes 10 tasks broken down into smaller steps, and each step is marked as either “performed” or “failed to perform” (Table). The global rating scale is a subjective evaluation of the overall ability of trainees. It uses a sliding scale of 1 (unsatisfactory) to 5 (outstanding) to grade knowledge of technical details, handling of instruments and “tissue,” and smoothness or awkwardness of movements (global rating scale available as an online eTable). Feedback is provided immediately, and residents work on areas that need improvement before they attempt surgery in live patients.

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