Craniofacial and Trauma Rehabilitation —
Training activity: 20

Details

Generate pre-surgical plans for patients requiring single jaw (BSSO Le Fort 1) and bi-maxillary orthognathic surgery and attend the surgical procedure

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Patient centred care and support
• Information requirements to complete the device
• Potential for errors
• Analogue articulator-based plans
• Communication with the multidisciplinary team
• Selection and use of materials
• Manufacture protocols and device risk assessment
• Final analogue wafer
• Attend trail fit of the occlusal wafer at the pre-surgical appointment
• Decontamination
• Patient care pathway
• Impact of plan/design on patient quality of life

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Identify what is expected of you in generating pre-surgical plans and attending the surgical procedure for orthognathic surgery. Consider how the learning outcomes apply, such as communicating with the surgical team and analysing patient information.
• Discuss with your training officer and the surgical team to gain clarity on the detail and precision expected for your pre-surgical plans and observations during the procedure.
• Discuss with the STP reconstructive team the differences between analogue and digital planning.

What is your prior experience of this activity?

• Think about what you already know about orthognathic surgery, pre-surgical planning (analogue or digital), or observing complex surgical procedures.
• Consider possible challenges you might face in generating precise digital and analogue plans or understanding surgical intricacies in the operating theatre and think about how you might handle them.
• Recognise the scope of your own practice for surgical planning and theatre attendance and know when you will need to seek advice or help and from whom.
• Acknowledge how you feel about undertaking this advanced training activity.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in advanced digital planning, understanding surgical mechanics, or sterile field observation, drawing upon previous theoretical knowledge or simpler planning exercises.
• Identify the specific insights you hope to gain about the critical relationship between pre-surgical planning and actual surgical execution in orthognathic cases.

What additional considerations do you need to make?

• Consult actions identified following previous experience with planning sessions or observations of orthognathic cases that could improve your approach.
• Identify important information you need to consider before embarking on the activity, such as the patient’s specific skeletal deformity, the surgeon’s preferred technique, or the sequence of surgical steps.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate while generating the pre-surgical plans or attending the surgical procedure?
• Are you encountering situations such as:
  • An anatomical variation found during surgery (e.g., nerve position or bone quality) that requires an immediate, minor modification to the pre-surgical plan?
  • A technical failure related to the delivery of the surgical plan or device (e.g., equipment used to apply the pre-bent plate)?
  • The complexity of the live surgical procedure exceeding your expectations of how the plan would be executed?
• How is the live surgical experience comparing to your planning?

How are you reacting to the unexpected development?

• How are you reacting and adapting your understanding or actions in the moment when faced with an unexpected development related to the pre-surgical plan or the surgical procedure?
• Is it affecting your confidence in the accuracy or completeness of your planning?

What was the conclusion or outcome?

• What is the immediate conclusion or outcome related to the pre-surgical plan in light of the actual surgical procedure?
• What vital learning are you acquiring during the experience about the interplay between pre-surgical planning and the realities of orthognathic surgery?

On action

What happened?

• Begin by summarising the key points of generating the pre-surgical plans, including the specific aspects of single jaw and bi-maxillary orthognathic surgery, and your observations during attending the surgical procedure.
• Consider specific events, actions, or interactions which felt important during planning (e.g., data analysis, software use, team discussions) and during surgery (e.g., how the plan translated to practice, unexpected surgical developments), including your own feelings during the experience. g., Finalising the cutting guides coordinates in the planning software under time pressure; observing a critical step during the Le Fort 1 osteotomy; or noting discrepancies between the pre-surgical plan and intraoperative execution.
• Include any ‘reflect-in-action’ moments where you adapted to the situation (e.g., adjusting your focus during surgery based on unfolding events) as it unfolded.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding generating pre-surgical plans and surgical implementation.
• What strengths did you demonstrate in your analytical skills for plan generation, your understanding of surgical requirements, or your ability to connect theoretical planning to practical execution?
• What skills and/or knowledge gaps were evident in interpreting complex imaging for planning or understanding surgical nuances during the procedure?
• Compare this experience against previous planning or surgical observation activities. Were any previous identified actions for development achieved?
• Has your practice improved in generating accurate pre-surgical plans and appreciating their surgical implementation?
• Identify any challenges you experienced (e.g., complex anatomical considerations, precision in planning, unexpected intraoperative findings) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
• Identify anything significant about the activity. Did you need to seek advice or clarification on planning parameters or surgical techniques? Did you need to escalate any concerns regarding plan feasibility or surgical safety (within your scope of practice)?
• Acknowledge any changes in your own feelings now that you are looking back on the experience, especially regarding the critical link between laboratory planning and surgical outcomes.

What will you take from this experience moving forward?

• Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learned, including from any feedback you received from the surgical team.
• What will you do differently next time you generate pre-surgical plans or attend an orthognathic surgery? Has anything changed in terms of your approach to detailed planning or your understanding of the surgical context?
• Do you need to practise any specific planning software features or review surgical anatomy further? E.g., Practising advanced features of planning software for mandibular osteotomy simulation or reviewing and documenting key steps of the surgical procedure to enhance plan-to-execution correlation or analysing pre-surgical plans using digital techniques.

Beyond action

Have you revisited the experiences?

• Look back at your reflections on generating pre-surgical plans and attending orthognathic surgery. What actions did you identify to improve your planning, understanding of surgical procedures, or integration of analogue/digital techniques? Have these actions been completed, and can you demonstrate this enhanced learning?
• Discuss with senior colleagues or surgeons, specific orthognathic cases and your role both analogue and digital planning. Has their feedback or your shared analysis given you a deeper insight into the surgical considerations or the planning process?

How have these experiences impacted upon current practice?

• How does the learning from generating these plans and attending surgery prepare you for observed assessments?
• How has your practice in analysing and interpreting multimodal imaging and information, selecting appropriate biomedical materials, and working effectively as part of a multidisciplinary team evolved through these complex cases?

 

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 5	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 8	Outcome Select appropriate biomedical materials and components used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.