Craniofacial and Trauma Rehabilitation —
Training activity: 4

Details

Contribute to the design, processing, and manufacture of surgical guides, and pre-bent fixation plates (laboratory) for complex surgical reconstruction in either trauma, oncology or craniofacial cases

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
• The variety of surgical plating systems for fixation
• Training requirements for pre-adapting of operating theatre stock/commercial medical devices
• Information requirements to complete the device
• Design requirements and options available for anatomical structures
• Surgical guide design and manufacture
• Materials selection and options
• Manufacture protocols and device risk assessment
• Sterilisation options (local and regional) for processing of surgical guides and fixation plates.
• Communication with the multidisciplinary team
• Selection and use of materials
• Cost efficiencies
• Timeframe for manufacture
• Decontamination/sterilisation
• 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 contributing to surgical guides and pre-bent fixation plates for complex reconstruction. Consider learning outcomes, such as effective communication with surgical teams and accurate material selection.
• Discuss with your training officer and the surgical team to gain clarity on the precision and integration required for these complex cases.

What is your prior experience of this activity?

• Think about what you already know about surgical guides, fixation plates, and the specific needs of complex trauma, oncology, or craniofacial reconstruction.
• Consider possible challenges you might face in contributing to such intricate cases, like precise anatomical features or tight tolerances, and think about how you might handle them.
• Recognise the scope of your own practice for this activity, particularly concerning its complexity, and know when you will need to seek advice or help and from whom.
• Acknowledge how you feel about undertaking this training activity involving complex surgical reconstruction.

What do you anticipate you will learn from the experience?

• Consider the specific skills you want to develop in 3D planning, precision manufacturing, or interdisciplinary collaboration, drawing upon previous, perhaps simpler, experiences.
• Identify the specific insights you hope to gain about the detailed requirements and surgical impact of guides and plates in complex reconstructive surgery.

What additional considerations do you need to make?

• Consult actions identified following previous experience with similar complex cases or observations of surgical procedures involving such devices.
• Identify important information you need to consider before embarking on the activity, such as the patient’s specific pathology, imaging data, or the surgical approach.

In action

Is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate during your contribution to the design, processing, or manufacture of surgical guides and pre-bent fixation plates?
• Are you encountering situations such as:
  • The digital plan or 3D data presenting a misalignment or artefact that compromises accuracy?
  • Digital simulation showing required plate adjustments that exceed expected manufacturing tolerances or anatomical limitations?
  • Unforeseen issues arising during the milling or printing of a surgical guide (e.g., material distortion)?
• How is this experience comparing with previous experiences of similar activities?

How are you reacting to the unexpected development?

• How is this impacting your actions? Did you need to modify your technique or seek immediate advice to ensure accuracy and quality?
• Consider the steps you are taking in the moment, such as:
  • Immediately cross-checking the digital plans with the consultant or senior colleague to verify critical measurements?
  • Are you re-running processing steps due to an observed artefact in the fabrication process?
  • Are you seeking clarification on sterilization requirements or surgical compatibility for the complex surgical aids?
• How are you feeling in this moment? Is the unexpected issue impacting your ability to contribute independently to the preparation of these complex surgical aids?

What is the conclusion or outcome?

• Identify how you are working within your scope of practice (e.g., recognising that a complex digital planning error required the lead planner’s input before continuing).
• What are you learning as a result of the unexpected development? For example, are you gaining specific insight into the precision required for complex surgical reconstruction, or learning how to troubleshoot errors in the planning software?

On action

What happened?

• Begin by summarising the key points of your contribution to the design, processing, and manufacture of surgical guides and pre-bent fixation plates for the specific complex surgical reconstruction case.
• Consider specific events, actions, or interactions which felt important, including your own feelings during the experience. g., Interpreting complex CT data to accurately define resection margins for guide design; troubleshooting software issues during 3D printing preparation; or receiving late input from the surgical team requiring rapid plate modification.
• Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded during your contribution.

How has this experience contributed to your developing practice?

• Identify what learning you can take from this experience regarding handling complex reconstruction elements. What strengths did you demonstrate in contributing to the design and manufacturing process for complex cases? What skills and/or knowledge gaps were evident in understanding the surgical requirements or material processing?
• Compare this experience against previous engagements with similar activities. Were any previous identified actions for development achieved? Has your practice improved in handling complex reconstruction elements?
• Identify any challenges you experienced (e.g., precision requirements, material handling, communication with the surgical team) 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, especially regarding the surgical context? Did you need to escalate to ensure you were working within your scope of practice or adhering to specifications?
• Acknowledge any changes in your own feelings now that you are looking back on the experience.

What will you take from the 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.
• What will you do differently next time you contribute to such complex cases? Has anything changed in terms of your approach to design, processing, or manufacture of surgical guides and plates?
• Do you need to practise any aspect of this activity further? E.g., Practising converting surgical specifications into accurate guide designs using planning software, or improving precision in laboratory manufacturing of pre-bent plates to meet surgical tolerances, or enhancing communication protocols with the surgical planning team.

Beyond action

Have you revisited the experiences?

• Reflect on your previous contributions to complex surgical reconstruction cases. What actions did you identify to enhance your design, processing, or manufacturing skills for surgical guides and fixation plates? Have these actions been completed, and how will you integrate this new learning into future practice?
• Engage in professional storytelling with colleagues about challenging complex reconstruction cases. Has the mutual exchange of experiences transformed your understanding of best practices or identified new areas for improvement?

How have these experiences impacted upon current practice?

• How does your learning from contributing to these complex cases prepare you for observed assessments like presenting an oncology case or discussing treatment options with a patient, given the multidisciplinary nature of these activities?
• How has your understanding of multidisciplinary team collaboration, selection of appropriate biomedical materials, and the application of digital techniques in surgical planning developed through these experiences?

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.
# 7	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 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.