Craniofacial and Trauma Rehabilitation —
Training activity: 20

Details

Generate comparative analogue and digital pre-surgical plans for use in orthognathic surgical planning 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.

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?

• How will you define a successful outcome for generating comparative analogue and digital pre-surgical plans? Does success include achieving a high degree of precision in both methods to ensure the best possible patient outcome?
• In what ways will you demonstrate that you are practicing in accordance with local and national health and safety policies and service governance while preparing these custom-made surgical aids?
• How will you measure the effectiveness of your communication with the surgical team and other stakeholders during the planning phase and while in the operating theatre?
• What level of detail and precision has your Training Officer identified as necessary for the comparative analysis and the final surgical plan?

What is your prior experience of this activity?

• What do you already know about orthognathic surgery (e.g., Le Fort 1 or BSSO), and how proficient are you currently with both analogue model surgery and digital CAD software for pre-surgical planning?
• What specific challenges do you anticipate, such as discrepancies between analogue and digital predictions, software glitches, or technical complexities in the operating theatre, and how do you plan to handle them?
• How will you recognise the scope of your own practice for this activity, and from whom (e.g., Consultant Surgeon or Orthodontist) will you seek advice if the skeletal deformity or planning parameters exceed your current training level?
• How do you feel about embarking on this advanced training activity, particularly the transition from laboratory-based planning to observing the live surgical execution?

What do you anticipate you will learn from the experience?

• What specific skills in advanced digital planning, surgical mechanics, or sterile field observation do you want to develop, drawing on your previous experiences with simpler planning tasks?
• What insights do you hope to gain about the critical relationship between pre-surgical planning and actual surgical execution?
• How do you anticipate this experience will improve your ability to assess and interpret patient needs, ensuring the plan accounts for their medical, physical, and psychological requirements?
• What do you expect to learn about practicing in partnership with the MDT, and how their various roles impact the patient’s care pathway?

What additional considerations do you need to make?

• Have you consulted the actions identified from previous experiences with orthognathic cases or digital manufacturing to ensure you have addressed earlier points of improvement?
• What important patient-specific information do you need to consider before starting, such as the skeletal deformity type, imaging data (CT/MRI), or the surgeon’s preferred technique?
• How will your selection of biomedical materials and components (e.g., surgical splints) be influenced by the specific requirements of a bi-maxillary procedure?
• How have you prepared to manage the regulatory requirements for custom-made medical devices within your department’s governance framework?

In action

During the activity is anything unexpected occur?

• Are you noticing anything surprising or different from what you anticipated while generating the comparative analogue and digital pre-surgical plans?
• 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, such as a software glitch during CAD planning or an issue with the 3D-printed splint?
  • Discrepancies between the digital simulation and the analogue model surgery results?
• How is the live surgical experience comparing to your theoretical planning and your previous experiences with similar orthognathic cases?

How are you reacting to the unexpected development?

• How are you reacting and adapting your understanding or actions in the moment when faced with a development that contradicts your pre-surgical plan?
• Are you responding to the situation appropriately to ensure the best interests of the patient and the delivery of quality patient-centred care?
• How are you communicating with the surgeons and the wider multidisciplinary team (MDT) to address discrepancies identified intraoperatively?
• Is the unexpected complexity affecting your confidence in the accuracy of your planning or your ability to undertake this advanced activity independently?
• Did you need to modify your approach to the selection of biomedical materials or components based on real-time surgical requirements?

What is the conclusion or outcome?

• How did you ensure you were working within your scope of practice while attending the surgical procedure?
• Did you recognise when to seek immediate advice or clarification from the Consultant Surgeon or Training Officer regarding surgical nuances or plan feasibility?
• What is the immediate outcome regarding the interplay between the pre-surgical planning and the physical realities of the orthognathic surgery?
• What vital learning are you acquiring in the moment about maintaining a safe clinical standard when translating laboratory-based plans into the operating theatre environment?

On action

What happened?

• How would you summarise the key stages of generating the comparative analogue and digital pre-surgical plans, and what were your specific observations while attending the orthognathic surgical procedure?
• Which specific interactions or clinical investigations felt most significant—for example, interpreting multimodal imaging, using planning software, or discussing the plan with the multidisciplinary team (MDT)?
• Can you describe any ‘reflect-in-action’ moments where you had to adapt, such as adjusting your focus during surgery based on unfolding events or noting discrepancies between the pre-surgical plan and the intraoperative execution?
• How did you feel while finalising cutting guide coordinates under time pressure, or observing a critical step like a Le Fort 1 osteotomy?
• How did you ensure the plans were documented according to local service governance and regulatory requirements for custom-made medical devices?

How has this experience contributed to your developing practice?

• What specific learning have you gained regarding the generation of accurate pre-surgical plans and their subsequent implementation in a live surgical environment?
• What strengths did you demonstrate in your analytical skills, such as connecting theoretical laboratory planning to practical surgical execution?
• What knowledge gaps were identified, perhaps in interpreting complex imaging for bi-maxillary cases or understanding specific surgical nuances during the procedure?
• How does this experience compare to previous planning or surgical observation activities; have you achieved any previously identified actions for development?
• How did you handle challenges such as complex anatomical variations or unexpected intraoperative findings, and did these affect your ability to maintain a safe clinical standard?
• Did you need to seek advice or clarification on planning parameters or escalate concerns to ensure you remained within your scope of practice?
• How have your feelings changed now that you are looking back on the critical link between laboratory planning and surgical outcomes?

What will you take from the experience moving forward?

• What specific ‘next steps’ will you take to support the assimilation of this learning, including any feedback received from the surgical team?
• What would you do differently next time you generate plans to better account for the patient’s medical, physical, or psychological requirements?
• How will this experience change your approach to detailed planning or your understanding of the broader surgical context?
• Are there specific aspects of the activity you need to practise further, such as advanced features of planning software for mandibular osteotomy simulation or reviewing surgical anatomy to enhance plan-to-execution correlation?
• How will you apply the learning from this activity to ensure you consistently deliver quality patient-centred care in future orthognathic cases?

Beyond action

Have you revisited the experiences?

• How have you reviewed your previous reflections (before, in, and on-action) for generating comparative analogue and digital pre-surgical plans to identify specific actions needed to improve your precision or workflow?
• Have you completed the actions identified in earlier cases—such as refining your digital simulation accuracy or analogue model surgery techniques—and are you now ready to demonstrate this integrated learning consistently in practice?
• In what ways has engaging in professional storytelling with senior surgeons or colleagues about the discrepancies between plans and intra-operative realities transformed your understanding of the “gold standard” for orthognathic planning?
• Has your view of the interplay between laboratory-based planning and surgical execution changed after observing the physical constraints, such as nerve positions or bone quality, encountered during the live procedure?
• How has revisiting these past reflections helped you evaluate if your previous plans truly prioritised the best interests of the patient and delivered quality patient-centred care?

How have these experiences impacted upon current practice?

• How has the cumulative learning from generating these comparative plans and attending surgery prepared you for observed ‘in-person’ assessments, such as the Observed Clinical Event (OCE) where you must present a simple orthognathic plan to the multidisciplinary team (MDT)?
• In what ways has your practice evolved regarding multidisciplinary partnership, particularly in your ability to communicate effectively with surgeons and orthodontists to ensure the plan meets the patient’s medical and physical requirements?
• How effectively are you now interpreting patient needs to ensure that your pre-surgical plans account for the psychological and social impact of major jaw surgery on the individual?
• How has your ability to select appropriate biomedical materials and components —such as surgical occlusal splints—matured based on your observations of their stability and performance in a sterile theatre environment?
• To what extent has your practice become more strictly aligned with service governance and regulatory requirements when documenting custom-made surgical aids or digital plan validations?
• Can you identify specific examples where you have improved in recognising the boundaries of your scope of practice, knowing exactly when a complex skeletal deformity requires escalation to a Consultant?
• How has this training activity shaped your development into a Clinical Scientist capable of formulating plans that meet a safe clinical standard in high-complexity reconstructive 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.