Craniofacial and Trauma Rehabilitation —
Training activity: 4

Details

Contribute to the design and manufacture of surgical guides in a complex surgical reconstruction in either trauma, oncology or craniofacial case.

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 success when contributing to the design and manufacture of surgical guides and pre-bent fixation plates, specifically regarding the precision required to transfer a digital plan to a live surgical procedure?
• How will you ensure that your contribution adheres to sterile field requirements and regulatory service governance for complex reconstructions in trauma or oncology?
• What steps will you take to ensure you are delivering quality patient-centred care while interpreting complex imaging data to define resection margins?

What is your prior experience of this activity?

• What is your current level of proficiency in analysing and interpreting multimodal imaging (CT, MRI, and surface data), and how will this assist you in formulating a treatment plan?
• What challenges do you foresee regarding digital simulation or material distortion during the milling or printing of a surgical guide, and how will you manage these to meet surgical tolerances?
• How will you recognize if a specific design complexity or anatomical variation is beyond your scope of practice, requiring the input of the lead planner or consultant surgeon?

What do you anticipate you will learn from the experience?

• What specific technical skills do you hope to develop in CAD/CAM planning software to accurately convert surgical specifications into custom surgical aids?
• How do you anticipate this experience will deepen your understanding of the interdisciplinary roles within the MDT and their specific impact on the patient care pathway?

What additional considerations do you need to make?

• What important data—such as patient-specific pathology, late inputs from the surgical team, or specific material properties—must you consider before embarking on the manufacturing process?
• How will you prepare to justify your treatment plan and present findings to the surgeon, ensuring you have accounted for both biocompatibility and surgical compatibility?

In action

During the activity is anything unexpected occurring?

• As you analyse the multimodal imaging and 3D data, are you noticing any unexpected misalignments, artefacts, or anatomical variations that compromise the accuracy of the surgical plan?
• Is the digital simulation showing required plate adjustments or resection margins that exceed the anticipated manufacturing tolerances or anatomical limitations?
• Are you encountering unforeseen technical difficulties, such as material distortion during the milling or 3D printing of the surgical guide?
• Have you received late clinical input from the surgical team (MDT) that necessitates a rapid modification to the pre-bent fixation plate or guide design?
• How does this specific experience in a complex trauma, oncology, or craniofacial case compare with your previous experiences of simpler medical device manufacturing?

How are you reacting to the unexpected development?

• How are you adapting your approach to ensure the surgical aids will effectively support the treatment while prioritising the best interests of the patient?
• Are you cross-checking the digital plans with a senior colleague or the consultant surgeon to verify critical measurements or surgical compatibility?
• Are you re-processing steps or adjusting the biomedical material mix due to an observed artefact or failure in the fabrication process?
• How are you ensuring that your real-time decisions and modifications to the device remain in accordance with local health and safety policies and regulatory standards?
• How are you feeling in this moment—is the unexpected challenge affecting your confidence in managing the design independently?

What is the conclusion or outcome?

• How are you ensuring you work within your defined scope of practice, such as recognising when a complex digital planning error requires the input of the lead planner or a specialist?
• What are you learning about the precision and clinical standards required for complex surgical reconstruction as a result of troubleshooting these issues?
• How are you ensuring that your communication with the clinical team clearly identifies any technical limitations or potential for failure in the manufactured device?
• Are you successfully concluding the process by verifying that the final surgical guide or plate aligns with the customised treatment requirements of the patient?
• What vital learning are you acquiring in the moment about the interplay between laboratory planning and the realities of the operating theatre?

On action

What happened?

• What were the key procedural elements and steps you took to contribute to the design, processing, and manufacture of surgical guides and pre-bent fixation plates for this complex reconstruction?
• How did you analyse and interpret the patient investigations, such as multimodal imaging (CT, MRI, or surface data), to accurately define resection margins for the guide design?
• What specific parameters or anatomical landmarks did you notice while evaluating the digital simulation to ensure the plate adjustments did not exceed manufacturing tolerances?
• What were the most significant interactions with the multidisciplinary team (MDT), such as Receiving late surgical input, and how did these influence the final treatment plan?
• Were there any ‘reflect-in-action’ moments—such as troubleshooting software issues or material distortion during milling—where you had to adapt to the situation as it unfolded?
• How would you describe your feelings during the experience, particularly when managing the technical precision required for a complex trauma or oncology case?

How has this experience contributed to your developing practice?

• What new knowledge or skills have you developed regarding 3D planning, precision manufacturing, and the interdisciplinary collaboration required for complex surgical reconstructions?
• What strengths did you demonstrate in ensuring the final surgical aids adhered to local and national health and safety policies and regulatory requirements?
• In what ways did this experience improve your ability to select appropriate biomedical materials (metallic, polymeric, or ceramic) based on their clinical performance and surgical compatibility?
• What skills or knowledge gaps were evident, particularly regarding the interpretation of complex 3D data or the limitations of specific manufacturing techniques?
• How did you ensure you were working within your defined scope of practice, and were there moments where you needed to escalate a technical planning error to a lead planner or consultant surgeon?
• How has your practice improved in handling complex reconstruction elements compared to your previous engagement with simpler medical device manufacturing?

What will you take from the experience moving forward?

• What specific ‘next steps’ or actions will you now take—such as further practice with CAD/CAM simulation—to support the assimilation of what you have learned?
• What will you do differently next time you contribute to a complex surgical plan to enhance communication with the surgical planning team?
• Has anything changed in terms of how you would justify a treatment plan or handle last-minute plate modifications based on the feedback you received?
• Which aspects of the activity do you need to practise further, such as improving technical precision to meet surgical tolerances or reviewing surgical anatomy?
• How has the learning from this activity supported your preparation for observed assessments, such as Case-Based Discussions (CBDs) or presenting an oncology case to the Reconstructive Science team?

Beyond action

Have you revisited the experiences?

• How have you reviewed the specific actions identified in your earlier reflections for the design and manufacture of surgical guides, and are you now prepared to demonstrate this new learning in practice?
• In what ways has engaging in professional storytelling with peers and senior colleagues regarding the challenges of complex reconstructions or biomedical material selection led to a transformation in your understanding of best practices?
• How has your perspective on reconstructive science changed now that you have transitioned from simpler custom medical devices to complex surgical reconstructions involving multidisciplinary input?
• When reviewing your past reflections, have you identified any new areas for improvement that were previously hidden, and how have you integrated these into your current training cycle?

How have these experiences impacted upon current practice?

• How is the technical learning gained from manufacturing surgical guides specifically supporting your preparation for observed ‘in-person’ assessments, such as Case-based Discussions (CBDs) or Observed Clinical Events (OCEs)?
• How has your understanding of multidisciplinary team (MDT) collaboration evolved, and has this improved your ability to work in partnership with other specialisms to deliver patient-centred care?
• To what extent does your current practice reflect an evolved understanding of biomedical materials and the proficiency to use digital techniques (such as CAD/CAM) to synthesise multimodal imaging for customised treatments?
• How has your ability to recognise your scope of practice developed over time, particularly in identifying when a complex craniofacial case or a major mechanical fault requires escalation to a senior colleague?
• How effectively are you now integrating the assessment of medical, physical, social, and psychological requirements into your routine clinical investigations to ensure a holistic approach to patient care?
• Can you identify specific examples where your clinical and technical proficiency has improved as a result of treating these training 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.