Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 24

Details

Provide pre-operative CAD planning, and CAM 3D models for the management of head and neck oncology and present the model in a clinic for discussion and planning with the surgeon

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?

• Success entails generating accurate pre-operative CAD plans and CAM 3D models for head and neck oncology cases, and effectively presenting these models in a clinic for discussion and surgical planning with the surgeon. The models should facilitate clear understanding and decision-making.
• Consider the learning outcomes related to analysing multimodal imaging, preparing surgical treatment plans, and communicating with healthcare professionals.
• Clarify the specific requirements for the models and the presentation format expected by the surgical team.

What is your prior experience of this activity?

• What is your current understanding of head and neck anatomy, oncology imaging, CAD/CAM applications for surgical planning, and presenting complex information to surgeons?
• What difficulties might arise in converting imaging data to accurate 3D models, ensuring model fidelity for complex defects, or communicating technical details to surgeons, and how will you prepare for them?
• When would it be appropriate to seek guidance from experienced surgeons, radiologists, or senior colleagues regarding image interpretation or surgical approaches?
• How confident are you in translating complex medical imaging into tangible 3D models for surgical use, and in leading a discussion with a surgeon?

What do you anticipate you will learn from the experience?

• Focus on improving your CAD/CAM skills for oncology, your ability to interpret complex imaging for surgical reconstruction, or your communication skills during multidisciplinary team discussions.
• What insights do you hope to gain about the surgeon’s perspective on 3D models for planning, or the impact of precise modelling on surgical outcomes in oncology?

What additional considerations do you need to make?

• Review any feedback from prior CAD/CAM projects or presentations to clinical teams.
• What crucial patient data, imaging, or specific surgical considerations (e.g., tumour margins, reconstructive options) do you need to gather before beginning the planning?

In action

During the activity did anything unexpected occur?

• Are you noticing anything surprising or different from what you anticipate during the model provision and presentation process? Are you encountering situations such as:
  • The surgeon raises unexpected questions or concerns about the model’s accuracy or utility?
  • There is a last-minute change to the surgical approach that impacts the model’s relevance?
  • You are facing technical issues during the presentation of the model?
• 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? For example, are you responding effectively to the surgeon’s queries on the spot? Are you adapting your presentation or explanation to address new information or concerns? Is it affecting your ability to undertake the activity independently?
• Consider the steps you are taking in the moment, such as:
  • Are you spontaneously suggesting alternative surgical paths based on the model in response to the surgeon’s suggestion?
  • Are you seeking advice from a more experienced colleague or your training officer regarding complex surgical planning input that is beyond your current scope?
• Consider how you feel in that moment. For instance, are you finding it difficult to adapt? Is it affecting your confidence? Do you feel positive you could reach a successful conclusion?

What is the conclusion or outcome?

• How are you working within your scope of practice?
  • Are you successfully completing the planning phase by ensuring the presentation of the 3D model accurately reflects the analysis and interpretation of the pre-operative multimodal imaging (e.g., CT/DICOM data)?
  • Are you practicing within the multidisciplinary team environment by clearly articulating the purpose, limitations, and potential inaccuracies of the 3D model to the surgeon during the planning discussion?
• What are you learning as a result of the unexpected development?
  • Are you developing proficiency in explaining complex 3D planning principles and surgical landmarks clearly and concisely to non-specialist members of the oncology team?
  • Are you learning how to quickly adapt the focus of the model presentation (e.g., shifting from bone margins to soft tissue reconstruction) in response to last-minute changes in the anticipated surgical approach?

On action

What happened?

• Summarise the key points of the experience, focusing on the pre-operative CAD planning, the CAM 3D model creation for oncology, and the presentation of this model in a clinic for discussion and planning with the surgeon.
• Consider specific events, actions, or interactions that felt important. Did the surgeon raise unexpected questions about the model’s accuracy, or were there last-minute changes to the surgical approach?
• Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For example, how did you respond to challenging questions from the surgeon on the spot or adapt your presentation to address new information during the clinic discussion?

How has this experience contributed to your developing practice?

• Identify what learning you can take from the experience. What strengths did you demonstrate in communicating complex CAD/CAM models to surgeons and facilitating multidisciplinary planning discussions? What skills and/or knowledge gaps were evident (e.g., anticipating surgical resection protocols or understanding the principles of soft tissue surgery)?
• Compare this experience against previous engagement with similar activities. Has your practice improved in supporting multidisciplinary surgical planning, such as improving model clarity or presentation techniques?
• Identify any challenges you experienced and how you reacted to these. Did the high-pressure clinical setting affect your ability to undertake the activity independently?
• Identify anything significant about the activity. Did you need to seek advice or clarification on surgical nuances or ensuring the model’s utility for preparing surgical treatment plans for complex head and neck surgery?
• 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 / ‘next steps’ you will now take to support the assimilation of what you have learnt.
• What will you do differently next time? For example, review the information required for different surgical procedures (CT scans, 3D models etc) or practice presenting a treatment plan to enhance clinical dialogue.
• Do you need to practise any aspect of this activity further?

Beyond action

Have you revisited the experiences?

• Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (CAD/CAM models for oncology)?
• When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to CAD planning, 3D model accuracy, or communication with the surgeon in the clinic setting?
• Have you completed these previously identified actions? If not, what are the barriers? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when performing this task?
• Have you engaged in professional storytelling or discussed your experiences of presenting 3D models for oncology cases with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of the importance of multimodal imaging analysis or the role of 3D models in surgical resection planning?

How have these experiences impacted upon current practice?

• Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module? For example, how does your improved confidence in analysing and interpreting multimodal imaging and presenting complex plans support your ability to succeed in an Observed Communication Event (OCE) where you present a facial prosthetic patient history and your treatment plan?
• How has your practice related to preparing surgical treatment plans for complex head and neck surgery and working as part of a multidisciplinary team (MDT) developed and evolved over time across multiple instances of undertaking this training activity?
• Can you identify specific examples of improvement or increased confidence in adapting your presentation to address unexpected surgical queries?
• Based on your experiences, how has your ability to recognise when something related to oncology CAD planning is beyond your scope of practice improved?
• Do you have a clearer understanding of when and from whom (e.g., Consultant in Restorative Dentistry, Head and Neck Surgeon) you need to seek advice or clarification regarding complex cranioplasty design or principles of soft tissue surgery?

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.
# 4	Outcome Identify patients who need further specialist support and refer to the appropriate healthcare specialist.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 7	Outcome Prepare surgical treatment plans for complex head and neck surgery.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	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.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.