Gauging the Optimal Simulator Complexity for Learning Cleft Lip Repair: A Cost-Benefit Analysis

Background: Simulation is valuable for surgical education. The popularity of high-fidelity cleft lip simulation has grown, yet cost limits widespread use. To address this, we developed a reduced-complexity prototype that preserves essential anatomy (skin/soft tissue and orbicularis oris muscle) but omits advanced features found in a previous trainer (nasal cartilages and skeleton). To evaluate the effect of simulator complexity, a hybrid retrospective–prospective cohort study compared trainees’ self-assessed improvement using both the new lower complexity simulator (LCS) and its higher complexity simulator (HCS) predecessor. Methods: Residents’ and fellows’ self-assessed knowledge and confidence in specific aspects of cleft lip repair were compared pre- and postsimulation using a 6-question, 4-point, cleft lip self-assessment and a 6-question, 5-point self-confidence questionnaire. Poisson regression analysis was used to analyze the effects of simulator type on self-improvement. Results: Among 52 participants, 26 used the new LCS, and 26 trained with the old HCS. Significant improvements pre- to postsimulation were observed in both groups. The difference in net score improvement between the LCS (mean = 3.7, SD = 2.2, P < 0.01) and HCS (mean = 2.7, SD = 1.9, P = 0.03) groups was not statistically significant ( P = 0.09). Multivariable analysis also did not show a significant effect of simulator type on net self-assessed improvement (odds ratio = 1.30, 95% confidence interval = 0.96–1.77). Conclusions: For relative novices, a reduced-complexity cleft lip simulator is likely as effective as its more complex counterpart. Cost-effective, reduced-complexity simulators have the potential to broaden accessibility of simulation-based education.