Advancing Surgical Precision in Z-Plasty and Melanoma Excision Through Quality Improvement Initiatives in Rural Settings.

Rural healthcare provider shortages have a severe impact on Canadians who seek care in rural and remote (R&R) settings, often arriving with poor health or medical emergencies. Healthcare providers working in such settings often face significant challenges in accessing skills development and maintenance courses to meet the unique medical demands of rural communities. As a result, it is vital to provide R&R healthcare providers with the appropriate simulation-based skills training. This approach led to the development of a Z-plasty and melanoma simulator tool, which was presented at a workshop during the Society of Rural Physicians of Canada (SRPC) conference in Niagara Falls, Ontario, from April 20 to 22, 2023. The workshop aimed to familiarize participants with the procedures and instruments required for Z-plasty and melanoma excisions in R&R practice. This paper describes the development of the simulators used in the foundational skills workshop, attended by medical students, residents, and physicians. It also analyzes the workshop's findings to guide future enhancements. The Z-plasty and melanoma simulators were created using additive manufacturing techniques, including three-dimensional printing and silicone. Participants in the SRPC Rural and Remote Medicine Course evaluated the functionality and realism of the simulators and provided feedback for improvements, using the Michigan Standard Simulation Experience Scale. Quantitative data indicated that the Z-plasty simulator achieved an overall score of 4.03 on a 5-point Likert scale, while the melanoma simulator scored 4.15. Participants' feedback was categorized into three main areas: self-efficacy, realism, and educational value. Qualitative analysis of the data revealed three themes for the Z-plasty simulator: physical resilience, materials science, and skills development. Similarly, the melanoma simulator yielded two main themes: physical reliance and materials science. Overall, the simulators demonstrated effective hands-on practice, representing a sustainable method for developing skills-based competencies in Z-plasty and melanoma excisions for R&R settings. Feedback from workshop participants will inform ongoing improvements to the simulators and their integration into future training events.