Evolution of Cleft Lip and Palate Surgical Training in the UK: A Qualitative Study

• Published in: The Cleft palate-craniofacial journal Vol. 60; no. 2; pp. 197 - 210
• Main Authors: Butterworth, Sophie, Hodgkinson, Emma L., Stock, Nicola M., Sainsbury, David C. G., Hodgkinson, Peter D.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-02-2023; SAGE PUBLICATIONS, INC
• Subjects: Birth defects; Cleft Lip - surgery; Cleft Palate - surgery; Humans; Plastic Surgery Procedures; Qualitative research; Surgeons; Surgery; Teaching; Training; Treatment Outcome; United Kingdom > UK; surgical technique; thematic analysis; surgeon perspective; cleft palate repair; Sommerlad; cleft palate; intravelar veloplasty
• ISSN: 1055-6656; 1545-1569
• DOI: 10.1177/10556656211058443

Background
Although the United Kingdom (UK) cleft surgeons follow a similar training pathway, and cleft centers adhere to similar protocols regarding the timing of palate surgery and surgical technique, speech outcomes still vary between centers.
Objective
To explore the training experiences of consultant cleft lip and palate (CL/P) surgeons, performing a Sommerlad radical intravelar veloplasty (IVVP) and their approach to teaching others.
Design
An exploratory, qualitative approach was adopted to understand the views of UK cleft surgeons performing a Sommerlad radical IVVP and discuss what was important during training and upon qualifying as a consultant.
Method
A semi-structured interview schedule was designed, interviews were conducted in-person or via videoconferencing, depending on preference and availability, with interested surgeons. The interviews were recorded, transcribed, and checked for accuracy. Analysis involved inductive thematic analysis.
Results
Fourteen cleft consultants from the UK participated (3F:11M). Seven of the consultants were trained in plastic surgery and four in maxillofacial surgery. Seven themes were identified from the thematic analysis. Three themes, namely Learning to perform palate repair, Teaching others to perform palate repair, and Ongoing learning as a consultant are discussed.
Conclusions
Cleft palate repair is clearly a technically challenging procedure to learn and teach with the potential to cause harm if performed incorrectly. Positive changes have been made to improve exposure to palate surgery, encourage practice away from the patient, and increase supervised practical experience. The role of colleagues in providing mentorship and support appears invaluable. We provide some simple recommendations that may improve the training experience and ensure parity for all trainees.