Simulation in Cleft Care: Evolution, Evidence, and Training the Future Surgeon.

Strict trainee work-week hour restrictions, increased complexities of surgical care, and shifting hospital policies have posed challenges to operating room training for residents in high-resource regions. A shortage of cleft-trained surgeon educators and inconsistent training curricula further limit exposure to cleft operative education in low-resource settings. Furthermore, teaching cleft surgery can be difficult given the confined space of the infant oral cavity and the small, delicate flaps used for reconstruction. In the face of these challenges, the role of simulation has expanded in surgical education to supplement intraoperative training and increase resident preparedness. Smile Train, a nonprofit cleft-focused organization, in partnership with the technology companies BioDigital (New York, NY) and Simulare Medical (Toronto, Ontario, Canada), and academic plastic surgeons, has developed and globally distributed a variety of simulation resources for cleft surgery. This work provided a comprehensive review of Smile Train-distributed simulator modalities, including surgical training videos, a digital simulation platform, high-fidelity physical simulators, and virtual reality models. This review described the evolution of these models, the effects on learner experience, knowledge, and surgical performance, as well as directions for future development.