A Model for Malpractice Preparedness for Plastic Surgery Residents

Dear Editor, We read with great interest the article by Chandawarkar et al,1 titled “A Model for Malpractice Preparedness for Plastic Surgery Residents,” which provides an educational learning module to guide residents facing lawsuits and malpractice claims. As the authors note, litigation against plastic surgeons is unfortunately on the rise and may disrupt both professional and personal lives.1 This article is valuable for offering essential guidelines, and we commend the authors for this pertinent initiative. Yet, before reaching the stage of legal action, we believe greater emphasis should be placed on prevention. In this regard, 1 notable gap in current training is the limited use of simulation-based tools specifically designed to address the management of clinical complications in plastic surgery.2 Complications in our specialty are diverse, unpredictable, and context-dependent, making them difficult to reproduce with standard simulation models or mannequins. Nevertheless, they represent critical moments where early recognition and appropriate management can prevent escalation to malpractice claims. We would therefore like to broaden the educational perspective by underscoring the role of simulation in preparing residents to manage surgical complications. Beyond technical training, clinical simulation is a pedagogical technique that enables learners to refine their reasoning, make decisions under pressure, and experience challenging scenarios without compromising patient safety.3,4 In this context, our department developed a series of interactive and progressive clinical case simulations based on real-life complications and tissue-preserving strategies in plastic surgery. We conducted a pilot study involving 12 plastic surgery residents, who were presented with 3 clinical cases related to breast reconstruction and free flap monitoring/rescue. These cases were delivered through a digital platform incorporating clinical images, sequential decision-making steps, and complication scenarios illustrated with real patient iconography. Participants were asked to make therapeutic decisions at key stages. In the event of incorrect choices, they were shown visual representations of the potential complications resulting from their decisions. Overall satisfaction was high, and residents appreciated the opportunity to simulate not only best practices, but also the real consequences of poor decision-making. Why is it so important to focus on complications in surgery? We believe this approach is essential because the development of knowledge and, above all, safe confidence in a young surgeon, is partly grounded in the credibility of lived or simulated experience. Therefore, conceptualizing surgical complications for educational purposes remains a significant challenge. To build meaningful clinical cases centered on complications, the first requirement is the collection of a comprehensive iconography of complications encountered over time. Unfortunately, in our field, complications are rarely documented or classified, partly due to the emotional and reputational difficulty of doing so. Nevertheless, overcoming this reluctance is critical: sharing our complications is part of transmitting experience and fostering a culture of learning from error.5 Several studies4,5 analyzing morbidity and mortality conferences have highlighted the value of reflecting on adverse outcomes to improve clinical practice. In this light, we believe that integrating complication-based clinical simulations, not just technical skills simulations, is essential for comprehensive surgical training and to prevent the risk of malpractice and lawsuits. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.