Simulation-Based Workshops Improve Practitioners’ Confidence, Clinical Practice for CL/P Care


  • Workshops may help break through barriers to CL/P care in developing countries
  • Patient outcomes may benefit from practitioners’ workshop participation
  • Simulation-based education preferred over traditional textbooks

CHAPEL HILL, N.C. / Oct. 15, 2020 – Simulation-based comprehensive cleft care workshops can improve cleft surgical teams’ confidence and have a sustained positive impact on participants’ clinical practices, according to a recent research study. The results were published in the October 2020 issue of The Cleft Palate-Craniofacial Journal (CPCJ).

“The use of simulation-based training for cleft surgery has gained considerable interest given numerous logistical challenges in surgical education (e.g., increasing trainee supervision, growing work hour limitations, etc.). This article is of particular interest to the readership in CPCJ because it offers a means to bring these advanced technologies to developing countries to improve global healthcare. Also unique to this article is that it demonstrates the outcome of a highly collaborative team of co-authors representing regions across the globe who partnered to take actions on a shared vision—to improve global cleft care.  The value and benefits of viewing cleft care from a global perspective cannot be overstated,” said Jamie L. Perry, PhD, CCC-SLP, editor of The Cleft Palate-Craniofacial Journal.

Nearly one in 500 to 700 births are affected with cleft lip and/or palate (CL/P) worldwide, an estimated 100,000 children per year. Timely treatment is crucial to prevent an increased risk of morbidity due to significant functional deficits, malnutrition, aspiration, and respiratory tract infections. Therefore, it is recommended that the cleft lip be repaired within the first year of life and, if present, the cleft palate be corrected before 18 months.

Numerous barriers prevent equitable access to comprehensive cleft care around the world. A lack of appropriate expertise and/or financial resources augment these barriers, particularly in developing regions of Latin America, Africa, and Asia.

”Simulation-based training has emerged as an essential component of medical and surgical education over the last decade in developed countries, but financial and logistical constraints have limited the application of cleft surgery simulation in developing countries,” according to Rami S. Kantar, MD, MPH, lead researcher. “The first simulation-based comprehensive cleft care workshop took place in the Middle East-North Africa region in April 2018 and was well-received by participants. In this follow-up study, we sought to validate those findings by reproducing the workshop in Latin America and evaluating these workshops as a model for sustainable care in regions where significant barriers to comprehensive cleft care exist.”

The workshop took place in Lima, Peru, in October 2019. It featured multidisciplinary didactic lectures of relevance to all cleft practitioners, covering surgical, speech, nurse, anesthetic, pediatric, psychosocial, and dental considerations, as well as team-based approaches to cleft care. Breakout sessions included hands-on simulations of cleft lip and palate repairs using high-fidelity cleft lip and palate simulators. A 1 to 4 faculty to participant ratio allowed personalized feedback based on participants’ performance, with repetition if needed.

Using a modified version of the Student Evaluation of Educational Quality (SEEQ) survey, participants were asked about their satisfaction with the workshop as an educational method for learning about cleft care. Researchers also evaluated participants’ perceptions of the workshop’s impact on their clinical practices.

Of the 180 workshop participants, 98 completed the satisfaction survey. The majority of survey respondents (91%) reported that they would recommend the workshop to their colleagues and that they would participate in similar activities again (90%). The biggest obstacle facing cleft care in survey respondents’ countries was financial (24.5%), followed by the absence of multidisciplinary cleft teams (20.4%), poor training (9.2%), absence of cleft centers (5.1%), patient travel distance (4.1%), and a lack of awareness about CL/P (4.1%). Establishing multidisciplinary cleft teams was the most important intervention (23.5%) respondents thought would help improve cleft care in their countries, followed by financial support (16.3%), better training (10.2%), establishing cleft centers (9.2%), and raising awareness about CL/P (5.1%).

In addition, participants reported that their procedural confidence improved significantly following the hands-on simulation-based sessions. Data also suggest that trainees prefer simulation-based educational tools over traditional textbooks.

“Our study provides significant insight into the potential role of simulation-based education in building sustainable cleft care in developing countries. However, many questions remain unanswered and are at the forefront of our future research and educational endeavors,” Kantar said. “In particular, we need to determine how an increase in workshop participants’ procedural confidence is affecting patient outcomes. Through global collaboration, we can make these education initiatives more widely available and help alleviate existing disparities in cleft care around the world.”

To learn more about the American Cleft Palate-Craniofacial Association and cleft and craniofacial conditions, please visit

About the American Cleft Palate-Craniofacial Association
The American Cleft Palate-Craniofacial Association (ACPA) is a nonprofit 501(c)(3) association of interested individuals and health care professionals who treat and/or perform research on oral cleft and craniofacial conditions. Since 1943, ACPA has worked to optimize outcomes for individuals with oral cleft and craniofacial conditions through education, support, research, advocacy and interdisciplinary team care. ACPA also provides information to affected individuals and families and seeks to educate the public about facial differences through its ACPA Family Services program. For more information, please visit