Play-Mohs: Using modeling clay to teach repairs following Mohs micrographic surgery.

To the Editor: Active learning is broadly defined as instructional strategies that engage students in the learning process; it has been shown to have many benefits over passive learning., Simulations, a form of active learning, can allow trainees to become more confident and proficient in their skills. Several substrates have been used for dermatologic simulations, including fruits, chicken skin, and pork belly. Shive et al used colored modeling clay such as Play-Doh (Hasbro, Inc) to explain tissue processing, margins, sectioning, and planes of examination in Mohs micrographic surgery.

Repair techniques following Mohs micrographic surgery can be an intimidating subject for dermatology residents to comprehend and master. We present an innovative learning activity involving Play-Doh, aimed at teaching residents with a hands-on, reproducible simulation to practice repairs of surgical defects.

In July 2021, dermatology residents (post-graduate year-2 to post-graduate year-4) participated in our activity. The objectives were to review the types of repairs and flaps, discuss their design and movement, and then recreate the flaps using Play-Doh. Photographic examples of the steps of a repair method were presented. The participants would then replicate the steps using Play-Doh and scalpels to create a hands-on visualization of the repair design and movement (Fig 1). The residents were able to repeat each flap multiple times. Voluntary surveys were administered before and after the activity (n = 9, 100% response rate). Preactivity questions evaluated experience with Mohs micrographic surgery, repairs, and flaps. Postactivity questions assessed the knowledge of flaps and resident satisfaction with the activity. The responses were recorded using a 5-point Likert scale.

Fig 1

The use of Play-Doh to show (A) the defect and drawing of a rhombic flap and (B) the finished product after manipulation of the flap.

All residents agreed or strongly agreed that they preferred active, hands-on learning methods to passive methods such as reading and lectures. The mean participant-reported knowledge of advancement, rotational, and transposition flaps increased by 0.84 Likert scale points from presurvey to postsurvey. The observed increase was greater for the first- and second-year residents, with a mean increase of 1.0 Likert scale point. All participants agreed or strongly agreed that the activity was a good educational experience with the statements “I have a greater understanding of flaps and Mohs repairs after this activity” and “I feel more confident in planning and performing Mohs repairs after this activity.”

The limitations of our study included a small number of participants (n = 9). Despite being an active learning activity, 1 resident noted that an assigned prereading may have been helpful. We plan to incorporate this in the future years to strengthen the utility of this experience. Although Play-Doh allowed for a hands-on approach of recreating flaps, we realize that it is limited in its ability to mimic the topographical differences in challenging locations often encountered in Mohs repairs. In addition, it does not allow residents to practice suturing. Future considerations include grouping this simulation with other active learning activities currently employed in the resident curriculum, such as the use of pork belly to practice suture techniques. With its low cost, no requirement of additional specialized faculty training, and ample opportunity for residents to practice in a short amount of time, we believe that this is a simple, yet effective active learning simulation.

Conflict of interest

None disclosed.