Page 54 - Read Online

Page 2 of 9 Lee et al. Plast Aesthet Res 2022;9:46 https://dx.doi.org/10.20517/2347-9264.2022.11

computer-based and virtual reality platforms facilitate integration into any existing medical school curricula.
Ultimately, this immersive technology enables every medical student to learn about the peripheral nervous system
and gain competency in treating real-life nerve pathologies.

Keywords: Virtual reality, peripheral nervous system, nerve, surgical education, medical education, simulation,
plastic surgery

INTRODUCTION
The problem in healthcare
Peripheral nerve injuries (PNI) currently affect more than one million people worldwide, and the
occurrence of trauma-induced PNI is steadily on the rise . In addition to trauma-based PNI, disease-
[1,2]
induced peripheral nerve disorders such as diabetic neuropathy are increasingly common with the rising
prevalence of obesity and diabetes . Over half of people with diabetic neuropathy in the United States
[3-5]
present with upper and lower extremity nerve compressions . Additionally, iatrogenic injuries frequently
[6]
occur through surgical procedures, such as hernia repair , total knee replacement , and episiotomy ,
[10]
[11]
[7-9]
with many patients reporting chronic pain due to neuromas of surgically transected nerves. These injuries
are notoriously devastating and life-altering as patients can face severe lifelong disabilities, including
sensory loss, motor loss, and neuropathic pain [2,12-14] . Despite advancements in microsurgical techniques and
basic and translational research, traditional treatments for nerve repair continue to have unsatisfactory
clinical outcomes [2,13] . Among the many factors that influence peripheral nerve injury prognosis - including
age and co-morbidities - the amount of time that elapses prior to end-organ reinnervation is perhaps the
most consequential [13-17] . The importance of time is evidenced by the poor outcomes that tend to occur with
proximal nerve injuries and delayed repairs. Therefore, education of medical students about the urgency of
injury identification and referral to a peripheral nerve surgeon in a timely manner is most important.

Patients are faced with numerous barriers to care, including a lack of awareness of the signs and symptoms
[18]
of common nerve injuries . Furthermore, upon reaching a diagnosis, patients face barriers in finding a
surgeon to care for their injury . In 2017, over 40% of counties in the U.S. had zero surgeons per 100,000
[19]
[20]
population . Additionally, access to surgeons trained in peripheral nerves, such as neurosurgeons, plastic
surgeons, and hand surgeons, is even more limited, and consequently, injured patients may suffer from
chronic pain and misdiagnoses.

The problem in medical education
Inaccessibility to peripheral nerve surgery is compounded by the lack of peripheral nerve training within the
medical education system; much of the nervous system curriculum content focuses on the central nervous
system and special senses. Medical students typically only gain brief exposure to the peripheral nervous
system (PNS) through anatomy dissections and elective clerkships, despite the wide-stretched reach of this
field. Consequently, this lack of knowledge leads to a gap in clinical skills related to gathering relevant,
patient-centered, hypothesis-driven history, and physical examination data in the clinical setting. Therefore,
it is imperative that medical students gain a thorough knowledge of how to identify and treat peripheral
nerve disorders. For example, a simple clinical physical examination technique may be taught for the upper
extremity carpal tunnel syndrome, but seems never to be taught for the nerve compression at the medial
ankle, the tarsal tunnel syndrome, for which a positive Tinel sign has an 80% positive predictive value of
successful nerve decompression .
[21]