Not long ago, people learning to perform trichiasis surgery practiced their cutting and suturing skills on oranges. From orange rinds, they went straight to live surgery.
With millions of people in Africa and Asia in need of trichiasis surgery to preserve their sight, Emily Gower, an epidemiologist and trachoma expert at the Wake Forest School of Medicine, knew there had to be a better way.
So Gower went to Jim Johnson, executive director of the Wake Forest Center for Applied Learning, who studies how adults learn new skills. As Johnson saw it, the budding trichiasis surgeons needed to practice on something more lifelike. The highly trained special-effects artists at Johnson’s company, Human Analogue Applications, got to work, using silicone and other substances to fashion the anatomical layers of the human eyelid.
The result was HEAD START, a brown-eyed, silicone mannequin that gazes patiently upward as students swath it in sterile drapes and cut into its orbicularis muscle, tarsal plate and conjunctiva. Crucial to the design are the dummy’s removable eyelids, which allow trainees to examine the precision of their work.
“You can take the eye cartridge out and see what the surgery looks like,” explains Gower. “Is the incision at the right height? Is it straight? Is it long enough? Are the sutures evenly spaced? Are they in the right layer of the eyelid?”
Experienced surgeons who tested HEAD START in 2014 were impressed. Even their own advanced skills were improved by operating on the mannequin, they said. Removing HEAD START’s eye cartridges and evaluating their handiwork, many of the surgeons “were surprised by the incompleteness of their incision, its angle or other aspects,” according to a May 2014 International Coalition for Trachoma Control position paper that endorsed the use of HEAD START as a standard procedure in trichiasis surgery training.