The learning design of the virtual simulation application, partnered with a physical simulator, is a perfect conduit to evaluate a learner’s clinical competency.

Learning Theory[edit | edit source]

Our system divides learning into four hierarchical processes that mirror Miller's pyramid: knowledge, application of knowledge, clinical skills competency, and clinical performance. This instructional design methodology is echoed across all four modules and was chosen for its flexibility. Our theory utilizes a strong instructional design methodology, with adult learning theories that will yield a positive clinical competency output through ubiquitous learning. The creation of both virtual and physical simulators provides a lifelike example of a clinical encounter where a novice learner can make mistakes and learn from past experiences without endangering patients. Each module course begins with an MCQ section with a threshold of 80% for passing (knowledge), a virtual simulation (application of knowledge), post-evaluations with self-directed feedback (clinical skills), and the final physical simulator (clinical performance).

Objective: Design a V-Y advancement to fill a circular defect with a 3cm diameter.

Instructions: Using the AmoSmile app, follow the guided physical simulation to achieve the above objective. Stepwise self-assessment questions are integrated into the app to provide a performance feedback loop towards mastery learning. After completion of the simulation, your score will be displayed alongside customized guidance for targeted review. All questions must be answered correctly in order to earn a Certificate of Completion.

Step 1: Set-up

Set-up your physical simulator (assembly instructions) and mark a circular skin and soft tissue defect with a 3cm diameter.

Step 2: Design

Tailor the defect into a rectangular configuration and mark its longest dimension, w. Draw a line, v, perpendicular to and bisecting w. Mark the V-apex of the flap along v. Place the V-apex closer to the defect to generate a smaller V-apex angle and accordingly a shorter flap with wider donor defect. Place the V-apex further from the defect to generate a larger V-apex angle and accordingly a longer flap with narrower donor defect.

Step 3: Incision

Incise your markings through epidermis, dermis, and into subcutaneous tissue

Step 4: Elevation

Elevate the skin adjacent to the flap and the defect so as to facilitate flap inset and donor site closure. Take care NOT to elevate the triangular flap itself so as to preserve its connection with the underlying blood supply

Step 5: Transposition

Advance the triangular flap into the adjacent defect and secure in place with two apical simple interrupted sutures

Step 6: Inset

Place a 3-point buried horizontal mattress suture to approximate the donor site at the V-apex, thereby generating the Y-limb

Step 7: Closure

Complete the remainder of the closure using simple interrupted sutures


We have developed a mobile app that guides learners through an entire curriculum, including step-by-step simulations and dynamic, customized training with competency tracking. Our physical simulator is low-cost, easily assembled, and entirely locally sourced, with the ability to simulate key steps of the procedure in a manner that is self-directed, accessible, and clinically translatable. The application has been revamped several times to enhance UI/UX components and truly deliver a self-directed learning experience by adding 360 feedback to the assessment sections to direct the learner back to sections that need more review. The physical simulator has reduced overall build cost by 62.5% using only locally sourced materials. Further, we have added several layers to the “skin,” which mimic the true epidermic layers, and a cured tube to improve the “skin” tension.

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