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IU surgeon leads innovative app to train remote physicians in cleft palate repair

Mar. 6, 2014

Roberto Flores, M.D., assistant professor of surgery at the IU School of Medicine and medical director for cleft and craniofacial anomalies at Riley Hospital for Children at IU Health, has spent years helping Hoosier children born with challenging physical conditions. 

Roberto Flores

Roberto Flores, M.D., demonstrates Smile Train's Virtual Training Simulator. | PHOTO COURTESY OF SMILE TRAIN

But with thousands of new cases of cleft palates across the globe every year, it's a difficult reality that patients' needs far outweigh the number of surgeons skilled at repairing the condition. It was in recognition of this fact that Dr. Flores agreed to partner with Smile Train, a New York City-based nonprofit that is the world's largest cleft lip and palate repair nonprofit.

The group's mission isn't to send doctors overseas to perform pediatric cleft lip and palate surgery, but rather to provide training to physicians in the developing world.

"There are countless benefits of this type of 'mission trip,'" Dr. Flores said. “Smile Train's approach allows you to empower regional communities to the point where they become less dependent on others; it is less costly in the long-run; and, ultimately, those who were once students will become teachers, allowing a continuum of learning to occur throughout these developing nations."

It's a sustainable approach absent in similar nonprofit organizations, and one that is much more far-reaching than traditional mission trips to provide medical treatment, he said.

His role at Smile Train is medical director of the Virtual Surgery Simulator, a free, Web-based, 3-D interactive surgical explorer that educates doctors in cleft lip and palate repair. He was tapped for the position by Court Cutting, M.D., who served as Dr. Flores' mentor at the New York University School of Medicine, where he first developed an interest in craniofacial surgery.

"This simulator will change the way surgeons will be trained in cleft lip and palate around the world," Dr. Flores said. "It's already gone above and beyond what other individuals have done within the practice of surgery education. It requires no special hardware for use, and practically anyone can use it as long as they have access to the Internet."

Tracking data shows the program has quickly grown into one of the most popular surgery simulators in the world, he added. Countries using the simulator include Honduras, Nepal, Egypt, Iraq and other areas too remote or dangerous for many doctors to travel.

Smile Train's philosophy could be summed up with the Chinese proverb, "Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime," said Dr. Flores, who also contributes to the group by grading Smile Train-educated physicians' performances based upon photos of their surgeries, as well as other information, after which he offers recommendations and advice to improve their techniques.

The next step in the Virtual Surgery Simulator's development is creating an app version that allows surgeons to use the program on their tablet or smartphone, a project under development in partnership between Smile Train and BioDigital Inc., also a New York City-based company, which specializes in the creation of 3-D animation and virtual training environments.

"In developing nations, it can actually be more difficult to access a textbook than the Internet," Dr. Flores said. "Increasing access to the surgery simulator via mobile app will boost its global reach and help children in need live a higher quality of life. It's my firm belief that remote, app-based education will be the future of surgical training."

At the IU School of Medicine, Dr. Flores also serves as the director of the craniofacial surgery fellowship program, where fellows and residents have watched him perform many difficult surgeries at Riley. Among his most challenging cases recently is a 3-year-old boy with an extremely rare form of cleft palate, in which the eyes and other facial structures did not form properly. The boy's story, and resilience, has garnered local and national media coverage, as well as loyal followers on social media.

"I believe the face is where the soul exists; when we think of someone, we think of their face, not any other part of their body," Dr. Flores said. "When one’s face is disfigured, it has a very deep effect on their psyche, so helping repair an individual’s face is an enormous responsibility. Hopefully those patients whom I have served have gone into society feeling as though they are part of society, not just a specimen within society."

In his role as a physician and an educator, Dr. Flores aims to teach the importance of affecting individuals’ lives each and every day.

"Every time I perform a surgery, I hope there is someone learning from it," he said. "Every time I operate, I hope that I'm fulfilling a greater purpose."

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