Bridging the gap between clinical knowledge and practical decision-making

What is the educational gap?

The educational gap is the distance between knowing the principles of wound care and making sound, practical decisions about a real wound. In particular, the integration of wound assessment, tissue handling, closure techniques, scar optimization, clinical judgment and appropriate referral may not always be taught as one structured, continuous process.

Each of those elements is taught somewhere: anatomy in one course, suturing in a workshop, wound healing in a lecture, referral criteria in a guideline. What is less often taught is how they connect at the moment of decision, in front of a patient, with a wound that is not a textbook one.

Which questions does a physician face?

A physician may know how to close a wound, yet still face a more complex set of questions:

• What should be done first?
• How should the tissues be handled?
• Should the wound be closed at all?
• What approach best protects function and future healing?
• When should intervention stop, and when should a specialist be involved?

None of these is answered by technique alone. Each is a decision, and decisions can be taught.

What does the evidence show?

The available evidence is limited but consistent in one direction: exposure to teaching on wounds and suturing varies widely, and confidence is often low.

In a cross-sectional study of 262 doctors in training in the United Kingdom, 64.5% (169 of 262) reported receiving teaching on wound healing during medical school, 18% during their Foundation training and 25% during postgraduate training (Duffaydar et al., 2025). Asked how they preferred to learn, 41% chose learning in the clinical workspace, 32% a blend of lectures and simulation, 19% simulation alone and 8% lectures only.

A systematic review of 22 studies on undergraduate medical students’ perceptions of plastic surgery, suturing and wound care, with a bias towards North American populations, found consistently low confidence in suturing; in one national survey it cites, only 13.5% of students (95 of 705) felt capable of suturing (Gupta et al., 2025). Repeated practice was among the factors associated with greater confidence.

The referral dimension has its own literature. Guidance on when to involve a plastic surgeon in wound care exists (Simman et al., 2023), which underlines that knowing when to stop is part of wound management, not an exception to it.

What does the evidence not show?

These studies measure the teaching that was received and the confidence that learners report. They do not measure patient outcomes, and none of them examines teaching on scar outcome specifically.

The observation that the path from closure to scar is rarely taught as a whole is therefore the Academy’s reading of how teaching is usually organized, informed by clinical and teaching experience. It is presented as a reasoned view, not as a data point, and the Academy’s own research is designed to test the educational response to it.

How does the Academy respond?

The Rafiee Wound-to-Scar™ Approach was developed to address this educational gap. It brings together clinical assessment, practical skills, patient safety and aesthetic awareness into a structured approach that considers the potential scar from the earliest stage of wound management.

In practice, that response takes two forms. The Rafiee Educational Approach organizes teaching into six phases, from assessment to follow-up, so that each decision is made explicit. The flagship program, Wound-to-Scar™, applies those phases to surgical wound management and scar optimization, and the teaching progression moves from knowledge and demonstration to simulation and supervised practice, the formats learners themselves say they prefer.

From treating the wound, to understanding the journey from wound to scar.