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Background Microsurgery depends largely on simulated training to acquire skills. Courses offered worldwide are usually short and intensive and depend on a physical laboratory. Our objective was to develop and validate a portable, low-cost microsurgery training kit. Methods We modified a miniature microscope. Twenty general surgery residents were selected and divided into two groups: (1) home-based training with the portable microscope (MicrosimUC, n = 10) and (2) the traditional validated microsurgery course at our laboratory (MicroLab, n = 10). Before the intervention, they were assessed making an end-to-end anastomosis in a chicken wing artery. Then, each member of the MicrosimUC group took a portable kit for remote skill training and completed an eight-session curriculum. The laboratory group was trained at the laboratory. After completion of training, they were all reassessed. Pre- and posttraining procedures were recorded and rated by two blind experts using time, basic, and specific scales. Wilcoxon's and Mann–Whitney tests were used to compare scores. The model was tested by experts (n = 10) and a survey was applied to evaluate face and content validity. Results MicrosimUC residents significantly improved their median performance scores after completion of training (p < 0.05), with no significant differences compared with the MicroLab group. The model was rated very useful for acquiring skills with 100% of experts considering it for training. Each kit had a cost of U.S. $92, excluding shipping expenses. Conclusion We developed a low-cost, portable microsurgical training kit and curriculum with significant acquisition of skills in a group of residents, comparable to a formal microsurgery course.

The COVID-19 pandemic has had an unprecedented impact on the delivery of healthcare services around the globe. This has resulted in important loss of life for our communities, including health professionals that have been exposed to the disease in their workplace. A human factors approach to the recent changes introduced due to the pandemic can help identify how we can minimize the impact of human error in these circumstances. We hereby present a case study illustrating the application of human factors in the difficult times we are going through at present. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective: Health services in Latin America have witnessed continuous expansion, improving access for patients requiring treatment for trauma and cancer. However, while demand for complex reconstruction is on the rise, the number of trained microsurgeons remains limited. The aim of this study is to investigate current experiences of plastic surgery residents with regard to microsurgery. It also aims to find out ways through which the number of trained microsurgeons in the region can be increased for better medical care. Methods:A cross-sectional survey was designed to obtain information regarding the exposure and training that plastic surgery residents receive during residency in Latin American countries. We ensured that our procedure followed the data protection rules laid down in the General Data Protection Regulation (GDPR). Results:We requested 129 microsurgeons in Latin American countries to respond to our survey questions. A total of 93 survey responses were received, corresponding to a response rate of 72.1%. An analysis of the survey data showed that in terms of hands-on microsurgical training, 79.6% of the respondents had previous experience of being involved in performing a microsurgical procedure. However, 59.1% of the respondents mentioned that this was part of their formal training program. The majority of respondents (74%) reported that they would not be confident in performing a microsurgical procedure unsupervised. About half, or 48.4% of the respondents said that they would consider applying for a microsurgery fellowship. However, only 63.4% reported that they had access to a fellowship program in their home country. Conclusion:Few resident plastic surgeons in Latin America are able to attain the required level of experience so as to feel comfortable acting as independent microsurgeons. Both time and effort are required to address this problem. A powerful tool to change this situation is to gain access to international microsurgical fellowships. An influx of returning trained microsurgeons can provide two benefits: (a) increasing the caseload in the short run, and (b) improving the training of plastic surgeons for future generations of doctors.

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