A Systematic Review of Evidence for Education and Training Interventions in Microsurgery

Abstract

Over the past decade, driven by advances in educational theory and pressures for efficiency in the clinical environment, there has been a shift in surgical education and training towards enhanced simulation training. Microsurgery is a technical skill with a steep competency learning curve on which the clinical outcome greatly depends. This paper investigates the evidence for educational and training interventions of traditional microsurgical skills courses in order to establish the best evidence practice in education and training and curriculum design. A systematic review of MEDLINE, EMBASE, and PubMed databases was performed to identify randomized control trials looking at educational and training interventions that objectively improved microsurgical skill acquisition, and these were critically appraised using the BestBETs group methodology. The databases search yielded 1,148, 1,460, and 2,277 citations respectively. These were then further limited to randomized controlled trials from which abstract reviews reduced the number to 5 relevant randomised controlled clinical trials. The best evidence supported a laboratory based low fidelity model microsurgical skills curriculum. There was strong evidence that technical skills acquired on low fidelity models transfers to improved performance on higher fidelity human cadaver models and that self directed practice leads to improved technical performance. Although there is significant paucity in the literature to support current microsurgical education and training practices, simulated training on low fidelity models in microsurgery is an effective intervention that leads to acquisition of transferable skills and improved technical performance. Further research to identify educational interventions associated with accelerated skill acquisition is required.

Twelve tips for postgraduate or undergraduate medics building a basic microsurgery simulation training course

“…Directed feedback and evaluation in addition to selfassessment, can be undertaken during simulated training to help direct trainees, by identifying their weaknesses and strengths and thereby accelerate the learning curve (Sedlack & Kolars 2004). Using the appropriate simulation models, skills have been shown to be transferrable to human models and patients in the operating theatre, (Anastakis et al 1999;Sturm et al 2008;Ghanem et al 2013), however more robust studies are required to definitively prove this transferability.…”

Simulation learning in plastic surgery

“…The best evidence for a competency-based simulation training programme for plastic surgery supports a laboratorybased mixed-fidelity model programme -low fidelity (for basic skills) and high fidelity (for advanced skills) -that encourages and facilitates deliberate practice in a distributed fashion. 105,106 There is strong evidence that technical skills acquired on lowfidelity models transfer to improved performance on higher fidelity human cadaver models, and that self-directed deliberate practice leads to improved technical performance. Although there is significant paucity in the literature to support current plastic surgery education and training practices, the incorporation of regular simulated training on low-fidelity models in microsurgery provides an effective intervention that leads to acquisition of transferable skills and improved technical performance.…”

Response to comments by de Boer & Qiu on “Success of free flap anastomoses performed within the zone of trauma in acute lower limb reconstruction”

“…2 We challenge their spurious assertion that the ALT is now the workhorse in main microsurgical centers for traumatic cases as that is not our experience within the UK. We absolutely challenge the respondents' statement that the ALT offers minimal donor site morbidity.…”

“…3 Current microsurgical competency can be achieved with a hierarchy of skills acquisition, moving from simulated ex-vivo non-biological materials to biological simulation models with high fidelity. 2 Trainees' progress from structural technical skill acquisition, to living animal models in accordance with 3Rs principles and on to achieve physiologically acceptable outcomes.…”