Defining Standards in Experimental Microsurgical Training: Recommendations of the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM)

Abstract

Background: Expectations towards surgeons in modern surgical practice are extremely high with minimal complication rates and maximal patient safety as paramount objectives. Both of these aims are highly dependent on individual technical skills that require sustained, focused, and efficient training outside the clinical environment. At the same time, there is an increasing moral and ethical pressure to reduce the use of animals in research and training, which has fundamentally changed the practice of microsurgical training and research. Various animal models were introduced and widely used during the mid-20th century, the pioneering era of experimental microsurgery. Since then, high numbers of ex vivo training concepts and quality control measures have been proposed, all aiming to reduce the number of animals without compromising quality and outcome of training. Summary: Numerous microsurgical training courses are available worldwide, but there is no general agreement concerning the standardization of microsurgical training. The major aim of this literature review and recommendation is to give an overview of various aspects of microsurgical training. We introduce here the findings of a previous survey-based analysis of microsurgical courses within our network. Basic principles behind microsurgical training (3Rs, good laboratory practice, 3Cs), considerations around various microsurgical training models, as well as several skill assessment tools are discussed. Recommendations are formulated following intense discussions within the European Society for Surgical Research (ESSR) and the International Society for Experimental Microsurgery (ISEM), based on scientific literature as well as on several decades of experience in the field of experimental (micro)surgery and preclinical research, represented by the contributing authors. Key Messages: Although ex vivo models are crucial for the replacement and reduction of live animal use, living animals are still indispensable at every level of training which aims at more than just a basic introduction to microsurgical techniques. Modern, competency-based microsurgical training is multi-level, implementing different objective assessment tools as outcome measures. A clear consensus on fundamental principles of microsurgical training and more active international collaboration for the sake of standardization are urgently needed.

Current status of simulation and training models in microsurgery: A systematic review

“…It is therefore important that future randomized control trials of good sample size are conducted to validate the already existing models. Although many training programs for microsurgical training are available worldwide, there is a lack of agreement regarding the standardization of microsurgical training (Tolba et al, ). Future work should therefore look into taking active steps to improve international collaboration in order to come up with a standardized prograe for fundamental principles of microsurgical training.…”

Objective Assessment of Microsurgery Competency—In Search of a Validated Tool

“…We believe that the acceptance and validation of such an assessment in all teaching units will be the first step towards global standardization of training and development of a uniform curriculum for microsurgery education. 38 39 40 This study is even more relevant considering the changing trends of medical education in India. Fig.…”

Experiences with basic microsurgical training programs and skill assessment methods at the University of Debrecen, Hungary

“…Perhaps most of the standardization protocols, publications, comparative analyses mainly focus on the clinical microsurgical skills. Regarding various organ and tissue transplantation models in rodents and considering the quality and the time factor, in the field of experimental microsurgery, certain milestones fall within different assessment and quite different dimension [28][29][30] .…”