How do we assess microsurgical skill?

Kalu, Peter U.; Atkins, Joanne; Baker, DM; Green, Colin J.; Butler, Peter E. M.

doi:10.1002/micr.20078

Cited by 54 publications

(73 citation statements)

References 21 publications

(18 reference statements)

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“…However, the assessment needs to be done by a senior member and may be time-consuming. [7][8][9][10][11] There are several instructional microsurgery courses worldwide. 5,6,[12][13][14] Attendance at these courses has become a popular method to acquire practical skill and does improve the microsurgical skills within a short time period in most trainees.…”

Section: Training Systemsmentioning

confidence: 99%

Validation of microsurgical models in microsurgery training and competence: A review

2007

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Section: Training Systemsmentioning

confidence: 99%

Validation of microsurgical models in microsurgery training and competence: A review

2007

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“…However, this approach has a poor validity; it is merely subjective and assessor dependent as well as time consuming [46]. Satterwhite et al [47] used a self-evaluation tool, where trainees had to assess their own confidence in performing microsurgical anastomoses.…”

Section: Assessment Tools and Clinical Translation Of Microsurgical Smentioning

confidence: 99%

“…Surgeons usually proceed with a certain task in a synthesizing manner and cannot stick to the rigid construct of a checklist [1]. Furthermore, checklists usually do not have any internal weighting for the different steps of a procedure and only use a binary system (procedure performed or not, correctly or incorrectly) [1, 46, 54]. …”

Section: Assessment Tools and Clinical Translation Of Microsurgical Smentioning

confidence: 99%

“…GRSs were initially developed for general surgical procedure but they were later adapted for microsurgery and modified by several authors [1, 35, 46, 55-57] (Table 2). These tools are making the parallel assessment of various details – believed to determine microsurgical outcome – possible (respect for tissue handling, time, flow of surgery, dexterity).…”

Section: Assessment Tools and Clinical Translation Of Microsurgical Smentioning

confidence: 99%

“…Various assessment tools – most of which were developed for general surgery training – were modified to adapt to the special demands of microsurgical training [1, 35, 46]. …”

Section: Assessment Tools and Clinical Translation Of Microsurgical Smentioning

confidence: 99%

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

et al. 2017

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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.

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Forces of Tool-Tissue Interaction to Assess Surgical Skill Level

et al. 2018

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IMPORTANCE The application of optimal forces between surgical instruments and tissue is fundamental to surgical performance and learning. To date, this force has not been measured clinically during the performance of microsurgery. OBJECTIVES To establish a normative catalog of force profiles during the performance of surgery, to compare force variables among surgeons with different skill levels, and to evaluate whether such a force-based metric determines or differentiates skill level. DESIGN, SETTING, AND PARTICIPANTS Through installation of strain gauge sensors, a force-sensing bipolar forceps was developed, and force data were obtained from predetermined surgical tasks at the Foothills Medical Centre, University of Calgary, a tertiary care center that serves Southern Alberta, Canada. Sixteen neurosurgeons (3 groups: novice, intermediate, and experienced) performed surgery on 26 neurosurgical patients with various conditions. Normative baseline force ranges were obtained using the force profiles (mean and maximum forces and force variability) from the experienced surgeons. Standardized force profiles and force errors (high force error [HFE], low force error [LFE], and force variability error [FVE]) were analyzed and compared among surgeons with different skill levels. MAIN OUTCOMES AND MEASURES Each trial of the forceps use was termed successful or unsuccessful. The force profiles and force errors were analyzed and compared. RESULTS This study included 26 patients (10 [38%] male and 16 [62%] female; mean [SD] age, 43 [15] years) undergoing neurosurgery by 16 surgeons (6 in the novice group, 5 in the intermediate group, and 5 in the experienced group). Unsuccessful trial-incomplete significantly correlated with LFE and FVE, and unsuccessful trial-bleeding correlated with HFE and FVE. The force strengths exerted by novice surgeons were significantly higher than those of experienced surgeons (0.74 vs 0.00; P < .001), and force variability decreased from novice (0.43) to intermediate (0.28) to experienced (0.00) surgeons; however, these differences varied among surgical tasks. The rate of HFE and FVE inversely correlated with surgeon level of experience (HFE, 0.27 for novice surgeons, 0.12 for intermediate surgeons, and 0.05 for experienced surgeons; FVE, 0.16 for novice surgeons, 0.10 for intermediate surgeons, and 0.05 for experienced surgeons). The rate of LFE significantly increased in intermediate (0.12) and novice (0.10) surgeons compared with experienced surgeons (0.04; P < .001). There was no difference in LFE between intermediate and novice surgeons. Stepwise discriminant analysis revealed that combined use of these error rates could accurately discriminate the groups (87.5%). CONCLUSIONS AND RELEVANCE Force-sensing bipolar forceps and force analysis may help distinguish surgeon skill level, which is particularly important as surgical education shifts to a competency-based paradigm.

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How do we assess microsurgical skill?

Cited by 54 publications

References 21 publications

Validation of microsurgical models in microsurgery training and competence: A review

Validation of microsurgical models in microsurgery training and competence: A review

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

Forces of Tool-Tissue Interaction to Assess Surgical Skill Level

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