How to become a good surgeon

A Microsurgical Skills Curriculum to Develop Unconscious Competence

“…In microsurgery, it is similarly essential to rehearse foundational skills to the point of unconscious competence to consistently achieve a successful clinical outcome despite the stress and fatigue involved with complex microsurgical reconstructions. 14,23,24 Most existing microsurgical skills curricula emphasize simulated anastomoses and some form of timed trial assessments. These curricula fail to develop unconscious competence for several reasons.…”

“…Numerous microsurgical skills curricula and assessment tools have been described in the literature. [2][3][4][5][6][7][8][9][10][11][12][13][14] Most of these curricula focus on performing simulated microsurgical anastomoses in a variety of synthetic or biological models (i.e., silastic tubes or chicken thighs). 13 However, there are no published curricula that utilize deliberate calisthenic exercises to improve intrinsic muscle strength or accuracy and precision of movement under the microscope.…”

“…[3][4][5][6][7][8][9] With a variety of assessment tools evaluating trainees based on intermittent surveys or time trials, the importance of supervised practice and real-time feedback from expert microsurgeons has become largely obsolete. 14 For plastic surgery trainees to develop proficiency in microsurgery, microsurgical curricula should focus on helping the learner achieve unconscious competence (►Fig. 1).…”

“…[16][17][18][19][20][21][22] Thus, plastic surgery trainees must develop unconscious habits to overcome the challenges of microsurgery and maintain proficiency in dynamic and challenging surgical scenarios. 14,23,24 The microsurgical skills curriculum described in this article was specifically designed to teach trainees the technical skills required to perform microsurgical procedures with unconscious competence. The curriculum includes 10 calisthenic exercises designed to improve intrinsic muscle strength as well as accuracy and precision of movement.…”

“…3 4 5 6 7 8 9 With a variety of assessment tools evaluating trainees based on intermittent surveys or time trials, the importance of supervised practice and real-time feedback from expert microsurgeons has become largely obsolete. 14…”