The Benefits of Expert Instruction in Microsurgery Courses

Abstract

Background Microsurgery requires repeated practice and training to achieve proficiency, and there are a variety of curriculums available. This study aims to determine the importance of an expert instructor to guide students through procedures. We compared student proficiency across two microsurgery courses: one with (Columbia University, United States [CU] cohort) and one without a dedicated microsurgery instructor (University of Thessaloniki, Greece [UT] cohort). Methods Students were divided into two cohorts of 22 students (UT cohort) and 25 students (CU cohort). Student progress was evaluated by examining patency (lift-up and milking tests), anastomotic timing, and quality (Anastomosis Lapse Index [ALI]) of end-to-end arterial and venous anastomoses on day 1 and again on day 5. Chi-squared tests evaluated patency immediately and 30 minutes postoperation. t-Tests evaluated anastomotic timing and ALI scores. p-Values < 0.05 were considered significant. Results We evaluated progress within and between each cohort. Within the CU cohort, the quality of the arterial and venous anastomosis improved, respectively (by 54%, p = 0.0059 and by 43%, p = 0.0027), the patency of both the arterial and venous anastomosis improved, respectively (by 44%, p = 0.0002 and by 40%, p = 0.0019), and timing of arterial and venous anastomosis reduced respectively (by 36%, p = 0.0002 and by 33%, p = 0.0010). The UT cohort improved the quality of their arterial anastomoses (by 29%, p = 0.0312). The UT cohort did not demonstrate significant improvement in the other above-mentioned parameters. The CU cohort improved materially over the UT cohort across categories of quality, patency, and timing. Conclusion There are clear benefits of an expert instructor when examining the rate of progress and proficiency level attained at the conclusion of the course. We suggest students who are seeking to maximize proficiency in microsurgical procedures enroll in courses with an expert instructor.

Superiority of living animal models in microsurgical training: beyond technical expertise

“…Advanced training exercises can be performed by trainees in rabbits, such as interposition vein graft [35], bypass graft, free tissue transfer (e.g., groin flap), and auricular transplantation. Apart from building technical skills faster and more efficiently under the guidance of an expert instructor [36], the presence of an experienced teacher during the execution of these exercises is fundamental in acquiring communication, teamwork, and decision-making skills.…”

“…By working in isolation with artificial specimens, the trainee is unlikely to receive immediate feedback from an instructor, which would be deemed invaluable in building better microsurgical skills [36]. In contrast, residents are being monitored from real-time video projectors and assessed with hand motion analysis technology through sophisticated computer software [16,[98][99][100][101].…”

Microsurgical education in Greece: past, present, and future

“…The integration of these skills in the microsurgical curricula is a work in progress [41]. Last but not least, studies show that expert instruction is pivotal in achieving timely and significant progress in microsurgical courses compared to courses which do not have a designated instructor [42].…”

Microsurgical education in the USA: Past, present and future

“…A teleconferencing software is used to connect an expert instructor with a student live. This does allow for all training and communications to happen online yet does not take away expert instruction; it has been previously noted that there are clear benefits in both progress and proficiency to receiving microsurgical training from an expert instructor [7].…”