Towards a Global Understanding and Standardisation of Education and Training in Microsurgery

Abstract

With an increasing emphasis on microsurgery skill acquisition through simulated training, the need has been identified for standardised training programmes in microsurgery. We have reviewed microsurgery training courses available across the six continents of the World. Data was collected of relevant published output from PubMed, MEDLINE (Ovid), and EMBASE (Ovid) searches, and from information available on the Internet of up to six established microsurgery course from each of the six continents of the World. Fellowships and courses that concentrate on flap harvesting rather than microsurgical techniques were excluded. We identified 27 centres offering 39 courses. Total course length ranged from 20 hours to 1,950 hours. Student-to-teacher ratios ranged from 2:1 to 8:1. Only two-thirds of courses offered in-vivo animal models. Instructions in microvascular end-to-end and end-to-side anastomoses were common, but peripheral nerve repair or free groin flap transfer were not consistently offered. Methods of assessment ranged from no formal assessment, where an instructor monitored and gave instant feedback, through immediate assessment of patency and critique on quality of repair, to delayed re-assessment of patency after a 12 to 24 hours period. Globally, training in microsurgery is heterogeneous, with variations primarily due to resource and regulation of animal experimentation. Despite some merit to diversity in curricula, there should be a global minimum standard for microsurgery training.

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

“…The added value, vocation and attitude of the tutors, prestige of the department and university, and special skills obtained altogether result in a quantitatively hardly measurable value that makes these courses engaging and keeps them alive. Although this survey was only a cross-section of our training for the given time within our peers in the ISEM, the abovementioned findings correlate well with the international literature [36-42]. …”

“…This was concluded by several groups after performing analyses on microsurgical courses on national or international levels [36-42]. Similarly, it has already been declared by several groups that an ideal training tool or concept does not exist.…”

“…The choice concerning the use of well-established traditional training models should stay in the hands of the training centers. Despite leaving this freedom to the training centers, there is an increasing need for standardization of skill assessment in surgical training [36]. …”

“…Microsurgery training is an essential part of surgical training programs for numerous specialties (e.g., hand surgeons, orthopedics, plastic surgeons, ENT specialists, ophthalmologists, experimental researchers) [32, 36]. The most important question is whether or not previous training on prosthetic models or living animals can really improve clinical surgical skills.…”

“…Leung et al [36] reviewed 39 different microsurgical courses offered worldwide. They reported that 75% (18/24) of the basic microsurgical courses did not include any evaluation method to test surgical performance and improvement.…”