Validated specialty‐specific models for multi‐disciplinary microsurgery training laboratories: a systematic review

Crouch, Gareth; Wong, Gerald L.; Hong, Jonathan; Varey, Alexander H. R.; Haddad, Roger; Wang, Zane Zhanxiang; Wykes, James; Koutalistras, N.; Clark, Jonathan; Solomon, Michael J.; Bannon, Paul G.; McBride, Kate E.; Ch’ng, Sydney

doi:10.1111/ans.16721

Cited by 5 publications

(5 citation statements)

References 34 publications

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“…For Crouch et al the objectives intended with the simulation are divided into four non-exclusive domains 25 , which are: • Use of specific equipment; • Performance of certain manual movements; • Recognition and familiarity with anatomical locations; • Replication of a surgical procedure in its entirety. This author identified in his study that most low-fidelity simulators described in the literature cover at least two of these domains, ensuring the gain of expertise in microsurgery at basic and intermediate levels 25 . In our understanding, we argue that this expertise in microsurgery was achieved by the study participants.…”

Section: Discussionmentioning

confidence: 99%

Low-fidelity simulation models in urology resident’s microsurgery training

Pinto,

Silva,

Bentes

et al. 2023

Acta Cir. Bras.

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To evaluate the gain of microsurgical skills and competencies by urology residents, using low-fidelity experimental models. Methods: The study involved the use of training boards, together with a low-fidelity microsurgery simulator, developed using a 3D printer. The model consists in two silicone tubes, coated with a resin, measuring 10 cm in length and with internal and external diameters of 0.5 and 1.5 mm. The support for the ducts is composed by a small box, developed with polylactic acid. The evaluation of the gain of skills and competencies in microsurgery occurred throughout a training course consisting of five training sessions. The first sessions (S1-S4) took place at weekly intervals and the last session (S5) was performed three months after S4.During sessions, were analyzed: the speed of performing microsurgical sutures in the pre and post-training and the performance of each resident through the Objective Structure Assessment of Technical Skill (OSATS) and Student Satisfaction Self-Confidence tools in Learning (SSSCL). Results: There was a decrease in the time needed to perform the anastomosis (p=0.0019), as well as a progressive increase in the score in the OSATS over during sessions S1 to S4. At S5, there was a slightly decrease in performance (p<0.0001), however, remaining within the expected plateau for the gain of skills and competences. The SSSCL satisfaction scale showed an overall approval rating of 96.9%, with a Cronback alpha coefficient of 83%. Conclusion: The low-fidelity simulation was able to guarantee urology residents a solid gain in skills and competencies in microsurgery.

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Section: Discussionmentioning

confidence: 99%

Low-fidelity simulation models in urology resident’s microsurgery training

Pinto,

Silva,

Bentes

et al. 2023

Acta Cir. Bras.

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“…Current microsurgical simulation and curricula predominantly 3 4 15 evaluate one aspect: technical performance, including assessment with lower fidelity models on synthetic and ex-vivo tissue, tracking and showing progression with objective assessment tools. 16 17 One study 18 perfused an ex-vivo chicken model with “blue blood” indocyanine green (ICG) fluorescence dye and experts assessed the patency of the vessel, this provides a high-fidelity model without the use of a live animal.…”

Section: Discussionmentioning

confidence: 99%

“…The traditional Halstedian model of training in surgery is inadequate, and it is imperative to find ways to shorten the curve otherwise potentially posing a serious safety risk for patients. [1][2][3] To address this educational need, microsurgery training curricula have been developed and validated for competency in microsurgical techniques. A systematic review highlighted the importance of simulation models in microsurgery training, concluding that high-fidelity models such as live animals appear to be the gold standard for simulation training, although called upon higher quality validation studies to achieve higher levels of evidence.…”

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confidence: 99%

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Evaluation of a Microsurgery Training Curriculum

Cuteanu

Hellich

Cardinal

et al. 2022

J Reconstr Microsurg

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Background Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, the majority focus on technical skill only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model. Methods A training curriculum was delivered over 5 days between 2017 to 2020 focusing on: 1) microscopic field manipulation, 2) knot tying, non-dominant hand usage, 3) 3D models/anastomosis, 4) tissue experience. The four levels of Kirkpatrick's evaluation model were applied:1) participants feedback 2) skills development using a validated, objective assessment tool (GAS form) and CUSUM charts were constructed to model proficiency gain 3) and 4) assessing skill retention/long-term impact. Results 155 participants undertook the curriculum, totalling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for 'good'. Unanimous agreement among the learners that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1—3 (median score 4) and days 4—5 (median score 5) (W = 494.5, p = 0.00170). The frequency of errors reduced with successive attempts (Chi-sq = 9.81, p = 0.00174). The steepest learning curve was in anastomosis and patency domains, requiring eleven attempts on average to reach proficiency. 88.5% survey respondents could apply the skills learnt and 76.9% applied the skills learnt within 6 months. Key areas of improvement were identified from this evaluation and actions to address them were implemented in following programmes. Conclusions Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows identification of areas of improvement, driving refinement of training programmes.

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“…Validation was evaluated by three reviewers (O.J.M., P.C., and J.M.E.) using the definitions as detailed by Crouch et al 24 ( See Table, Supplemental Digital Content 2 , which shows definitions applied to evaluate validity of models, http://links.lww.com/PRS/F766. )…”

Section: Methodsmentioning

confidence: 99%

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

Escandón

Ciudad²,

Poore

et al. 2022

Plastic &Amp; Reconstructive Surgery

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ince first described, supermicrosurgery has been broadly accepted and implemented because of a superior and widespread knowledge of the anatomy of perforators and of lymphatic surgery. [1][2][3][4] In fact, the technical considerations and applications of supermicrosurgery are currently incorporated in different fields Background: Supermicrosurgical simulators and experimental models promote test viability, a faster learning curve, technical innovations, and improvements of the surgical dexterities. The authors aimed to present a systematic review and meta-analysis of preclinical experimental models and simulation platforms used for supermicrosurgery. Methods: An electronic search was conducted across the PubMed MEDLINE, Embase, Web of Science, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data collection included the types of experimental models and outcomes. Pooled estimates were calculated with a random-effect meta-analysis using the DerSimonian-Laird model. Results: Thirty-eight articles were incorporated in the qualitative synthesis. Twenty-three articles reported the use of in vivo models (60.5%), 12 used ex vivo models (31.5%), and three used synthetic models (7.9%). The superficial inferior epigastric system of rats was the most common in vivo model, whereas chicken wings and hindlimbs were the most common methods used in ex vivo models. The most common methods to evaluate patency of anastomoses were gross inspection, passage of nylon thread into the lumen, and intravascular flow of an injected dye. Nineteen studies were incorporated in the meta-analysis. The overall rate of a successful anastomosis was 94.9% (95% CI, 92.3 to 97.5%). The success rate of in vivo models using rats was 92.5% (95% CI, 88.8 to 96.3%). The success rate of ex vivo models was 97.7% (95% CI, 94.6 to >99%). Conclusion: Simulators that have high fidelity concerning the dissection of the vascular pedicle, flap elevation, supermicrovascular anastomosis, and adequate assessment of a successful anastomosis possess adequate predictive validation to evaluate and simulate the supermicrosurgical technique. (Plast. Reconstr. Surg. 151: 775e, 2023) Clinical Relevance Statement: Supermicrosurgical simulators are designed to reproduce specific clinical scenarios; therefore, these should be implemented sequentially to develop specific competencies. Supermicrosurgical models must be regarded as mutually inclusive learning platforms to optimize the learning curve.

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Validated specialty‐specific models for multi‐disciplinary microsurgery training laboratories: a systematic review

Cited by 5 publications

References 34 publications

Low-fidelity simulation models in urology resident’s microsurgery training

Low-fidelity simulation models in urology resident’s microsurgery training

Evaluation of a Microsurgery Training Curriculum

Experimental Models and Practical Simulators for Supermicrosurgery: An Updated Systematic Review and Meta-analysis

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