title: Tracking the learning curve in microsurgical skill acquisition.
abstract: BACKGROUND
  Despite advances in surgical training, microsurgery is still based on an apprenticeship model. To evaluate skill acquisition and apply targeted feedback to improve their training model, the authors applied the Structured Assessment of Microsurgery Skills to the training of microsurgical fellows. They hypothesized that subjects would demonstrate measurable improvement in performance throughout the study period and consistently across evaluators.
  
  
  METHODS
  Seven fellows were evaluated during 118 microsurgical cases by 16 evaluators over three 1-month evaluation periods in 1 year (2010 to 2011). Evaluators used the Structured Assessment of Microsurgery Skills questionnaire, which measures dexterity, visuospatial ability, operative flow, and judgment. To validate the data, microsurgical anastomoses in rodents performed by the fellows in a laboratory at the beginning and end of the study period were evaluated by five blinded plastic surgeons using the same questionnaire. Primary outcomes were change in scores between evaluation periods and interevaluator reliability.
  
  
  RESULTS
  Between the first two evaluation periods, all skill areas and overall performance improved significantly. Between the second two periods, most skill areas improved, but only a few improved significantly. Operative errors decreased significantly between the first and subsequent periods (81 versus 36; p < 0.05). In the laboratory study, all skills were significantly (p < 0.05) or marginally (0.05 ≤ p < 0.10) improved between time points. The overall interevaluator reliability of the questionnaire was acceptable (α = 0.67).
  
  
  CONCLUSIONS
  The Structured Assessment of Microsurgery Skills questionnaire is a valid instrument for assessing microsurgical skill, providing individualized feedback with acceptable interevaluator reliability. Use of the questionnaire is anticipated to enhance microsurgical training.
authors.affiliation: Houston, Texas From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.forename: Edward I
authors.initials: EI
authors.lastname: Chang
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Hiroo
authors.initials: H
authors.lastname: Suami
authors.forename: David M
authors.initials: DM
authors.lastname: Adelman
authors.forename: Patrick
authors.initials: P
authors.lastname: Garvey
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hanasono
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods; D004521:Educational Measurement; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D008866:Microsurgery / Q000193:education*; D015588:Observer Variation; D015203:Reproducibility of Results; D013647:Task Performance and Analysis