title: Effectiveness of a microvascular surgery training curriculum for orthopaedic surgery residents.
abstract: BACKGROUND
  The safe and effective acquisition of microvascular surgical skills is a challenge for any residency program. Variable clinical exposure to microsurgery, premiums on operating room efficiency, and a steep learning curve make these skills difficult to acquire through clinical experience alone. The purpose of this study was to determine the effectiveness of a training curriculum on the development of microvascular surgical skills in our orthopaedic residents.
  
  
  METHODS
  A microvascular training curriculum was completed during each third-year resident's rotation on the hand and upper-extremity service. The training cycle began with learning the basics of microvascular surgery on nonliving models and progressed to performing end-to-end arterial anastomoses on a live rat femoral artery in the second session. Outcome evaluations consisted of the Global Rating Scale score, achievement of patency, and time to completion. T test analyses of Global Rating Scale scores, achievement of patency, and time to completion were conducted to determine significance (p < 0.05).
  
  
  RESULTS
  All residents significantly improved (p < 0.005) on Global Rating Scale scores from a mean score (and standard deviation) of 15 ± 4 points for the initial score to 20 ± 3 points for the post-test score. Of the twelve residents, patency was achieved by eleven at the final evaluation, compared with six before training. Time to completion of the anastomosis also significantly improved (p < 0.005), from a mean of 37:17 ± 8:41 minutes for the initial time to 24:46 ± 5:32 minutes for the final time.
  
  
  CONCLUSIONS
  In an effort to improve the microvascular surgical skills of orthopaedic residents at our institution, a microvascular training curriculum was developed and was implemented. This curriculum was effective at improving resident microvascular surgical skills at the completion of an eight-week course.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, OP-31, Portland, OR 97239. E-mail address for J.-W.K. Ko: jiawei.ko@gmail.com. E-mail address for A.J. Mirarchi: mirarchi@ohsu.edu.
authors.forename: Jia-Wei Kevin
authors.initials: JW
authors.lastname: Ko
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, OP-31, Portland, OR 97239. E-mail address for J.-W.K. Ko: jiawei.ko@gmail.com. E-mail address for A.J. Mirarchi: mirarchi@ohsu.edu.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Lorzano
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, OP-31, Portland, OR 97239. E-mail address for J.-W.K. Ko: jiawei.ko@gmail.com. E-mail address for A.J. Mirarchi: mirarchi@ohsu.edu.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Mirarchi
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003479:Curriculum; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D059032:Learning Curve; D008866:Microsurgery / Q000193:education*; D055806:Microvessels / Q000601:surgery; D061646:Operative Time; D019637:Orthopedic Procedures / Q000193:education*; D009985:Orthopedics / Q000193:education*