Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models.
BACKGROUND
Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model.


METHODS
Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant.


RESULTS
Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively.


CONCLUSIONS
Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.
Santiago, Chile.|From the Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Catolica de Chile.
Jose R
JR
Rodriguez
Santiago, Chile.|From the Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Catolica de Chile.
Ricardo
R
Yañez
Santiago, Chile.|From the Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Catolica de Chile.
Ignacio
I
Cifuentes
Santiago, Chile.|From the Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Catolica de Chile.
Julian
J
Varas
Santiago, Chile.|From the Experimental Surgery and Simulation Center, Section of Plastic and Reconstructive Surgery, Surgery Division, School of Medicine, Pontificia Universidad Catolica de Chile.
Bruno
B
Dagnino
D000714:Anastomosis, Surgical / Q000193:education; D000818:Animals; D001158:Arteries / Q000601:surgery; D002645:Chickens; D002677:Chile; D002983:Clinical Competence; D003479:Curriculum; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000193:education*; D008953:Models, Anatomic; D023421:Models, Animal; D017145:Models, Educational; D051381:Rats; D017207:Rats, Sprague-Dawley; D000066908:Simulation Training / Q000379:methods*; D016037:Single-Blind Method; D014680:Veins / Q000601:surgery
Lascar I, Totir D, Cinca A, et al. Training program and learning curve in experimental microsurgery during the residency in plastic surgery. Microsurgery 2007;27:263267.
Hui KC, Zhang F, Shaw WW, et al. Learning curve of microvascular venous anastomosis: A never ending struggle? Microsurgery 2000;20:2224.
Fanua SP, Kim J, Shaw Wilgis EF. Alternative model for teaching microsurgery. Microsurgery 2001;21:379382.
Hino A. Training in microvascular surgery using a chicken wing artery. Neurosurgery 2003;52:14951497; discussion 1497.
Lahiri A, Lim AY, Qifen Z, Lim BH. Microsurgical skills training: A new concept for simulation of vessel-wall suturing. Microsurgery 2005;25:2124.
Furka I, Brath E, Nemeth N, Miko I. Learning microsurgical suturing and knotting techniques: Comparative data. Microsurgery 2006;26:47.
Ilie VG, Ilie VI, Dobreanu C, Ghetu N, Luchian S, Pieptu D. Training of microsurgical skills on nonliving models. Microsurgery 2008;28:571577.
Olabe J, Olabe J. Microsurgical training on an in vitro chicken wing infusion model. Surg Neurol. 2009;72:695699.
Marsh DJ, Norton SE, Mok J, Patel HD, Chen HC. Microsurgical training the chicken thigh model. Ann Plast Surg. 2012;59:355356.
Bates BJ, Wimalawansa SM, Monson B, Rymer MC, Shapiro R, Johnson RM. A simple cost-effective method of microsurgical simulation training: The turkey wing model. J Reconstr Microsurg. 2013;29:615618.
Jeong HS, Moon MS, Kim HS, Lee HK, Yi SY. Microsurgical training with fresh chicken legs. Ann Plast Surg. 2013;70:5761.
Chan WY, Matteucci P, Southern SJ. Validation of microsurgical models in microsurgery training and competence: A review. Microsurgery 2007;27:494499.
Varas J, Mejía R, Riquelme A, et al. Significant transfer of surgical skills obtained with an advanced laparoscopic training program to a laparoscopic jejunojejunostomy in a live porcine model: Feasibility of learning advanced laparoscopy in a general surgery residency. Surg Endosc. 2012;26:34863494.
Grober ED, Hamstra SJ, Wanzel KR, et al. Validation of novel and objective measures of microsurgical skill: Hand-motion analysis and stereoscopic visual acuity. Microsurgery 2003;23:317322.
Temple CL, Ross DC. A new, validated instrument to evaluate competency in microsurgery: The University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument. Plast Reconstr Surg. 2011;127:215222.
Nimmons GL, Chang KE, Funk GF, Shonka DC, Pagedar NA. Validation of a task-specific scoring system for a microvascular surgery simulation model. Laryngoscope 2012;122:21642168.
Datta V, Mackay S, Mandalia M, Darzi A. The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg. 2001;193:479485.
Hirsch ED Jr. The core knowledge curriculum: What’s behind its success? Educational Leadership 1993;50:2330.
Lewis T, Aggarwal R, Sugden C, Darzi A. The adoption of advanced surgical techniques: Are surgical masterclasses enough? Am J Surg. 2012;204:110114.
Van Nortwick SS, Lendvay TS, Jensen AR, Wright AS, Horvath KD, Kim S. Methodologies for establishing validity in surgical simulation studies. Surgery 2010;147:622630.
Ramachandran S, Ghanem AM, Myers SR. Assessment of microsurgery competency: Where are we now? Microsurgery 2013;33:406415.
Grober ED, Roberts M, Shin EJ, Mahdi M, Bacal V. Intraoperative assessment of technical skills on live patients using economy of hand motion: Establishing learning curves of surgical competence. Am J Surg. 2010;199:8185.
Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Med Teach. 2007;29:855871.
Miller A, Archer J. Impact of workplace based assessment on doctors’ education and performance: A systematic review. BMJ 2010;341:c5064.
Moulton CA, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R. Teaching surgical skills: What kind of practice makes perfect?: A randomized, controlled trial. Ann Surg. 2006;244:400409.
Ezra DG, Aggarwal R, Michaelides M, et al. Skills acquisition and assessment after a microsurgical skills course for ophthalmology residents. Ophthalmology 2009;116:257262.
Ilie V, Ilie V, Ghetu N, Popescu S, Grosu O, Pieptu D. Assessment of the microsurgical skills: 30 minutes versus 2 weeks patency. Microsurgery 2007;27:451454.