Added Qualifications in Microsurgery: Consideration for Subspecialty Certification in Microvascular Surgery in Europe

Abstract

Background While implementation of subspecializations may increase expertise in a certain area of treatment, there also exist downsides. Aim of this study was, across several disciplines, to find out if the technique of microsurgery warrants the introduction of a "Certificate of Added Qualifications (CAQ) in microsurgery." Methods An anonymous, web-based survey was administered to directors of microsurgical departments in Europe (n = 205). Respondents were asked, among other questions, whether they had completed a 12-month microvascular surgery fellowship and whether they believed a CAQ in microvascular surgery should be instituted. Results The response rate was 57%, and 33% of the respondents had completed a 12-month microvascular surgery fellowship.A total of 61% of all surgeons supported a CAQ in microsurgery. Answers ranged from 47% of support to 100% of support, depending on the countries surveyed. Discussion This is one of the few reports to evaluate the potential role of subspecialty certification of microvascular surgery across several European countries. The data demonstrate that the majority of directors of microsurgical departments support such a certificate. There was significantly greater support for a CAQ in microsurgery among those who have completed a formal microvascular surgery fellowship themselves. Conclusion This study supports the notion that further discussion and consideration of subspecialty certification in microvascular surgery appears necessary. There are multiple concerns surrounding this issue. Similar to the evolution of hand surgery certification, an exploratory committee of executive members of the respective medical boards and official societies may be warranted.

Certification and Accreditation in Plastic Surgery Subspecialty Training

“…A review of the literature yields 2 articles, which broached the topic of implementing a formal certification in microsurgery. 16 , 17 Layliev et al 16 surveyed microsurgery fellowship directors and residency program directors in the United States for whether or not there should be a CAQ in microsurgery. Seventy-three percent of surgeons responded to Layliev et al’s 16 survey; 25% supported a CAQ in microsurgery and 75% did not.…”

“…More specifically, the majority of residency program directors in the United States did not support a CAQ in microsurgery (17% versus 83%), while microsurgery fellowship directors were split 44% in favor of a CAQ and 56% against it. 16 Similarly, Heidekrueger et al 17 surveyed directors of microsurgery programs in Europe. Fifty-seven percent of those surveyed in the European study responded; 61% of respondents (range, 47%–100% depending on the country) supported a CAQ in microsurgery.…”

“…In both studies, there was a statistically significant difference in support for a CAQ between those surgeons who had themselves completed a fellowship compared with those who had not. 16 , 17 …”

“…In Europe, the survey was limited to the first 2 options for CAQ eligibility, with option 2 being more popular. 17 Both articles concluded that an exploratory committee of executive members from respective medical boards and official societies is recommended to further explore the topic. 16 , 17 …”

“…Ultimately, microsurgery survey results suggest that the focus may not be on whether an individual has been fellowship-trained, but whether they are capable of performing a number of procedures within their subspecialty. 16 , 17 The appropriate overseeing societies for each subspecialty as well as the board of plastic surgery should be intimately involved to determine the appropriate quality standards for any certification process. 17 …”