Ahead of the Curve: Tracking Progress in Novice Microsurgeons

Brosious, John P.; Kleban, Shawna R.; Goldman, Joshua J.; Mohsin, Adnan; Williams, Shelly J.; Wang, Wei Z.; Menezes, John M.; Baynosa, Richard C.

doi:10.1055/s-0038-1670652

Cited by 12 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another example is the ex vivo ovine model for microsurgical training on parotidectomy and facial nerve reanimation [67]. Persistent, repeated, interval [68], deliberate, self-directed practice on low-fidelity platforms are excellent alternatives to high-fidelity models [69][70][71]. It is found that having previous practical experience with ex vivo models enhances skill retention [70,72], confidence [73], and cognitive perception within the operating room because the technical skills have been mastered and become automatic.…”

Section: Discussionmentioning

confidence: 99%

Superiority of living animal models in microsurgical training: beyond technical expertise

et al. 2021

View full text Add to dashboard Cite

Background Many studies are investigating the role of living and nonliving models to train microsurgeons. There is controversy around which modalities account for the best microsurgical training. In this study, we aim to provide a systematic literature review of the practical modalities in microsurgery training and compare the living and nonliving models, emphasizing the superiority of the former. We introduce the concept of non-technical skill acquisition in microsurgical training with the use of living laboratory animals in the context of a novel proposed curriculum. Methods A literature search was conducted on PubMed/Medline and Scopus within the past 11 years based on a combination of the following keywords: “microsurgery,” “training,” “skills,” and “models.” The online screening process was performed by two independent reviewers with the Covidence tool. A total of 101 papers was identified as relevant to our study. The protocol was reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Living models offer the chance to develop both technical and non-technical competencies (i.e., leadership, situation awareness, decision-making, communication, and teamwork). Prior experience with ex vivo tissues helps residents consolidate basic skills prior to performing more advanced techniques in the living tissues. Trainees reported a higher satisfaction rate with the living models. Conclusions The combination of living and nonliving training microsurgical models leads to superior results; however, the gold standard remains the living model. The validity of the hypothesis that living models enhance non-technical skills remains to be confirmed. Level of evidence: Not ratable.

show abstract

Section: Discussionmentioning

confidence: 99%

Superiority of living animal models in microsurgical training: beyond technical expertise

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The learning curve in microsurgery is steep and has been extensively researched. 24 To account for this, every effort was made to compare same-experienced trainees for comparison within each cohort and across cohorts. That being said, we acknowledge intercohort variability may have contributed to the disparate results across both cohorts.…”

Section: Limitationsmentioning

confidence: 99%

“…This allows the students to reflect on their mistakes and remediate any failed or unsuccessful attempts. 24 From a pedagogical point of view, students build a relationship with their instructor. The interaction between student and instructor is invaluable; it helps students develop resilience, patience, and confidence toward accomplishing their task.…”

Section: Limitationsmentioning

confidence: 99%

The Benefits of Expert Instruction in Microsurgery Courses

Paladino

Gasteratos

Akelina

et al. 2020

J Reconstr Microsurg

View full text Add to dashboard Cite

Background Microsurgery requires repeated practice and training to achieve proficiency, and there are a variety of curriculums available. This study aims to determine the importance of an expert instructor to guide students through procedures. We compared student proficiency across two microsurgery courses: one with (Columbia University, United States [CU] cohort) and one without a dedicated microsurgery instructor (University of Thessaloniki, Greece [UT] cohort). Methods Students were divided into two cohorts of 22 students (UT cohort) and 25 students (CU cohort). Student progress was evaluated by examining patency (lift-up and milking tests), anastomotic timing, and quality (Anastomosis Lapse Index [ALI]) of end-to-end arterial and venous anastomoses on day 1 and again on day 5. Chi-squared tests evaluated patency immediately and 30 minutes postoperation. t-Tests evaluated anastomotic timing and ALI scores. p-Values < 0.05 were considered significant. Results We evaluated progress within and between each cohort. Within the CU cohort, the quality of the arterial and venous anastomosis improved, respectively (by 54%, p = 0.0059 and by 43%, p = 0.0027), the patency of both the arterial and venous anastomosis improved, respectively (by 44%, p = 0.0002 and by 40%, p = 0.0019), and timing of arterial and venous anastomosis reduced respectively (by 36%, p = 0.0002 and by 33%, p = 0.0010). The UT cohort improved the quality of their arterial anastomoses (by 29%, p = 0.0312). The UT cohort did not demonstrate significant improvement in the other above-mentioned parameters. The CU cohort improved materially over the UT cohort across categories of quality, patency, and timing. Conclusion There are clear benefits of an expert instructor when examining the rate of progress and proficiency level attained at the conclusion of the course. We suggest students who are seeking to maximize proficiency in microsurgical procedures enroll in courses with an expert instructor.

show abstract

“…Another synthetic model described in the literature for microsurgery skills training is the “Japanese noodle model” which has shown close resemblance to the rat's femoral artery owing to the same diameter (Prunières et al, ). Brosious et al () described the use of silastic tubes to simulate blood vessels in order to learn microsurgical anastomosis. Hoşnuter et al () introduced the concept of polyethylene stretch film membrane to simulate adventitial stripping, thereby improving silicone model's fidelity.…”

Section: Bench Modelsmentioning

confidence: 99%

Current status of simulation and training models in microsurgery: A systematic review

et al. 2019

View full text Add to dashboard Cite

With the prolific uptake of simulation-based training courses, this systematic review aims to identify the available microsurgical simulation and training models, their status of validation, associated studies, and levels of evidence (LoE) for each training model, thereby establishing a level of recommendation (LoR). MEDLINE, Embase, and the Cochrane Library databases were searched for English language articles, describing microsurgery simulators and/or validation studies. All studies were assessed for LoE, and each model was subsequently awarded a LoR using a modified Oxford Centre for Evidence-Based Medicine classification, adapted for education, with 1 being the highest and 4 the lowest score. A total of 86 studies were identified describing 64 models and simulators ranging from bench models, cadaveric animal tissue, cadaveric human tissue, live animal models, virtual reality simulators, and training curricula. Of these, 49 simulators had at least one validation study. Models were assessed for face (n = 42), content (n = 31), construct (n = 25), transfer (n = 10), and concurrent validity (n = 1) by these studies. The most commonly identified modality was bench models (n = 28) followed by cadaveric animal tissue (n = 24). The cryopreserved rat aorta model received the highest LoR followed by chicken wing, chicken thigh and practice cardboard models. Microsurgery simulation is a growing field and increasing numbers of models are being produced. However, there are still only a few validation studies with a high LoE. It is therefore imperative that training models and/or programs are evaluated for validity and efficacy in order to allow utilization in microsurgical skills acquisition.

show abstract

Ahead of the Curve: Tracking Progress in Novice Microsurgeons

Cited by 12 publications

References 27 publications

Superiority of living animal models in microsurgical training: beyond technical expertise

Superiority of living animal models in microsurgical training: beyond technical expertise

The Benefits of Expert Instruction in Microsurgery Courses

Current status of simulation and training models in microsurgery: A systematic review

Contact Info

Product

Resources

About