Innovative Clinical Scenario Simulator for Step-by-Step Microsurgical Training

Abstract

Background Microsurgical training should be implemented with consideration of operative difficulties that occur in actual clinical situations. We evaluated the effectiveness of a novel clinical scenario simulator for step-by-step microsurgical training that progressed from conventional training to escalated training with additional obstacles. Methods A training device was designed according to multiple and intricate clinical microsurgery scenarios. Twenty surgical residents with no experience in microsurgery were randomly assigned to either the control group (conventional training curricula, n = 10) or the experimental group (step-by-step training courses, n = 10). After 4 weeks of laboratory practice, the participants were scheduled to perform their first microvascular anastomoses on patients in an operating room. The Global Rating Scale (GRS) scores and operative duration were used to compare microsurgical skills between the two groups. Results There were no significant differences in the participants’ baseline characteristics before microsurgical training between the groups with respect to age, sex, postgraduate year, surgical specialty, or mean GRS score (p < 0.05). There were also no significant differences in recipient sites between the two groups (p = 0.735). After training, the GRS scores in both groups were significantly improved (p = 0.000). However, in the actual microsurgical situations, the GRS scores were significantly higher in the experimental than control group (p < 0.05). There was no significant difference in the operative duration between the two groups (p < 0.13). Conclusion Compared with a traditional training program, this step-by-step microsurgical curriculum based on our clinical scenario simulator results in significant improvement in acquisition of microsurgical skills.

A Microsurgical Skills Curriculum to Develop Unconscious Competence

“…For example, as the curriculum evolves, we anticipate creating a formalized set of simulated challenging scenarios under which the calisthenic exercises can be performed. 30 These include a shaking workstation to mimic when a donor site is being closed during microsurgery and an artificially created restricted space to emulate anastomoses that occur in a deep operative field. Mastery of both the calisthenic exercises and the ability to perform anastomoses in these challenging settings will further solidify a trainee's achievement of unconscious competence in microsurgery.…”