Longitudinal Microsurgery Laboratory Training during Hand Surgery Fellowship

Abstract

Background Laboratory training courses have traditionally offered an attractive method to learn microsurgery in a low-risk environment. However, courses are often limited by cost, accessibility, and their one-time, nonlongitudinal nature. Our aims were to (1) describe our institution's microsurgical training course for hand surgery fellows, which is longitudinal and integrated within our fellowship curriculum and (2) investigate how this course affects the microsurgical confidence and competence of trainees throughout their fellowship year. Methods All hand fellows who trained in our 1-year combined hand surgery fellowship from 2016 through 2018 participated in this study. Baseline data on the type and duration of residency training, previous microsurgery experience and self-reported confidence, knowledge, and interest in microsurgery were recorded. Self-reported scores were documented using a continuous scale ranging from 0 to 10. An initial 3-day laboratory course combining the use of didactic teaching, a nonliving synthetic model, and a live rat model was conducted. Repeat laboratory training occurred thereafter at 6 and 12 months. At the end of each session, fellows repeated the baseline questionnaire and faculty assessed their microsurgical competence using a standardized global rating scale (GRS). Results A total of six fellows (2 years) were enrolled. At the end of the initial course, there was a statistically significant increase in mean self-reported confidence in microsurgery from 4.3 to 6.2 and knowledge from 4.7 to 6.5. Mean scores in interest were unchanged, from 9.2 to 9.3. There was also an increase in mean GRS score from day 3 to months 6 and 12. Conclusion A longitudinal microsurgical training course integrated within a hand surgery fellowship is associated with increased confidence and microsurgical skill. This study describes our approach and its feasibility.

Novel Porcine Kidney-Based Microsurgery Training Model for Developing Basic to Advanced Microsurgical Skills

“…Although this model is specifically designed for microsurgery training, the porcine kidney may be useful for other modalities such as human kidney transplantation training. 3,4 In addition, vascular dissection may be useful for training surgeons performing vascular access and arteriovenous fistula creation. 10,21 Comparing to others nonliving training model such as chicken parts, 13,15,22,23 human placenta 12 and fresh cadaveric' vessels, 24 the kidney's pork is cheap, normally is not used for human consumption and don't have risk of viral transmission.…”

“…[1][2][3] Even simple procedures require different levels of complex skills. 2,4,5 Until recently, training with more experienced surgeons during surgeries in patients has been the traditional method of gaining skills based on the experience principle. 3,6 However, with increasing concerns regarding patient safety, the traditional method of surgical training is being replaced by other forms of learning, mainly to master microsurgical skills.…”

“…Depending on the model, different skills may be acquired. 3,4,6,7 Different models have been created to improve motor skills for microsurgical skills, including dissection, anastomosis, hemostasis, and instrument manipulation. For this purpose, several models 9-12 using samples from mice, chicken, placentas, latex, silicone, and vegetables have been described.…”

“…The beginning of microsurgery training should include artificial models, which represent the first step of most microsurgery courses globally. [4][5][6]9 The first steps involve adapting the surgeon to the microscopic field, manipulating instruments, creating sutures, transitioning between macroscopic and microscopic fields, and manipulating delicate structures. 2,4 Despite the importance of these models, they often do not simulate more complex training modalities or reflect possible complications that can occur during surgery in humans.…”

“…[4][5][6]9 The first steps involve adapting the surgeon to the microscopic field, manipulating instruments, creating sutures, transitioning between macroscopic and microscopic fields, and manipulating delicate structures. 2,4 Despite the importance of these models, they often do not simulate more complex training modalities or reflect possible complications that can occur during surgery in humans. [13][14][15] Thus, models that more closely resemble surgical practice are needed to identify alternatives for vascular anastomosis training.…”