Microsurgery Training in Latin America: A Survey of Residents’ Experiences

Abstract

Objective: Health services in Latin America have witnessed continuous expansion, improving access for patients requiring treatment for trauma and cancer. However, while demand for complex reconstruction is on the rise, the number of trained microsurgeons remains limited. The aim of this study is to investigate current experiences of plastic surgery residents with regard to microsurgery. It also aims to find out ways through which the number of trained microsurgeons in the region can be increased for better medical care. Methods:A cross-sectional survey was designed to obtain information regarding the exposure and training that plastic surgery residents receive during residency in Latin American countries. We ensured that our procedure followed the data protection rules laid down in the General Data Protection Regulation (GDPR). Results:We requested 129 microsurgeons in Latin American countries to respond to our survey questions. A total of 93 survey responses were received, corresponding to a response rate of 72.1%. An analysis of the survey data showed that in terms of hands-on microsurgical training, 79.6% of the respondents had previous experience of being involved in performing a microsurgical procedure. However, 59.1% of the respondents mentioned that this was part of their formal training program. The majority of respondents (74%) reported that they would not be confident in performing a microsurgical procedure unsupervised. About half, or 48.4% of the respondents said that they would consider applying for a microsurgery fellowship. However, only 63.4% reported that they had access to a fellowship program in their home country. Conclusion:Few resident plastic surgeons in Latin America are able to attain the required level of experience so as to feel comfortable acting as independent microsurgeons. Both time and effort are required to address this problem. A powerful tool to change this situation is to gain access to international microsurgical fellowships. An influx of returning trained microsurgeons can provide two benefits: (a) increasing the caseload in the short run, and (b) improving the training of plastic surgeons for future generations of doctors.

Beyond Borders: A Global Microsurgery Training and Case Exposure Survey

“…However, it is vital to note that a solid foundation in microsurgical training is necessary for trainees to begin performing these procedures. 6 Therefore, relying solely on fellowship training may not be sufficient to develop the necessary skills. This further emphasizes the importance of having sufficient exposure to develop essential skills during specialty training.…”

“…For instance, one study examined international microsurgical training, but the scope was limited to trainees from five Latin American countries, making it geographically restricted. 6 Similarly, three other studies have examined the status of microsurgical training in individual countries, with two studies conducted in the United States, one of which surveyed program directors, while the other surveyed residents in integrated and independent plastic surgery programs. 2,12 The third article described the state of microsurgical training for plastic and maxillofacial surgeons in the United Kingdom.…”

“…Almost one-third of trainees are not receiving any simulation training in microsurgery, which could result in inadequate preparation for clinical practice. 6…”

“…Almost one-third of trainees are not receiving any simulation training in microsurgery, which could result in inadequate preparation for clinical practice. 6 Furthermore, training opportunities vary depending on geographical location, indicating a potential for inequality of access to training. These variations in training may be influenced by factors such as funding, infrastructure, and local training policies.…”

“…The level of training and experience of the surgeon is known to be a critical factor in the success rate of free tissue transfer, and exposure to microsurgical procedures is essential for competency development. 6 Emerging evidence suggests that appropriately supervised trainees can perform complex reconstructive microsurgery without significantly impacting the complication rate. [7][8][9][10] However, trainees and educators still face significant pressure to demonstrate clinical competency to facilitate microsurgical training.…”