Evaluation of a Microsurgery Training Curriculum

Abstract

Background Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, with the majority focus on technical skills only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model.

Methods A training curriculum was delivered over 5 days between 2017 and 2020 focusing on (1) microscopic field manipulation, (2) knot tying, nondominant hand usage, (3) 3-D models/anastomosis, and (4) tissue experience. The Kirkpatrick model was applied to evaluate the curriculum at four levels: (1) participants' feedback (2) skills development using a validated, objective assessment tool (Global Assessment Score form) and CUSUM charts were constructed to model proficiency gain (3) and (4) assessing skill retention/long-term impact.

Results In total, 155 participants undertook the curriculum, totaling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for “good.” All participants agreed that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1 and 3 (median score 4) and days 4 and 5 (median score 5) (W = 494.5, p = 0.00170). The frequency of errors reduced with successive attempts (chi square = 9.81, p = 0.00174). The steepest learning curve was in anastomosis and patency domains, requiring 11 attempts on average to reach proficiency. In total, 88.5% survey respondents could apply the skills learnt and 76.9% applied the skills learnt within 6 months. Key areas of improvement were identified from this evaluation, and actions to address them were implemented in the following programs.

Conclusion Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows the identification of areas of improvement, driving the refinement of training programs.

Keywords

microsurgery - curriculum - evaluation

• References

• 1 Singh M, Ziolkowski N, Ramachandran S, Myers SR, Ghanem AM. Development of a five-day basic microsurgery simulation training course: a cost analysis. Arch Plast Surg 2014; 41 (03) 213-217
• 2 Grober ED, Hamstra SJ, Wanzel KR. et al. Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill. J Urol 2004; 172 (01) 378-381
• 3 Crouch G, Wong G, Hong J. et al. Validated specialty-specific models for multi-disciplinary microsurgery training laboratories: a systematic review. ANZ J Surg 2021; 91 (06) 1110-1116
• 4 Javid P, Aydın A, Mohanna PN, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: a systematic review. Microsurgery 2019; 39 (07) 655-668
• 5 Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005; 27 (01) 10-28
• 6 Chen J, Xun H, Abousy M, Long C, Sacks JM. No microscope? No problem: a systematic review of microscope-free microsurgery training models. J Reconstr Microsurg 2022; 38 (02) 106-114
• 7 Merrill MD, Drake L, Lacy MJ, Pratt J. the ID2 Research Group. Reclaiming instructional design. Educ Technol 1996; 5–7 (05) 36
• 8 Kirkpatrick DL. Training and Development Handbook: A Guide to Human Resource Development. New York: McGraw Hill; 1976
• 9 Kirkpatrick DL. Evaluating Training Programs. San Francisco: Berrett-Koehler; 1994
• 10 Kirkpatrick JD, Kirkpatrick WK. Kirkpatrick's Four Levels of Training Evaluation,. 2016. Alexandria, U.S.: Association for Talent Development;
• 11 Office H. Guidance on the Operation of the Animals (Scientific Procedures) Act 1986. 11 March Updated 2020. [Online]. Accessed January 05, 2023 at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/662364/Guidance_on_the_Operation_of_ASPA.pdf
• 12 Ghanem AM, Al Omran Y, Shatta B, Kim E, Myers S. Anastomosis lapse index (ALI): a validated end product assessment tool for simulation microsurgery training. J Reconstr Microsurg 2016; 32 (03) 233-241
• 13 Shepard LA. Commentary: evaluating the validity of formative and interim assessment. Educ Meas 2009; 28 (03) 32-27
• 14 Miskovic D, Wyles SM, Carter F, Coleman MG, Hanna GB. Development, validation and implementation of a monitoring tool for training in laparoscopic colorectal surgery in the English National Training Program. Surg Endosc 2011; 25 (04) 1136-1142
• 15 Paladino JR, Gasteratos K, Akelina Y, Marshall B, Papazoglou LG, Strauch RJ. The benefits of expert instruction in microsurgery courses. J Reconstr Microsurg 2021; 37 (02) 143-153
• 16 Navia A, Tejos R, Canahuate S. et al. MicrosimUC: validation of a low-cost, portable, do-it-yourself microsurgery training kit. J Reconstr Microsurg 2022; 38 (05) 409-419 Jun
• 17 Dąbrowski F, Stogowski P, Białek J. et al. Video-based microsurgical education versus stationary basic microsurgical course: a noninferiority randomized controlled study. J Reconstr Microsurg 2022; 38 (07) 585-592
• 18 Albano NJ, Zeng W, Lin C, Uselmann AJ, Eliceiri KW, Poore SO. Augmentation of chicken thigh model with fluorescence imaging allows for real-time, high fidelity assessment in supermicrosurgery training. J Reconstr Microsurg 2021; 37 (06) 514-518
• 19 Satterwhite T, Son J, Carey J. et al. Microsurgery education in residency training: validating an online curriculum. Ann Plast Surg 2012; 68 (04) 410-414
• 20 Moulton CA, Dubrowski A, Macrae H, Graham B, Grober E, Reznick R. Teaching surgical skills: what kind of practice makes perfect?: a randomized, controlled trial. Ann Surg 2006; 244 (03) 400-409
• 21 Anastakis DJ, Regehr G, Reznick RK. et al. Assessment of technical skills transfer from the bench training model to the human model. Am J Surg 1999; 177 (02) 167-170
• 22 Masud D, Haram N, Moustaki M, Chow W, Saour S, Mohanna PN. Microsurgery simulation training system and set up: an essential system to complement every training programme. J Plast Reconstr Aesthet Surg 2017; 70 (07) 893-900
• 23 Rodriguez JR, Yañez R, Cifuentes I, Varas J, Dagnino B. Microsurgery workout: a novel simulation training curriculum based on nonliving models. Plast Reconstr Surg 2016; 138 (04) 739e-747e
• 24 Boecker A, Kornmann J, Xiong L. et al. A structured, microsurgical training curriculum improves the outcome in lower extremity reconstruction free flap residency training: The Ludwigshafen Concept. J Reconstr Microsurg 2021; 37 (06) 492-502
• 25 Bates R. A critical analysis of evaluation practice: the Kirkpatrick model and the principle of beneficence. Eval Program Plann 2004; 27 (03) 341-347