Abstract
Background This study examined the need for improved training in the identification and management
of free flap (FF) compromise and assessed a potential role for simulated scenario
training.
Methods Online needs assessment surveys were completed by plastic surgeons and a subsample
with expertise in microsurgery education participated in focus groups. Data were analyzed
using descriptive statistics and mixed qualitative methods.
Results In this study, 77 surgeons completed surveys and 11 experts participated in one of
two focus groups. Forty-nine (64%) participants were educators, 65 and 45% of which
reported having an insufficient volume of FF cases to adequately teach the management
and identification of compromise, respectively. Forty-three percent of educators felt
that graduating residents are not adequately prepared to manage FF compromise independently.
Exposure to normal and abnormal FF cases was felt to be critical for effective training
by focus group participants. Experts identified low failure rates, communication issues,
and challenging teaching conditions as current barriers to training. Most educators
(74%) felt that simulated scenario training would be “very useful” or “extremely useful”
to current residents. Focus groups highlighted the need for a widely accepted algorithm
for re-exploration and salvage on which to base the development of a training adjunct
consisting of simulated scenarios.
Conclusion Trainee exposure to FF compromise is inadequate in existing plastic surgery programs.
Early exposure, high case volume, and a standardized algorithmic approach to management
with a focus on decision making may improve training. Simulated scenario training
may be valuable in addressing current barriers.
Keywords
free flap - education - simulation
