Microsurgery Fellowships—Development of a Clinical Curriculum

Abstract

Background Microsurgery fellowships have become an integral part of every plastic surgery training program. While each subspecialty differs in terms of reconstructive requirements, the basic tenets and skill sets remain the same. We explore the possibility of designing a clinical curriculum for microsurgery that can provide residents and fellows with a more foundational and structured approach to microsurgical training.

Methods Thirteen core and desired skills to accommodate an “ideal” microsurgery curriculum were listed and categorized according to the level of difficulty. The curriculum was then sent to plastic surgery trainees, fellows, and consultants within Scotland in the form of a survey. They were asked to assign a level of difficulty, basic, intermediate, or advanced, to each of the 13 skill sets.

Results A total of 27 surgeons were surveyed; the majority of which were plastic surgery registrars. Overall a broad, generic clinical curriculum was felt to be lacking, but would be beneficial at the start of training. The curriculum should emphasize a step-wise progression, starting from achieving competency in safe, efficient anastomosis at the basic level to eventually mastering the principles of complex reconstruction at a more advanced level.

Conclusions A generic clinical curriculum offers a framework for tracking progress, the potential for competency-based assessment, and aid in designing a microsurgery fellowship. The curriculum should reflect the evolving nature of the specialty and provide a foundational platform for future innovations.

Keywords

education - microsurgery - development - training - fellowships - teaching

• References

• 1 Swing SR. Assessing the ACGME general competencies: general considerations and assessment methods. Acad Emerg Med 2002; 9 (11) 1278-1288
• 2 Chan WY, Matteucci P, Southern SJ. Validation of microsurgical models in microsurgery training and competence: a review. Microsurgery 2007; 27 (05) 494-499
• 3 Crosby NL, Clapson JB, Buncke HJ, Newlin L. Advanced non-animal microsurgical exercises. Microsurgery 1995; 16 (09) 655-658
• 4 Erel E, Aiyenibe B, Butler PE. Microsurgery simulators in virtual reality: review. Microsurgery 2003; 23 (02) 147-152
• 5 Ilie V, Ilie V, Ghetu N, Popescu S, Grosu O, Pieptu D. Assessment of the microsurgical skills: 30 minutes versus 2 weeks patency. Microsurgery 2007; 27 (05) 451-454
• 6 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
• 7 Ilie VG, Ilie VI, Dobreanu C, Ghetu N, Luchian S, Pieptu D. Training of microsurgical skills on nonliving models. Microsurgery 2008; 28 (07) 571-577
• 8 Southern SJ, Ramakrishnan V. Dexter: a device for the assessment of microsurgical instrumentation and instruction of trainees. Microsurgery 1998; 18 (07) 430-431
• 9 McMillan C, D'Hondt V, Marshall AH, Binhammer P, Lipa J, Snell L. Surgeon-reported needs for improved training in identifying and managing free flap compromise. J Reconstr Microsurg 2017; 33 (06) 381-388
• 10 Swing SR. The ACGME outcome project: retrospective and prospective. Med Teach 2007; 29 (07) 648-654
• 11 Sears ED, Larson BP, Chung KC. A national survey of program director opinions of core competencies and structure of hand surgery fellowship training. J Hand Surg Am 2012; 37 (10) 1971-1977.e7