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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2019; 04(02): e73-e76
DOI: 10.1055/s-0039-3400244
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Error-Based Teaching Approach Decreases Vessel Anastomosis Errors: A Pilot Study

Eric de Haas 
1   Medical School Class of 2020 Program, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Jill P. Stone
2   Division of Plastic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
William de Haas
2   Division of Plastic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
,
Christiaan H. Schrag
2   Division of Plastic Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
› Author Affiliations
Further Information

Publication History

03 June 2019

29 September 2019

Publication Date:
22 November 2019 (online)

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Abstract

Background Microsurgical anastomosis of vessels is a challenging skill that surgical residents should practice on models before attempting in the clinical setting. These skills are often taught using synthetic materials, animal tissue, or live animal models. With increasing constraints on surgical resident's time, it is important to maximize efficiency of microsurgical training. The purpose of this study is to determine if teaching surgical residents about common vessel anastomosis errors decreases the total number of suture errors during a 4-day training course.

Methods Plastic surgery residents (R1–R3) were randomly assigned to receive additional teaching focused on either common microsurgical errors or traditional microsurgical manuals. The residents then performed anastomosis on rat femoral arteries in which the total number of sutures and errors were recorded by staff microsurgeons who were blinded to the intervention.

Results Residents who received teaching on common microsurgical errors performed a total of 73 sutures of which 12 were errors. The control group who studied using traditional microsurgical manuals performed a total of 125 sutures of which 38 were errors. There was a statistically significant decrease in the total number of suture errors (Fisher's exact test; p-value = 0.04) and in the number of partial depth bite errors (Fisher's exact test p-value = 0.03).

Conclusion Teaching surgical residents about common vessel anastomosis errors decreased the total number of errors when compared with traditional education methods using microsurgery manuals. Partial depth bite errors were also decreased through error-based teaching.

Keywords

microsurgery - vessel anastomosis - surgical training
 

  • References

  • 1 Chan W, Niranjan N, Ramakrishnan V. Structured assessment of microsurgery skills in the clinical setting. J Plast Reconstr Aesthet Surg 2010; 63 (08) 1329-1334
    CrossrefPubMedSearch in Google Scholar
  • 2 Balasundaram I, Aggarwal R, Darzi LA. Development of a training curriculum for microsurgery. Br J Oral Maxillofac Surg 2010; 48 (08) 598-606
    CrossrefPubMedSearch in Google Scholar
  • 3 Bates BJ, Wimalawansa SM, Monson B, Rymer MC, Shapiro R, Johnson RM. A simple cost-effective method of microsurgical simulation training: the turkey wing model. J Reconstr Microsurg 2013; 29 (09) 615-618
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Sidhu RS, Park J, Brydges R, MacRae HM, Dubrowski A. Laboratory-based vascular anastomosis training: a randomized controlled trial evaluating the effects of bench model fidelity and level of training on skill acquisition. J Vasc Surg 2007; 45 (02) 343-349
    CrossrefPubMedSearch in Google Scholar
  • 5 Hirschl RB. The making of a surgeon: 10,000 hours?. J Pediatr Surg 2015; 50 (05) 699-706
    CrossrefPubMedSearch in Google Scholar
  • 6 Ramachandran S, Ghanem AM, Myers SR. Assessment of microsurgery competency-where are we now?. Microsurgery 2013; 33 (05) 406-415
    CrossrefPubMedSearch in Google Scholar
  • 7 Stone JP, Doherty CC, Schrag CH. Incidence and type of errors in microsurgical technique in surgical trainees. J Reconstr Microsurg 2016; 32 (07) 528-532
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Trignano E, Fallico N, Zingone G, Dessy LA, Campus GV. Microsurgical training with the three-step approach. J Reconstr Microsurg 2017; 33 (02) 87-91
    PubMedSearch in Google Scholar
  • 9 Ko J-W, Lorzano A, Mirarchi AJ. Effectiveness of a microvascular surgery training curriculum for orthopaedic surgery residents. J Bone Joint Surg Am 2015; 97 (11) 950-955
    CrossrefPubMedSearch in Google Scholar
  • 10 Furka I, Brath E, Nemeth N, Miko I. Learning microsurgical suturing and knotting techniques: comparative data. Microsurgery 2006; 26 (01) 4-7
    CrossrefPubMedSearch in Google Scholar
  • 11 Fischer MA, Mazor KM, Baril J, Alper E, DeMarco D, Pugnaire M. Learning from mistakes. Factors that influence how students and residents learn from medical errors. J Gen Intern Med 2006; 21 (05) 419-423
    CrossrefPubMedSearch in Google Scholar
  • 12 Gardner A, Rich M. Error management training and simulation education. Clin Teach 2014; 11 (07) 537-540
    CrossrefPubMedSearch in Google Scholar
  • 13 Maerz L. Avoiding common surgical errors. Ann Surg 2006; 244 (05) 837
    PubMedSearch in Google Scholar
  • 14 Pafitanis G, Veljanoski D, Ghanem AM, Myers S. Intimal surface suture line (end-product) assessment of end-to-side microvascular anastomosis. Plast Reconstr Surg Glob Open 2017; 5 (07) e1409
    CrossrefPubMedSearch in Google Scholar
  • 15 Austin GT, Hammond FW, Schaberg SJ, Scharpf HO. A laboratory model for vascular microsurgery. J Oral Maxillofac Surg 1983; 41 (07) 450-455
    CrossrefPubMedSearch in Google Scholar