Validating a Scalable Approach to Microsurgery Education in Resource-Limited Countries

Abstract

Background

Microsurgery remains largely nonexistent in sub-Saharan Africa due to a lack of access to specialized training and microsurgical instruments. However, smartphones with magnification capabilities are globally widespread, even in low-resource nations. The use of smartphones as simulators for microsurgery training has been previously reported, but little is known with respect to skills acquisition over time.

Methods

A cohort of Ethiopian plastic surgery attendees and residents participated in a microsurgery training workshop. Before and after the workshop, as well as 6 months afterward, participants were recorded performing a synthetic vessel repair using a smartphone for magnification. Video recordings were graded by four microsurgeons using the Stanford Microsurgery and Resident Training (SMaRT) scale, a validated instrument for assessing microsurgical skills.

Results

A total of 13 participants were surveyed and recorded. Overall microsurgical performance SMaRT scores significantly improved (2.05 vs. 2.72 on a five-point scale; p = 0.001) upon completion of the workshop, and continued to increase (3.05), but not significantly so (p = 0.201) 6 months afterward. However, improvements were maintained at 6 months. Significant improvement was noted in all SMaRT scale domains postworkshop and further significant improvement in instrument handling was noted at 6 months.

Conclusion

Our findings suggest that smartphones can serve as valuable tools for microsurgery training in low-resource settings. Further research is warranted to evaluate the long-term impact of smartphone-based simulation training on skill acquisition and clinical outcomes in low-resource settings, but even in the short-term participants were able to demonstrate significant improvement, as well as maintenance to improvement of skill at 6 months follow-up.

Keywords

global surgery - microsurgery education - education

Publikationsverlauf

Eingereicht: 23. November 2024

Angenommen: 12. Mai 2025

Accepted Manuscript online:
21. Mai 2025

Artikel online veröffentlicht:
03. Juni 2025

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