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

Introduction: Microsurgery remains largely nonexistent in sub-Saharan Africa due to 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 attendings and residents participated in a microsurgery training workshop. Before and after the workshop, as well as six months afterwards, participants were recorded performing a synthetic vessel repair using a smartphone for magnification. Video recordings were and graded by four microsurgeons using the Stanford Microsurgery and Resident Training (SMaRT) scale, a validated instrument for assessing microsurgical skill. Results: 13 participants were surveyed and recorded. Overall microsurgical performance SMaRT scores significantly improved (2.05 vs 2.72 on a 5-point scale; p = 0.001) upon completion of the workshop, and continued to increase (3.05), but not significantly so (p = 0.201) six months afterwards. However, improvements were maintained at six months. Significant improvement was noted in all SMaRT scale domains post workshop and further significant improvement in instrument handling was noted at six 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 six months follow-up.

Publication History

Received: 23 November 2024

Accepted after revision: 12 May 2025

Accepted Manuscript online:
21 May 2025