Fellowship Training and Ways of Thinking and Practicing in Microsurgery: An Investigation in the UK and USA

Description: Introduction: Microsurgery is an essential skill for a plastic surgeon that expands the options for reconstruction. The opportunities for development of microsurgical skills during specialty training are very limited, therefore these skills need to be developed during a microsurgical fellowship. The theory of “threshold concepts” describes how learners develop the ways of thinking and practicing in their discipline.

Methods: A qualitative research methodology was followed. Semi-structured interviews with trainers and trainees from microsurgical units in the UK and the USA were conducted. Data were analyzed using the DedooseTM qualitative data analysis software and interpreted using the theory of “threshold concepts.”

Results: 5 trainees and 4 trainers from the UK and the USA participated in this research project. Although some trainees had particular difficulty in developing their practical microsurgical skills initially, this improved rapidly with adequate practice. Cognitive skills and especially the ability to expect the unexpected and the ability recognize complications presented as a significant challenge for trainees and transformed their understandings regarding the qualities of a microsurgeon.

Conclusions: This project has identified various factors that influence learning during a microsurgical fellowship. Microsurgical units should balance between the provision of services and providing adequate training opportunities for the microsurgical fellows.