Microsurgery Skill Retention - Implications for Continuous Professional Development and Revalidation

Introduction: Microsurgery is associated with a steep learning curve that requires deliberate practice to reach proficiency and excellence. Time away from regular microsurgery practice may lead to skill loss. Last year, the United Kingdom introduced medical revalidation to address increasing societal expectations that clinicians' performance is safe and effective throughout their career. This study aims to evaluate microsurgical skill loss over an average period of one year in a cohort of trainees who had previously attended a 5-day basic microsurgery course.

Methodology and Material: Candidates undergoing a standardized 5-day microsurgery skills course were evaluated by hand motion analysis (HMA) on the first day (pre-test) and last day (post-test). They were then recalled to a one day top-up training session approximately one year following their course completion date. At recall (retention-test), candidates performed the same standardized assessment (an end to end microvascular anastomosis) and were evaluated using the same HMA protocol. Three end-to-end microvascular anastomoses on non-living animal models were performed after the retention-test, followed immediately by another HMA standardized assessment (restoration-test). Both retention and restoration test scores were compared with trainees’ pre and post-test scores using a linear mixed effect repeated measure ANCOVA model.

Results: Average time (Mean + SD) to complete the task increased from 19.2 + 8 minutes (at post-test) to 21.1 + 6 minutes (retention-test) demonstrating evidence of skill loss. Top up training received at the recall session improved average time to complete the procedure to 16.3 + 4 minutes (restoration-test) demonstrating the value of top-up training. A similar pattern was noted when the number of hand movements and path length of the dominant index finger were analyzed.

Conclusions: This study demonstrates that microsurgery skill loss can be accurately measured following an educational intervention as well as after a period of idleness. The findings present the foundation for a model for definition of continuous professional development.