A Novel Model for Acquisition of Microsurgical Skills: A Pilot Study for Junior Residents

Background: Microsurgical training has largely relied on the apprenticeship model where trainees acquire skills and gain experience in the operating room. However, with restrictions in work hours as well as a greater awareness of patient safety, it is imperative that surgical training is efficient and thoughtful. Mastery of microsurgical skills is a core competency for a training neurosurgeon (ACGME 2018) and, relies on significant dexterity and regular practice under high powered magnification. Synthetic simulation models are typically expensive (Ishikawa et al 2010) or specific to one tissue type (e.g., vessel wall; Byvaltsev et al 2018). There is a need for an affordable, comprehensive training model that contains analogs to the different types of tissues that neurosurgeons encounter.

Methods: We aimed to develop a cost-effective model to teach the basic principles of microsurgery to junior residents. We used the chicken thigh as our model to teach dural closure, arachnoid dissection, vessel anastomosis, and nerve coaptation. The chicken skin was used to teach dural closure, the areolar fascia in the scale of the chicken resembled the arachnoid and served as a way of teaching arachnoid dissection, and the nerve and artery served as substrates for nerve and vessel anastomoses respectively ([Fig. 1]). We used this model to teach microsurgical skills to the PGY-3 resident class (n = 3) at our institution. Each PGY-3 received one-on-one instructions from a faculty member on each skill over the course of an hour. Pre- and post-intervention surveys were conducted looking at self-reported confidence in microsurgical skills.

Fig. 1

Results: In the pre-intervention survey, there was no significant difference is reported confidence and comfort with microsuturing skills between the PGY-1 and PGY-3 residents ([Fig. 2]). After the hour-long individualized intervention, all three PGY-3 residents reported that the skills they learned from the session would help them in the operating room (strongly agree, n = 3) and that they picked up new technical strategies that advanced their surgical skills (strongly agree, n = 3). We plan to conduct a session to test the reliability of the model at 3 months from the initial intervention by timing the three skills in residents who received the intervention compared to those who did not.

Fig. 2

Conclusion: We describe an affordable, easily accessible model to teach and assess varying techniques in microsurgical dissection and suturing to junior neurosurgical residents. Future work will assess the reliability of this model as an assessment tool by comparing the speed and efficiency of suturing among residents in varying stages of training.

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Artikel online veröffentlicht:
05. Februar 2024