Added Qualifications in Microsurgery: Consideration for Subspecialty Certification in Microvascular Surgery in Europe

Abstract

Background While implementation of subspecializations may increase expertise in a certain area of treatment, there also exist downsides. Aim of this study was, across several disciplines, to find out if the technique of microsurgery warrants the introduction of a “Certificate of Added Qualifications (CAQ) in microsurgery.”

Methods An anonymous, web-based survey was administered to directors of microsurgical departments in Europe (n = 205). Respondents were asked, among other questions, whether they had completed a 12-month microvascular surgery fellowship and whether they believed a CAQ in microvascular surgery should be instituted.

Results The response rate was 57%, and 33% of the respondents had completed a 12-month microvascular surgery fellowship.

A total of 61% of all surgeons supported a CAQ in microsurgery. Answers ranged from 47% of support to 100% of support, depending on the countries surveyed.

Discussion This is one of the few reports to evaluate the potential role of subspecialty certification of microvascular surgery across several European countries. The data demonstrate that the majority of directors of microsurgical departments support such a certificate. There was significantly greater support for a CAQ in microsurgery among those who have completed a formal microvascular surgery fellowship themselves.

Conclusion This study supports the notion that further discussion and consideration of subspecialty certification in microvascular surgery appears necessary. There are multiple concerns surrounding this issue. Similar to the evolution of hand surgery certification, an exploratory committee of executive members of the respective medical boards and official societies may be warranted.

Keywords

reconstructive surgery - microsurgery - microvascular surgery - Certificate of Added Qualifications - curriculum

Note

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

• References

• 1 Bishop WJ. The Early History of Surgery. London: Hale; 1960
• 2 American Board of Medical Specialties. ABMS history of improving care. Available at: http://www.abms.org/aboutabms/history/ . Accessed March 10, 2015
• 3 American College of Surgeons. What are the surgical specialties?. Available at: https://www.facs.org/education/resources/medical-students/faq/specialties . Accessed March 10, 2015
• 4 The American Board of Surgery. About certification. Available at: http://www.absurgery.org/default.jsp?examoffered . Accessed March 10, 2015
• 5 Omer Jr GE. Development of hand surgery: education of hand surgeons. J Hand Surg Am 2000; 25 (4) 616-628
• 6 Omer GE. The Joint Committee for Surgery of the Hand. J Hand Surg Am 1982; 7 (3) 221-223
• 7 Noone RB. Facing the challenges of subspecialization. Plast Reconstr Surg 2013; 132 (1, Suppl): 23S-31S
• 8 Murphy JB. Resection of arteries and veins injured in continuity – end-to-end suture: experimental and clinical research. Med Rec 1897; 51: 73-88
• 9 Carrel A, Morel B. Anastomose bout à bout de la jugulaire et de la carotide primitive. Lyon Med 1902; 99: 114-116
• 10 Carrel A. La technique opératoire des anastomoses vasculaires et la transplantation des viscères. Lyon Med 1902; 98: 850-852
• 11 Carrel A, Guthrie CC. Results of a replantation of the thigh. Science 1906; 23 (584) 393-394
• 12 Tyagi S, Kumar S. Microsurgery: an important tool for reconstructive surgery - a clinical review. Int J Pharma Bio Sci 2010; 1 (3)
• 13 Buncke Jr HJ, Schulz WP. Total ear reimplantation in the rabbit utilising microminiature vascular anastomoses. Br J Plast Surg 1966; 19 (1) 15-22
• 14 Buncke Jr HJ, Buncke CM, Schulz WP. Immediate Nicoladoni procedure in the Rhesus monkey, or hallux-to-hand transplantation, utilising microminiature vascular anastomoses. Br J Plast Surg 1966; 19 (4) 332-337
• 15 Microsurgeon.org. The history of microsurgery. Available at: http://microsurgeon.org/history . Accessed March 10, 2015
• 16 Balasundaram I, Aggarwal R, Darzi LA. Development of a training curriculum for microsurgery. Br J Oral Maxillofac Surg 2010; 48 (8) 598-606
• 17 Chan W, Niranjan N, Ramakrishnan V. Structured assessment of microsurgery skills in the clinical setting. J Plast Reconstr Aesthet Surg 2010; 63 (8) 1329-1334
• 18 Ghanem AM, Hachach-Haram N, Leung CC, Myers SR. A systematic review of evidence for education and training interventions in microsurgery. Arch Plast Surg 2013; 40 (4) 312-319
• 19 Kolbeschlag J, Gehl B, Daiegeler A , et al. Microsurgical training in Germany - results of a survey among trainers and trainees [in German]. Handchir Mikrochir Plast Chir 2014; 46: 234-241
• 20 Leung CC, Ghanem AM, Tos P, Ionac M, Froschauer S, Myers SR. Towards a global understanding and standardisation of education and training in microsurgery. Arch Plast Surg 2013; 40 (4) 304-311
• 21 Satterwhite T, Son J, Carey J , et al. Microsurgery education in residency training: validating an online curriculum. Ann Plast Surg 2012; 68 (4) 410-414
• 22 Selber JC, Chang EI, Liu J , et al. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg 2012; 130 (4) 550e-557e
• 23 Temple CL, Ross DC. A new, validated instrument to evaluate competency in microsurgery: the University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument [outcomes article]. Plast Reconstr Surg 2011; 127 (1) 215-222
• 24 Reconstructive Microsurgery European School . Available at: http://www.rmes.es . Accessed March 10, 2015
• 25 Mogelvang C. Certificate of Added Qualifications: CAQ or “QAC”ery?. Plast Reconstr Surg 1998; 101 (5) 1381-1383
• 26 Layliev J, Broer PN, Saadeh PB , et al. The certificate of added qualifications in microsurgery: consideration for subspecialty certification in microvascular surgery in the United States. Plast Reconstr Surg 2015; 135 (1) 313-316
• 27 McCormack RM. “Plastikos”—capable of being molded. Plast Reconstr Surg 1969; 44 (3) 291-292
• 28 Evgeniou E, Tsironi M, Riley D. Improving fellowship training in microsurgery: a threshold concepts perspective on the curricula of fellowship programs. J Reconstr Microsurg 2015; 31 (8) 579-589
• 29 Tuggle CT, Patel A, Broer N, Persing JA, Sosa JA, Au AF. Increased hospital volume is associated with improved outcomes following abdominal-based breast reconstruction. J Plast Surg Hand Surg 2014; 48 (6) 382-388
• 30 Goldfarb CA, Lee WP, Briskey D, Higgins JP. An American Society for Surgery of the Hand (ASSH) task force report on hand surgery subspecialty certification and ASSH membership. J Hand Surg Am 2014; 39 (2) 330-334
• 31 American Society for Surgery of the Hand. General Requirements. Available at: http://www.assh.org/About-ASSH/Get-Involved/Join-ASSH/Subspecialty-Certificate-in-Surgery-of-the-Hand . Accessed November 11, 2015