Development of a training curriculum for microsurgery.

Recent changes in healthcare necessitate revision of the current apprenticeship model of surgical training. Current methods of assessment such as examinations and logbooks are not criteria-based, so are subjective and lack validity and reliability. The objective feedback of technical skills is crucial to the structured learning of surgical skills. We review current publications about training and methods of assessment in microsurgery. Searches on PubMed using keywords (microsurgery, training, assessment, simulation, and skill) were used to retrieve relevant articles, and further cross-referencing was done to obtain more information. New methods of assessment that are objective include checklists, global rating scales (GRS), and dexterity analysis, which give feedback of technical skills during training. Vital (living), non-vital, prosthetic, and virtual reality simulation models can be used to train surgeons to a proficient level outside the operating theatre before they operate on real patients. After reviewing the current evidence we propose a curriculum for microsurgical training that starts outside the operating theatre. The surgical community should follow the example of other high-risk industries such as aviation, where continuous assessment on simulators is a part of training, but further research is necessary before such methods can be used for summative assessment and revalidation.