Chacon Miranda A, Myers Paige L, Patel Alap U, Mitchell Drew C, Langstein Howard N, Leckenby Jonathan I
From the Division of Plastic Surgery, Department of Surgery, University of Rochester Medical Center, Rochester.
Ann Plast Surg. 2020 Jul;85(S1 Suppl 1):S122-S126. doi: 10.1097/SAP.0000000000002322.
Current microsurgical training courses average 5 consecutive 8-hour days and cost US $1500 to US $2500/individual, making training a challenge for residents who are unable to take leave from clinical duties. This residency-integrated microsurgery course was designed for integration with a residency program, averaging 3 hours/week over 7 weeks. This allows for one-on-one training, beginning with synthetic tissue and concluding with in vivo stimulation. This study was performed to validate this longitudinal training course.
After recruitment and before the start of coursework, subjects completed a baseline anastomosis without guidance and a survey regarding microsurgical experience. Subjects completed approximately 3 hours/week of practical exercises. Weeks 1 to 5 used synthetic models, whereas 6 to 7 used in vivo rodent models. Nine minimum anastomoses of increasing complexity were completed and assessed with the Anastomosis Lapse Index and the Stanford Microsurgery and Residency Training scale. Scoring was performed by 3 independent reviewers and averaged for comparison.
Five subjects completed the course for study. Presurvey results showed an average confidence in theoretical knowledge of 2/5; technical ability to perform procedures, 1.8/5; and ability to manage complications, 1.8/5. Postsurvey revealed confidence in theoretical knowledge of 2.5/5; technical ability to perform procedures, 2.25/5; and ability to manage complications, 2.25/5. None of these differences were significant. Each individual component of the Stanford Microsurgery and Residency Training scale scoring system improved postcourse with P < 0.05, and overall performance score improved from an average of 2.6 to 3.9 (P = 0.006). The total number of errors recorded using the Anastomosis Lapse Index reduced from 6.58 to 3.41 (P = 0.02). Time to completion reduced from an average of 28 minutes, 8 seconds to 24 minutes, 5 seconds (P = 0.003).
Despite a lack in significant confidence improvement, completion of the residency-integrated microsurgery course leads to significant and quantifiable improvement in resident microsurgical skill and efficiency.
当前的显微外科培训课程平均持续5个连续的8小时工作日，每位学员的费用为1500至2500美元，这使得无法从临床工作中请假的住院医师面临培训挑战。这个与住院医师培训项目相结合的显微外科课程设计为与住院医师培训项目整合，在7周内平均每周3小时。这允许进行一对一培训，从合成组织开始，以体内刺激结束。本研究旨在验证这一长期培训课程。
在招募学员并在课程开始前，受试者在无指导的情况下完成一次基线吻合，并完成一份关于显微外科经验的调查问卷。受试者每周完成约3小时的实践练习。第1至5周使用合成模型，而第6至7周使用体内啮齿动物模型。完成并评估了9次难度递增的最小吻合，并使用吻合口失误指数和斯坦福显微外科与住院医师培训量表进行评估。评分由3名独立评审员进行，并取平均值进行比较。
5名受试者完成了该研究课程。预调查结果显示，理论知识的平均信心得分为2/5；执行手术的技术能力得分为1.8/5；处理并发症的能力得分为1.8/5。调查后显示，理论知识的信心得分为2.5/5；执行手术的技术能力得分为2.25/5；处理并发症的能力得分为2.25/5。这些差异均无统计学意义。斯坦福显微外科与住院医师培训量表评分系统的每个单独组成部分在课程结束后均有改善（P < 0.05），总体表现评分从平均2.6提高到3.9（P = 0.006）。使用吻合口失误指数记录的总错误数从6.58减少到3.41（P = 0.02）。完成时间从平均28分08秒减少到24分05秒（P = 0.003）。
尽管信心提升不显著，但完成与住院医师培训项目相结合的显微外科课程可使住院医师的显微外科技能和效率得到显著且可量化的提高。
