Mastering Microsurgery: A Novel Benchmarking Tool for Microsurgical Training

ABSTRACT Introduction and Objective The shift of surgical training from apprenticeship towards competency-based training demands objective assessments of microsurgical skills to achieve mastery. Our objective was to create a novel platform to provide feedback to surgical trainees relative to competency expected at their level of exposure. Methods A 5-day simulated microsurgery course was run between 2013-2016 with 107 participants. Data of end-to-end micro-anastomoses was collected on days 1, 3, and 5 using video recording and hand motion analysis system. Videos were analysed to calculate the QMUL Global Rating Scale. Two charts were created to track the acquisition of microsurgical skills which plotted the number of hand movements and the QMUL Global Rating Scale against the participants' cumulative number of micro-anastomoses performed. Participant data was used to calculate a skills acquisition line for each quartile, analogous to percentiles on a growth chart. Results For a cumulative number of 0 prior micro-anastomoses, the GRS score at the 25th, 50th and 75th percentile was 45.5, 55, and 62 respectively. As the number cumulative anastomoses increased, there was a distinct increase in the GRS score to 89.5, 93, and 92 for the group with 55-100 previous micro-anastomoses. This was replicated with a decreased number of hand movements with experience. This tool allows trainees to track where they lie in the skill spectrum relative to prior experience and defines the standard an "expert" would achieve. Conclusion In conclusion, our tool allows trainees to track improvement and permits provision of focused training to trainees at lower percentiles which has potential to improve clinical outcomes.
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