Evaluation of a Microsurgery Training Curriculum

J Reconstr Microsurg. 2022 Dec 23. doi: 10.1055/a-2003-7689. Online ahead of print.

Abstract

Background Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, the majority focus on technical skill only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model. Methods A training curriculum was delivered over 5 days between 2017 to 2020 focusing on: 1) microscopic field manipulation, 2) knot tying, non-dominant hand usage, 3) 3D models/anastomosis, 4) tissue experience. The four levels of Kirkpatrick's evaluation model were applied:1) participants feedback 2) skills development using a validated, objective assessment tool (GAS form) and CUSUM charts were constructed to model proficiency gain 3) and 4) assessing skill retention/long-term impact. Results 155 participants undertook the curriculum, totalling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for 'good'. Unanimous agreement among the learners that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1-3 (median score 4) and days 4-5 (median score 5) (W = 494.5, p = 0.00170). The frequency of errors reduced with successive attempts (Chi-sq = 9.81, p = 0.00174). The steepest learning curve was in anastomosis and patency domains, requiring eleven attempts on average to reach proficiency. 88.5% survey respondents could apply the skills learnt and 76.9% applied the skills learnt within 6 months. Key areas of improvement were identified from this evaluation and actions to address them were implemented in following programmes. Conclusions Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows identification of areas of improvement, driving refinement of training programmes.