Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Research Priorities in Light of Current Trends in Microsurgical Training: Revalidation, Simulation, Cross-Training, and Standardisation

  • Nicholas, Rebecca Spenser (Department of Plastic Surgery, Royal London Hospital) ;
  • Madada-Nyakauru, Rudo N. (Imperial College London) ;
  • Irri, Renu Anita (Imperial College London) ;
  • Myers, Simon Richard (Academic Plastic Surgery Group, Barts and the London School of Medicine and Dentistry) ;
  • Ghanem, Ali Mahmoud (Academic Plastic Surgery Group, Barts and the London School of Medicine and Dentistry)
  • Received : 2013.02.23
  • Accepted : 2013.04.05
  • Published : 2014.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Plastic surgery training worldwide has seen a thorough restructuring over the past decade, with the introduction of formal training curricula and work-based assessment tools. Part of this process has been the introduction of revalidation and a greater use of simulation in training delivery. Simulation is an increasingly important tool for educators because it provides a way to reduce risks to both trainees and patients, whilst facilitating improved technical proficiency. Current microsurgery training interventions are often predicated on theories of skill acquisition and development that follow a 'practice makes perfect' model. Given the changing landscape of surgical training and advances in educational theories related to skill development, research is needed to assess the potential benefits of alternative models, particularly cross-training, a model now widely used in non-medical areas with significant benefits. Furthermore, with the proliferation of microsurgery training interventions and therefore diversity in length, cost, content and models used, appropriate standardisation will be an important factor to ensure that courses deliver consistent and effective training that achieves appropriate levels of competency. Key research requirements should be gathered and used in directing further research in these areas to achieve on-going improvement of microsurgery training.

Keywords

References

  1. General Medical Council. Registration and licensing: revalidation [Internet]. London: General Medical Council; c2013 [cited 2012 Dec 28]. Available from: http://www.gmc-uk.org/doctors/revalidation.asp.
  2. Stevens RJ. Do consultants want e-learning in plastic surgery for continuing professional development and revalidation? J Plast Reconstr Aesthet Surg 2011;64:e50-2. https://doi.org/10.1016/j.bjps.2010.09.012
  3. Rogers SN, Lowe D. British Association of Oral and Maxillofacial Surgeons first national audit in support of revalidation. Br J Oral Maxillofac Surg 2011;49:478-9. https://doi.org/10.1016/j.bjoms.2010.09.017
  4. Moulton CA, Dubrowski A, Macrae H, et al. Teaching surgical skills: what kind of practice makes perfect? a randomized, controlled trial. Ann Surg 2006;244:400-9.
  5. Bardes CL, Gillers D, Herman AE. Learning to look: developing clinical observational skills at an art museum. Med Educ 2001;35:1157-61. https://doi.org/10.1046/j.1365-2923.2001.01088.x
  6. Alricsson M, Werner S. The effect of pre-season dance training on physical indices and back pain in elite cross-country skiers: a prospective controlled intervention study. Br J Sports Med 2004;38:148-53. https://doi.org/10.1136/bjsm.2002.2402
  7. Kloubec JA. Pilates for improvement of muscle endurance, flexibility, balance, and posture. J Strength Cond Res 2010;24:661-7. https://doi.org/10.1519/JSC.0b013e3181c277a6
  8. Robotin MC, Jones SC, Biankin AV, et al. Defining research priorities for pancreatic cancer in Australia: results of a consensus development process. Cancer Causes Control 2010;21:729-36. https://doi.org/10.1007/s10552-010-9501-1
  9. Kilian BJ, Binder LS, Marsden J. The emergency physician and knowledge transfer: continuing medical education, continuing professional development, and self-improvement. Acad Emerg Med 2007;14:1003-7. https://doi.org/10.1111/j.1553-2712.2007.tb02380.x
  10. Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Br J Surg 2004;91:1549-58. https://doi.org/10.1002/bjs.4816
  11. Selber JC, Chang EI, Liu J, et al. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg 2012;130:551e-8e.
  12. Temple CL, Ross DC. A new, validated instrument to evaluate competency in microsurgery: the University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument. Plast Reconstr Surg 2011;127:215-22. https://doi.org/10.1097/PRS.0b013e3181f95adb
  13. Kalu PU, Atkins J, Baker D, et al. How do we assess microsurgical skill? Microsurgery 2005;25:25-9. https://doi.org/10.1002/micr.20078
  14. Jabbour N, Sidman J. Assessing instrument handling and operative consequences simultaneously: a simple method for creating synced multicamera videos for endosurgical or microsurgical skills assessments. Simul Healthc 2011;6:299-303. https://doi.org/10.1097/SIH.0b013e318216fce4
  15. Datta V, Mackay S, Mandalia M, et al. The use of electromagnetic motion tracking analysis to objectively measure open surgical skill in the laboratory-based model. J Am Coll Surg 2001;193:479-85. https://doi.org/10.1016/S1072-7515(01)01041-9
  16. Balasundaram I, Aggarwal R, Darzi LA. Development of a training curriculum for microsurgery. Br J Oral Maxillofac Surg 2010;48:598-606. https://doi.org/10.1016/j.bjoms.2009.11.010
  17. Grober ED, Roberts M, Shin EJ, et al. Intraoperative assessment of technical skills on live patients using economy of hand motion: establishing learning curves of surgical competence. Am J Surg 2010;199:81-5. https://doi.org/10.1016/j.amjsurg.2009.07.033
  18. Schoffl H, Froschauer SM, Dunst KM, et al. Strategies for the reduction of live animal use in microsurgical training and education. Altern Lab Anim 2008;36:153-60.
  19. Berkley J, Turkiyyah G, Berg D, et al. Real-time finite element modeling for surgery simulation: an application to virtual suturing. IEEE Trans Vis Comput Graph 2004;10:314-25. https://doi.org/10.1109/TVCG.2004.1272730
  20. Meier AH, Rawn CL, Krummel TM. Virtual reality: surgical application: challenge for the new millennium. J Am Coll Surg 2001;192:372-84. https://doi.org/10.1016/S1072-7515(01)00769-4
  21. Grober ED, Hamstra SJ, Wanzel KR, et al. Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill. J Urol 2004;172:378-81. https://doi.org/10.1097/01.ju.0000123824.74075.9c
  22. Evgeniou E, Loizou P. Simulation-based surgical education. ANZ J Surg 2013;83:619-23. https://doi.org/10.1111/j.1445-2197.2012.06315.x
  23. Sadideen H, Hamaoui K, Saadeddin M, et al. Simulators and the simulation environment: getting the balance right in simulation-based surgical education. Int J Surg 2012;10:458-62. https://doi.org/10.1016/j.ijsu.2012.08.010
  24. Megaw R, Rane-Malcolm T, Brannan S, et al. Revalidation and electronic cataract surgery audit: a Scottish survey on current practice and opinion. Eye (Lond) 2011;25:1471-7. https://doi.org/10.1038/eye.2011.203
  25. Satterwhite T, Son J, Carey J, et al. Microsurgery education in residency training: validating an online curriculum. Ann Plast Surg 2012;68:410-4. https://doi.org/10.1097/SAP.0b013e31823b6a1a
  26. Torkington J, Williams G. Training the trainees will improve uptake of laparoscopic colorectal surgery. Colorectal Dis2010;12:707-8. https://doi.org/10.1111/j.1463-1318.2010.02225.x
  27. Stefanidis D, Arora S, Parrack DM, et al. Research priorities in surgical simulation for the 21st century. Am J Surg 2012;203:49-53. https://doi.org/10.1016/j.amjsurg.2011.05.008
  28. Bryan L, Harter N. Studies on the telegraphic language: the acquisition of a hierarchy of habit. Psychol Rev 1899;6:345-75. https://doi.org/10.1037/h0073117
  29. Schmidt RA, Bjork RA. New conceptualizations of practice: common principles in three paradigms suggest new concepts for training. Psychol Sci 1992;3:207-17. https://doi.org/10.1111/j.1467-9280.1992.tb00029.x
  30. Edmonds K, Hammond MF. How can visual arts help doctors develop medical insight? Int j Art Des Educ 2012;31:78-89. https://doi.org/10.1111/j.1476-8070.2012.01716.x
  31. Dolev JC, Friedlaender LK, Braverman IM. Use of fine art to enhance visual diagnostic skills. JAMA 2001;286:1020-1. https://doi.org/10.1001/jama.286.9.1020
  32. Bajaj AK. Cross-training in plastic surgery [Internet]. Arlington Heights: Plastic and Reconstructive Surgery (Journal of the American Society of Plastic Surgeons); 2012 Nov 19 [cited 2014 Feb 1]. Available from: http://journals.lww.com/plasreconsurg/blog/PRSonallySpeaking/pages/post.aspx?PostID=120.
  33. Ames JB, Lurie JD, Tomek IM, et al. Does surgeon volume for total hip arthroplasty affect outcomes after hemiarthroplasty for femoral neck fracture? Am J Orthop (Belle Mead NJ) 2010;39:E84-9.
  34. Milburn JA, Khera G, Hornby ST, et al. Introduction, availability and role of simulation in surgical education and training: review of current evidence and recommendations from the Association of Surgeons in Training. Int J Surg 2012;10:393-8. https://doi.org/10.1016/j.ijsu.2012.05.005
  35. Aucar JA, Groch NR, Troxel SA, et al. A review of surgical simulation with attention to validation methodology. Surg Laparosc Endosc Percutan Tech 2005;15:82-9. https://doi.org/10.1097/01.sle.0000160289.01159.0e
  36. Spencer F. Teaching and measuring surgical techniques: the technical evaluation of competence. Bull Am Coll Surg 1978;64:9-12.
  37. Gawande AA, Zinner MJ, Studdert DM, et al. Analysis of errors reported by surgeons at three teaching hospitals. Surgery 2003;133:614-21. https://doi.org/10.1067/msy.2003.169
  38. Darzi A, Smith S, Taffinder N. Assessing operative skill. Needs to become more objective. BMJ 1999;318:887-8. https://doi.org/10.1136/bmj.318.7188.887
  39. Barnes RW. Surgical handicraft: teaching and learning surgical skills. Am J Surg 1987;153:422-7. https://doi.org/10.1016/0002-9610(87)90783-5
  40. Yule S, Flin R, Paterson-Brown S, et al. Development of a rating system for surgeons' non-technical skills. Med Educ 2006;40:1098-104. https://doi.org/10.1111/j.1365-2929.2006.02610.x
  41. Beard JD. Assessment of surgical skills of trainees in the UK. Ann R Coll Surg Engl 2008;90:282-5.
  42. Friedman L, Leedom DK, Howell WC. Training situational awareness through pattern recognition in a battlefield environment. Mil Psychol 1991;3:105-12. https://doi.org/10.1207/s15327876mp0302_3
  43. Nugent E, Joyce C, Perez-Abadia G, et al. Factors influencing microsurgical skill acquisition during a dedicated training course. Microsurgery 2012;32:649-56. https://doi.org/10.1002/micr.22047
  44. Van Herzeele I, O'Donoghue KG, Aggarwal R, et al. Visuospatial and psychomotor aptitude predicts endovascular performance of inexperienced individuals on a virtual reality simulator. J Vasc Surg 2010;51:1035-42. https://doi.org/10.1016/j.jvs.2009.11.059
  45. Singley MK, Anderson JR. The transfer of cognitive skill. Cambridge, MA: Harvard University Press; 1989.
  46. Kramer AF, Strayer DL, Buckley J. Development and transfer of automatic processing. J Exp Psychol Hum Percept Perform 1990;16:505-22. https://doi.org/10.1037/0096-1523.16.3.505
  47. Ferguson MC, Rice MS. The effect of contextual relevance on motor skill transfer. Am J Occup Ther 2001;55:558-65. https://doi.org/10.5014/ajot.55.5.558
  48. Rosenbaum DA, Carlson RA, Gilmore RO. Acquisition of intellectual and perceptual-motor skills. Annu Rev Psychol 2001;52:453-70. https://doi.org/10.1146/annurev.psych.52.1.453
  49. Wokes J. Microsurgery training courses: a review. Face Mouth Jaw Surg 2012;2:12-5.
  50. Martins PN, Montero EF. Basic microsurgery training: comments and proposal. Acta Cir Bras 2007;22:79-81. https://doi.org/10.1590/S0102-86502007000100014
  51. Grober ED, Hamstra SJ, Wanzel KR, et al. The educational impact of bench model fidelity on the acquisition of technical skill: the use of clinically relevant outcome measures. Ann Surg 2004;240:374-81. https://doi.org/10.1097/01.sla.0000133346.07434.30
  52. Studinger RM, Bradford MM, Jackson IT. Microsurgical training: is it adequate for the operating room? Eur J Plast Surg 2005;28:91-3. https://doi.org/10.1007/s00238-005-0756-9
  53. Martin JA, Regehr G, Reznick R, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84:273-8. https://doi.org/10.1002/bjs.1800840237
  54. Grober ED, Hamstra SJ, Wanzel KR, et al. Validation of novel and objective measures of microsurgical skill: Hand-motion analysis and stereoscopic visual acuity. Microsurgery 2003;23:317-22. https://doi.org/10.1002/micr.10152

Cited by

  1. Regenerative effect of the polydeoxyribonucleotide after sciatic nerve transection in mouse vol.12, pp.6, 2014, https://doi.org/10.1007/s13770-015-0023-5