24. The Duke Microsurgery Training Model: Curriculum Creation and Implementation

Abstract

Background: Given the increased emphasis on patient safety within healthcare systems, the ACGME now supports the use of competency-based education models. In surgery, the Fundamentals of Laparoscopic Surgery and Endoscopic Surgery were created to ensure a basic level of competency among graduating general surgery residents. In plastic surgery, despite the highly technical nature of the field, there are no comparable national programs. Regarding microsurgery, currently only 16% of programs require a skills assessment prior to participation in microsurgery in the operating room. Furthermore, 77% of residents think that a comprehensive, multi-year training curriculum would be beneficial. Therefore, our goal was to create a comprehensive, multi-year curriculum for Duke Plastic Surgery residents to develop microsurgery skills. Methods: The Duke Microsurgery Training Model was created by evaluating currently published curricula for microsurgery training including currently available skills simulations and assessment rubrics. They were then adapted into a proposed multi-year microsurgery curriculum for a 6-year integrated residency program to support the development of microsurgery skills. Results: We developed a 6-year microsurgery curriculum that will be implemented over the course of this year. Based on the curriculum, each class has one dedicated teaching session in the microsurgery lab to work on a pre-defined set of level appropriate skills. Additionally, the PGY 1/2 classes will have a dedicated introduction to microsurgery including the standard instruments and use and the microscope use. The curriculum will be evaluated using standardized survey data and will be iteratively improved based on resident feedback. Further, each resident will be video recorded performing an end-to-end anastomosis at the end of each year. These will be reviewed and graded in a blinded manner using the Stanford Microsurgery and Resident Training Scale (SMaRT). The grades will be released to the residents yearly as part of their comprehensive feedback. Conclusion: Creation and implementation of the Duke Microsurgery Training Model will allow Duke to create a standardized and competency-based training model for the highly technical skill of microsurgical anastomosis. Using this model, we hope to have the junior residents become proficient in microsurgical skills before performing these skills intraoperatively.