Effectiveness of a microvascular surgery training curriculum for orthopaedic surgery residents.

Abstract

The safe and effective acquisition of microvascular surgical skills is a challenge for any residency program. Variable clinical exposure to microsurgery, premiums on operating room efficiency, and a steep learning curve make these skills difficult to acquire through clinical experience alone. The purpose of this study was to determine the effectiveness of a training curriculum on the development of microvascular surgical skills in our orthopaedic residents. A microvascular training curriculum was completed during each third-year resident's rotation on the hand and upper-extremity service. The training cycle began with learning the basics of microvascular surgery on nonliving models and progressed to performing end-to-end arterial anastomoses on a live rat femoral artery in the second session. Outcome evaluations consisted of the Global Rating Scale score, achievement of patency, and time to completion. T test analyses of Global Rating Scale scores, achievement of patency, and time to completion were conducted to determine significance (p < 0.05). All residents significantly improved (p < 0.005) on Global Rating Scale scores from a mean score (and standard deviation) of 15 ± 4 points for the initial score to 20 ± 3 points for the post-test score. Of the twelve residents, patency was achieved by eleven at the final evaluation, compared with six before training. Time to completion of the anastomosis also significantly improved (p < 0.005), from a mean of 37:17 ± 8:41 minutes for the initial time to 24:46 ± 5:32 minutes for the final time. In an effort to improve the microvascular surgical skills of orthopaedic residents at our institution, a microvascular training curriculum was developed and was implemented. This curriculum was effective at improving resident microvascular surgical skills at the completion of an eight-week course.