Trauma’12 Winning Abstract - End Product Assessment in Microsurgery Simulation Training - A New Insider View

Abstract

Background There are various assessment methods that allow the evaluation of skills acquisition in microsurgery simulation training such as global rating scores and check lists. The present scoring systems are used to analyse the process of conducting an anastomosis. This paper presents a novel quantitative method based on assessing the intimal surface of the anastomosis to analyse the end product. Method 24 candidates were recruited for a five day microsurgical skills acquisition course. The cohort ranged from undergraduate medical students to experts microsurgeons. On days three and five, the trainees performed two assessment anastomoses on cryopreserved rat aortas (average diameter = 1.75 millimeter). These were cut open to expose the intimal surface of the anastomosis and a high magnification photo was taken. The photos were then analysed using ImageJ. The perfect anastomosis was defined as having equidistant insertion points, equal suture lengths across the anastomosis line, and a single axis meaning that there is no torsion in the vessel edges. In turn, 4 parameters were measured: 1) distance between the proximal insertion points, 2) distance between the distal insertion points, 3) length of sutures placed, 4) number of axes. Using these parameters, a 10 component scoring system was produced by a 3 point linkert scale giving 0, 5, and 10 points for scores between the range of 0–50th, 51st to 75th and above the 75th centile respectively. The maximum score achievable is 100. Results The thresholds of this scoring system were defined based on the population performance. In our cohort the scores ranged from 0–95. This system demonstrated both concurrent and construct validity (p Conclusion This novel scoring system satisfies an area of microsurgical skills acquisition assessment that has not yet been covered in great depth. The system allows objective assessment of the anastomosis's quality thus paving the way for identifying clinical safe threshold of microsurgery simulated training. In the future we can correlate this system to physiological anastomosis outcome measures such as patency rate and other methods of microsurgery assessment skills to establish the predictive validity of this system in discriminating trainees who have reached clinically competent standards in microsurgery.