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Achieving Microsurgical Competency in Orthopaedic Residents Utilizing a Self-Directed Microvascular Training Curriculum

Luther, Gaurav, MD1; Blazar, Philip, MD1; Dyer, George, MD1

doi: 10.2106/JBJS.17.01089
Topics in Training
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Disclosures

Background: Education in microvascular surgery is limited by variable experience, a difficult learning curve, and potentially catastrophic complications caused by failed anastomoses. Furthermore, utilization of live-animal training models can be difficult because of lack of access and high maintenance costs. The purpose of this study was to determine the effectiveness and cost of a self-directed microvascular training curriculum utilizing synthetic microvessels and nonliving models in an orthopaedic residency program.

Methods: Twenty-five orthopaedic residents ranging from postgraduate year (PGY)-1 to PGY-4 were prospectively enrolled. The curriculum consisted of learning the basics of microsurgery on nonliving models and progressed to anastomoses on a 1-mm synthetic microvessel. Outcomes included Global Rating Scale (GRS) scores (5 to 25 points), patency, anastomosis time, comfort level (1 to 10 points), time to complete the curriculum, and curriculum utility (1 to 10 points). Blinded qualitative assessments (from 1 to 10 points) of pre-curriculum and post-curriculum anastomoses were made by 4 hand surgery faculty members. Outcome measures were obtained at baseline and post-curriculum. The curriculum cost was calculated as the setup cost and the maintenance cost per resident. Student t tests and Fisher exact tests were utilized for significance.

Results: All residents successfully completed the curriculum. The mean anastomosis time (and standard deviation) decreased from 40 ± 3 minutes to 22 ± 4 minutes (p < 0.001). The mean GRS score improved from 12 ± 2 points to 18 ± 2 points (p < 0.01). Patency was achieved by 44% at baseline evaluation and by 96% at post-curriculum evaluation (p < 0.0001). The mean comfort level improved from 3 ± 1.2 points to 6 ± 1.7 points (p < 0.0001) on a scale of 1 to 10 points. Also on a scale of 1 to 10, the blinded mean qualitative anastomoses score improved from 4.8 ± 2.2 points (poor) to 8.0 ± 1.1 points (good) (p < 0.0001). The mean time to complete the curriculum was 5.5 ± 1.4 hours, and, on a scale of 1 to 10, curriculum utility was rated by the residents to be 8 ± 1.8 points. The cost of the initial setup was $1,795 with a yearly utilization cost per resident of $42.

Conclusions: The implementation of a self-directed curriculum utilizing synthetic microvessels and nonliving models demonstrated significant improvements in resident microvascular skill. This curriculum represents a modest startup cost and low yearly cost per resident.

1Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

E-mail address for G. Luther: Luthera@gmail.com

Investigation performed at the Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/F117).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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