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Tracking the Learning Curve in Microsurgical Skill Acquisition

Selber, Jesse C. M.D., M.P.H.; Chang, Edward I. M.D.; Liu, Jun M.S.; Suami, Hiroo M.D., Ph.D.; Adelman, David M. M.D., Ph.D.; Garvey, Patrick M.D.; Hanasono, Matthew M. M.D., Ph.D.; Butler, Charles E. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 550e–557e
doi: 10.1097/PRS.0b013e318262f14a
Reconstructive: Trunk: Original Articles

Background: Despite advances in surgical training, microsurgery is still based on an apprenticeship model. To evaluate skill acquisition and apply targeted feedback to improve their training model, the authors applied the Structured Assessment of Microsurgery Skills to the training of microsurgical fellows. They hypothesized that subjects would demonstrate measurable improvement in performance throughout the study period and consistently across evaluators.

Methods: Seven fellows were evaluated during 118 microsurgical cases by 16 evaluators over three 1-month evaluation periods in 1 year (2010 to 2011). Evaluators used the Structured Assessment of Microsurgery Skills questionnaire, which measures dexterity, visuospatial ability, operative flow, and judgment. To validate the data, microsurgical anastomoses in rodents performed by the fellows in a laboratory at the beginning and end of the study period were evaluated by five blinded plastic surgeons using the same questionnaire. Primary outcomes were change in scores between evaluation periods and interevaluator reliability.

Results: Between the first two evaluation periods, all skill areas and overall performance improved significantly. Between the second two periods, most skill areas improved, but only a few improved significantly. Operative errors decreased significantly between the first and subsequent periods (81 versus 36; p < 0.05). In the laboratory study, all skills were significantly (p < 0.05) or marginally (0.05 < p < 0.10) improved between time points. The overall interevaluator reliability of the questionnaire was acceptable (α = 0.67).

Conclusions: The Structured Assessment of Microsurgery Skills questionnaire is a valid instrument for assessing microsurgical skill, providing individualized feedback with acceptable interevaluator reliability. Use of the questionnaire is anticipated to enhance microsurgical training.


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Houston, Texas

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Received for publication April 17, 2012; accepted April 27, 2012.

Disclosure:The authors have no disclosures or conflicts of interest relevant to the content of this article.

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Jesse C. Selber, M.D., M.P.H., Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, 1400 Pressler Street, Unit 1488, Houston, Texas 77030,

©2012American Society of Plastic Surgeons