I am interested in the teaching and learning of surgery, particular the technical skills in the OR. Using microvascular anastomosis as a model of a complex surgical task, I am interested to understand how simulation, particularly low-fidelity simulation models can be used to acquire the necessary skills for surgery.

Laparascopic surgery has the best developed simulation models and programmes for this. We should ride on the knowledge gained from their experience to also develop more effective, efficient, and evidence supported microvascular training programmes.

Microsurgery Assessment

Does teaching/ learning of microsurgery help develop skills in other areas of surgery? and vice versa?

• almeland2019 suggests teaching microsurgery does not improve their macrosurgical skills, but does increase their interest in plastic surgery. I have some concerns about the study methodology.

How much time do you need to develop microsurgical skills?

• onoda2015 suggests 7-8 hours a day for 15 days is sufficient.

Training

There is some evidence that surgical aptitude and attitude can predict performance in surgical training see Moore2015

For medical students: the effect of a curriculum entering surgical rotation: Evaluation of Technical and Non-Technical Skills Curriculum for Students Entering Surgery

• Predictors of Surgical Performance: see Maan2012
• Entrustable Professional Activities
  • Potential benefits and pitfalls
• Educational Needs in Hand Surgery

• Fitts-Posner: Learning and Skilled Performance

There is good evidence that low fidelity/cheaper simulation works as well as more expensive high tech ones, particularly for novices. See this Systematic Review

1. Low-Fi training can improve cadaveric endoscopic sinus surgery in cadaver
2. May need at least moderate fidelity for non-technical skill acquisition
3. Box trainer as good as hi tech laparascopic trainer in novices

1. Retention and Decay
2. Motivation
3. Metacognition. See burman2014; also mentioned in peyre2011

1. Technical and Non-technical skills are interdependent

1. Objective assessment of technical skills in surgery

• kim2019

How much simulation?

• Does more simulation help in fracture reduction?

While becoming more common, there are concerns about:

• transferability
  • Predictors of transfer
• retention
  • A recent review
• The role and validity of surgical simulation

Assessment

• Surgical training assessment by Darzi
• A secondary task can differentiate experts from trained and novices. See stefanidis2007
• Systematic Review of Surgical Competency

Success in Medicine

Peyre2011 discusses Fitts-Posner, Transfer Theory, and Expert Performance Theory

Personal Learning Plan

Expertise

Glossary

Sleep Deprivation on Surgeon's Dexterity

• The reflective practitioner. How professionals think in action