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Background: Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model’s complexity, characteristics, advantages, disadvantages, and validation measures taken.

Methods: A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria.

Results: Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators.

Conclusions: A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today’s training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.

• up to date review of various forms of non-biological simulation - including VR ones
• only 57 articles
• metrics-based validation lacking
• specifics:
  • VR role uncertain
  • prosthetics “much greater educational value”
    • reduced costs, reduction in animal use, improved performance on animals, skill retention

It is therefore the authors’ wish that the information presented in this review be used to design an accessible training curriculum revolving around the implementation of nonbiological simulators, with the purpose of teaching microsurgical skills of increasing complexity, in a stepwise fashion, to train the next generation of plastic and reconstructive surgery residents in the practice of microsurgery.

• surgical_education
• How to write a Systematic Review

• Abi-Rafeh, J., Zammit, D., Mojtahed Jaberi, M., Al-Halabi, B., & Thibaudeau, S. (2019). Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review. Plastic and Reconstructive Surgery, 144(3), 496e–507e. https://doi.org/10.1097/PRS.0000000000005990

• created 2021-06-12