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Microtools: A systematic review of validated assessment tools in microsurgery

      Summary

      Background

      Microsurgery is a technically demanding aspect of surgery that is integral to a variety of sub-specialties. Microsurgery is required in high-risk cases where time is limited and pressure is high, so there is increasing demand for skills acquisition beforehand. The aim of this review was to analyse the available literature on validated microsurgical assessment tools.

      Methods

      Covidence was used to screen papers for inclusion. Keywords included ‘microsurgery’, ‘simulation’, ‘end-product assessment’ and ‘competence’. Inclusion criteria specified simulation models which demonstrate training and assessment of skill acquisition simultaneously. Tools which were used for training independently of technical assessment were excluded and so were tools which did not include a microvascular anastomosis. Each assessment tool was evaluated for validity, bias, complexity and fidelity and reliability using PRISMA and SWiM guidelines.

      Results

      Thirteen distinct tools were validated for use in microsurgical assessment. These can be divided into overall assessment and end-product assessment. Ten tools assessed the ‘journey’ of the operation, and three tools were specifically end-product assessments.
      All tools achieved construct validity. Criterion validity was only assessed for the UWOMSA
      • Temple CL
      • Ross DC.
      A new, validated instrument to evaluate competency in microsurgery: The University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument.
      and GRS.
      • Reznick R
      • Regehr G
      • MacRae H
      • Martin J
      • McCulloch W
      Testing technical skill via an innovative "bench station" examination.
      Interrater reliability was demonstrated for each tool except the ISSLA
      • Pafitanis G
      • Veljanoski D
      • Ghanem AM
      • Myers S.
      Intimal surface suture line (End-Product) assessment of end-to-side microvascular anastomosis.
      and SAMS.
      • Chan W
      • Niranjan N
      • Ramakrishnan V.
      Structured assessment of microsurgery skills in the clinical setting.
      Four of the tools addressed demonstrate predictive validity.
      • Chan W
      • Niranjan N
      • Ramakrishnan V.
      Structured assessment of microsurgery skills in the clinical setting.
      • Kim E
      • Norman ICF
      • Myers S
      • Singh M
      • Ghanem A.
      The end game - a quantitative assessment tool for anastomosis in simulated microsurgery.
      • Odobescu A
      • Dawson D
      • Goodwin I
      • Harris PG
      • BouMerhi J
      • Danino MA.
      High-fidelity microsurgical simulation: The thiel cadaveric nerve model and evaluation instrument.
      • Satterwhite T
      • Son J
      • Carey J
      • et al.
      The Stanford Microsurgery and Resident Training (SMaRT) Scale: validation of an on-line global rating scale for technical assessment.

      Conclusion

      Thirteen assessment tools achieve variable validity for use in microsurgery. Interrater reliability is demonstrated for 11 of the 13 tools. The GRS and UWOMSA achieve intrarater reliability. The End Product Intimal Assessment tool and the Imperial College of Surgical Assessment device were valid tools for objective assessment of microsurgical skill.

      Keywords

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      References

        • Temple CL
        • Ross DC.
        A new, validated instrument to evaluate competency in microsurgery: The University of Western Ontario Microsurgical Skills Acquisition/Assessment instrument.
        Plast Reconstr Surg. 2011; 127 ([outcomes article]): 215-222
        • Reznick R
        • Regehr G
        • MacRae H
        • Martin J
        • McCulloch W
        Testing technical skill via an innovative "bench station" examination.
        Am J Surg. 1997; 173: 226-230
        • Pafitanis G
        • Veljanoski D
        • Ghanem AM
        • Myers S.
        Intimal surface suture line (End-Product) assessment of end-to-side microvascular anastomosis.
        Plast Reconstr Surg Glob Open. 2017; 5: e1409
        • Chan W
        • Niranjan N
        • Ramakrishnan V.
        Structured assessment of microsurgery skills in the clinical setting.
        J Plast Reconstr Aesthet Surg. 2010; 63: 1329-1334
        • Kim E
        • Norman ICF
        • Myers S
        • Singh M
        • Ghanem A.
        The end game - a quantitative assessment tool for anastomosis in simulated microsurgery.
        J Plast Reconstr Aesthet Surg. 2020; 73: 1116-1121
        • Odobescu A
        • Dawson D
        • Goodwin I
        • Harris PG
        • BouMerhi J
        • Danino MA.
        High-fidelity microsurgical simulation: The thiel cadaveric nerve model and evaluation instrument.
        Plast Surg. 2019; 27: 289-296
        • Satterwhite T
        • Son J
        • Carey J
        • et al.
        The Stanford Microsurgery and Resident Training (SMaRT) Scale: validation of an on-line global rating scale for technical assessment.
        Ann Plast Surg. 2014; 72: S84-S88
        • Lascar I
        • Totir D
        • Cinca A
        • et al.
        Training program and learning curve in experimental microsurgery during the residency in plastic surgery.
        Microsurgery. 2007; 27: 263-267
        • Stefanidis D.
        Optimal acquisition and assessment of proficiency on simulators in surgery.
        Surg Clin N Am. 2010; 90: 475-489
        • Sturm LP
        • Windsor JA
        • Cosman PH
        • Cregan P
        • Hewett PJ
        • Maddern GJ.
        A systematic review of skills transfer after surgical simulation training.
        Ann Surg. 2008; 248: 166-179
        • Pandey V
        • Wolfe J
        • Black S
        • Cairols M
        • Liapis C
        • Bergqvist D.
        Self-assessment of technical skill in surgery: The need for expert feedback.
        Ann R Coll Surg Engl. 2008; 90: 286-290
        • Carmines EG
        • Zeller RA.
        Reliability and Validity Assessment.
        SAGE Publications, 1979
      1. Innovation VH. Covidence Systematic Review Software. Melbourne, Australia.

        • Liberati A
        • Altman DG
        • Tetzlaff J
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Campbell M
        • McKenzie JE
        • Sowden A
        • et al.
        Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline.
        BMJ. 2020; 368: l6890
      2. Taber KS. The use of Cronbach's alpha when developing and reporting research instruments in science education.

        • Selber JC
        • Chang EI
        • Liu J
        • et al.
        Tracking the learning curve in microsurgical skill acquisition.
        Plast Reconstr Surg. 2012; 130: 550e-557e
        • Dumestre D
        • Yeung JK
        • Temple-Oberle C.
        Evidence-based microsurgical skills acquisition series part 2: Validated assessment instruments - A systematic review.
        J Surg Educ. 2015; 72: 80-89
        • Malik MM
        • Hachach-Haram N
        • Tahir M
        • Al-Musabi M
        • Masud D
        • Mohanna PN.
        Acquisition of basic microsurgery skills using home-based simulation training: A randomised control study.
        J Plast Reconstr Aesthet Surg. 2017; 70: 478-486
        • Arora S
        • Miskovic D
        • Hull L
        • et al.
        Self vs expert assessment of technical and non-technical skills in high fidelity simulation.
        Am J Surg. 2011; 202: 500-506
        • Chacon MA
        • Myers PL
        • Patel AU
        • Mitchell DC
        • Langstein HN
        • Leckenby JI.
        Pretest and posttest evaluation of a longitudinal, residency-integrated microsurgery course.
        Ann Plast Surg. 2020; 85: S122-S1S6
        • Nugent E
        • Joyce C
        • Perez-Abadia G
        • et al.
        Factors influencing microsurgical skill acquisition during a dedicated training course.
        Microsurgery. 2012; 32: 649-656
        • Ezra DG
        • Aggarwal R
        • Michaelides M
        • et al.
        Skills acquisition and assessment after a microsurgical skills course for ophthalmology residents.
        Ophthalmology. 2009; 116: 257-262
        • Moulton CA
        • Dubrowski A
        • Macrae H
        • Graham B
        • Grober E
        • Reznick R.
        Teaching surgical skills: what kind of practice makes perfect?: A randomized, controlled trial.
        Ann Surg. 2006; 244: 400-409
        • Aoun SG
        • El Ahmadieh TY
        • et al.
        A pilot study to assess the construct and face validity of the Northwestern Objective Microanastomosis Assessment Tool.
        J Neurosurg. 2015; 123: 103-109
        • Pines AR
        • Alghoul MS
        • Hamade YJ
        • et al.
        Assessment of the interrater reliability of the congress of neurological surgeons microanastomosis assessment scale.
        Oper Neurosurg. 2017; 13: 108-112
        • Grober ED
        • Hamstra SJ
        • Wanzel KR
        • et al.
        Validation of novel and objective measures of microsurgical skill: Hand-motion analysis and stereoscopic visual acuity.
        Microsurgery. 2003; 23: 317-322
        • Satterwhite T
        • Son J
        • Carey J
        • et al.
        Microsurgery education in residency training: Validating an online curriculum.
        Ann Plast Surg. 2012; 68: 410-414
        • Longfield EA
        • Holsinger FC
        • Selber JC.
        Reconstruction after robotic head and neck surgery: When and why.
        J Reconstr Microsurg. 2012; 28: 445-450
        • Selber JC
        • Baumann DP
        • Holsinger CF.
        Robotic harvest of the latissimus dorsi muscle: Laboratory and clinical experience.
        J Reconstr Microsurg. 2012; 28: 457-464
        • Alrasheed T
        • Liu J
        • Hanasono MM
        • Butler CE
        • Selber JC.
        Robotic microsurgery: Validating an assessment tool and plotting the learning curve.
        Plast Reconstr Surg. 2014; 134: 794-803
        • Applebaum MA
        • Doren EL
        • Ghanem AM
        • Myers SR
        • Harrington M
        • Smith DJ.
        Microsurgery competency during plastic surgery residency: An objective skills assessment of an integrated residency training program.
        Eplasty. 2018; 18: e25
        • Lahiri A
        • Sebastin SJ
        • Yusoff SK
        • Sze Chong AK.
        Computer aided assessment in microsurgical training.
        J Hand Surg Asian Pac. 2016; 21: 212-221
        • Ghanem AM
        • Al Omran Y
        • Shatta B
        • Kim E
        • Myers S.
        Anastomosis Lapse Index (ALI): A validated end product assessment tool for simulation microsurgery training.
        J Reconstr Microsurg. 2016; 32: 233-241
        • Rajan S
        • Sathyan R
        • Sreelesh LS
        • et al.
        Objective assessment of microsurgery competency-in search of a validated tool.
        Indian J Plast Surg. 2019; 52: 216-221
        • Brewster LP
        • Risucci DA
        • Joehl RJ
        • et al.
        Comparison of resident self-assessments with trained faculty and standardized patient assessments of clinical and technical skills in a structured educational module.
        Am J Surg. 2008; 195: 1-4
        • Nayar SK
        • Musto L
        • Baruah G
        • Fernandes R
        • Bharathan R.
        Self-assessment of surgical skills: A systematic review.
        J Surg Educ. 2020; 77: 348-361
        • Kazemi H
        • Rappel JK
        • Poston T
        • Hai Lim B
        • Burdet E
        • Leong Teo C
        Assessing suturing techniques using a virtual reality surgical simulator.
        Microsurgery. 2010; 30: 479-486