Abstract
Background
Microsurgery remains largely nonexistent in sub-Saharan Africa due to a lack of access
to specialized training and microsurgical instruments. However, smartphones with magnification
capabilities are globally widespread, even in low-resource nations. The use of smartphones
as simulators for microsurgery training has been previously reported, but little is
known with respect to skills acquisition over time.
Methods
A cohort of Ethiopian plastic surgery attendees and residents participated in a microsurgery
training workshop. Before and after the workshop, as well as 6 months afterward, participants
were recorded performing a synthetic vessel repair using a smartphone for magnification.
Video recordings were graded by four microsurgeons using the Stanford Microsurgery
and Resident Training (SMaRT) scale, a validated instrument for assessing microsurgical
skills.
Results
A total of 13 participants were surveyed and recorded. Overall microsurgical performance
SMaRT scores significantly improved (2.05 vs. 2.72 on a five-point scale; p = 0.001) upon completion of the workshop, and continued to increase (3.05), but not
significantly so (p = 0.201) 6 months afterward. However, improvements were maintained at 6 months. Significant
improvement was noted in all SMaRT scale domains postworkshop and further significant
improvement in instrument handling was noted at 6 months.
Conclusion
Our findings suggest that smartphones can serve as valuable tools for microsurgery
training in low-resource settings. Further research is warranted to evaluate the long-term
impact of smartphone-based simulation training on skill acquisition and clinical outcomes
in low-resource settings, but even in the short-term participants were able to demonstrate
significant improvement, as well as maintenance to improvement of skill at 6 months
follow-up.
Keywords
global surgery - microsurgery education - education
