CC BY-NC 4.0 · Arch Plast Surg 2013; 40(04): 312-319
DOI: 10.5999/aps.2013.40.4.312
Topic: Simulation for Excellence in Microsurgery Training

A Systematic Review of Evidence for Education and Training Interventions in Microsurgery

Ali M Ghanem
Academic Plastic Surgery Group, Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, London, UK
Nadine Hachach-Haram
Academic Plastic Surgery Group, Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, London, UK
Clement Chi Ming Leung
Academic Plastic Surgery Group, Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, London, UK
Simon Richard Myers
Academic Plastic Surgery Group, Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, London, UK
› Author Affiliations

Over the past decade, driven by advances in educational theory and pressures for efficiency in the clinical environment, there has been a shift in surgical education and training towards enhanced simulation training. Microsurgery is a technical skill with a steep competency learning curve on which the clinical outcome greatly depends. This paper investigates the evidence for educational and training interventions of traditional microsurgical skills courses in order to establish the best evidence practice in education and training and curriculum design. A systematic review of MEDLINE, EMBASE, and PubMed databases was performed to identify randomized control trials looking at educational and training interventions that objectively improved microsurgical skill acquisition, and these were critically appraised using the BestBETs group methodology. The databases search yielded 1,148, 1,460, and 2,277 citations respectively. These were then further limited to randomized controlled trials from which abstract reviews reduced the number to 5 relevant randomised controlled clinical trials. The best evidence supported a laboratory based low fidelity model microsurgical skills curriculum. There was strong evidence that technical skills acquired on low fidelity models transfers to improved performance on higher fidelity human cadaver models and that self directed practice leads to improved technical performance. Although there is significant paucity in the literature to support current microsurgical education and training practices, simulated training on low fidelity models in microsurgery is an effective intervention that leads to acquisition of transferable skills and improved technical performance. Further research to identify educational interventions associated with accelerated skill acquisition is required.

This article was presented at the Inaugural Meeting of the International Microsurgery Simulation Society on Jun 30, 2012 in London, UK.

Publication History

Received: 23 January 2013

Accepted: 08 February 2013

Article published online:
01 May 2022

© 2013. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (

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