Microsurgical Simulation. An Educational Strategy to Improve the Learning Curve Based on a Simulation Model

Background: Microsurgery requires significant precision and skills. Simulation is a useful tool for the development of skills and abilities and is part of resident’s education and training programs. Several evaluation measures have been developed to assess the learning curve and skills learned in the simulation. The OSATS scale is a tool that can be implemented in microsurgery to measure skills and the learning curve. This ability cannot be achieved through observation, because it takes a lot of skill and experience. Material and Methods: Prospective study, experimental, single-blind, including 28 residents who were evaluated for 4 weeks on a voluntary basis. Fourteen students were randomly divided into an experimental group and 14 students into a control group. The study evaluated the average time to perform a microsurgical anastomosis, using the OSATS scale at the beginning of the study and at the end to get the results. Results: The average initial time to perform microsurgical anastomosis in the experimental group was 19 minutes and an average score of 6.8 points on the OSATS scale was obtained. The control group performed an average time of 21 minutes and a score of 6.3 points on the OSATS scale (p > 0.05). After performing the training in the simulation microsurgery model, the experimental group and the control group were compared, finding a reduction in the final average time of 12 minutes to perform a microsurgical anastomosis and a score of 17 points on the OSATS scale; comparing the control group, the average time was 19 minutes and a score of 7 points on the OSATS scale (p > 0.05). Discusion: A statistically significant difference was found in the experimental group in the evaluated parameters: average time for microsurgical anastomosis, tissue manipulation, dexterity movements, use of equipment, and microsurgical planning; however, no statistically significant difference was found for the knowledge of the steps to follow during the microsurgical procedure. When comparing the studies where simulation is implemented for the residents, an improvement in the learning curve and positive results for medical training were observed. Conclusion: The implementation of simulation models for residents in training is a feasible and efficient tool to generate confidence in microsurgical skills. Residents develop skills and aptitudes in microsurgical training by decreasing the time and improving the learning curve in microsurgical techniques. It is important to highlight the