2025 Proffered Presentations
S145: ESTABLISHING AN ASYNCHRONOUS CURRICULUM FOR MICROSURGICAL EDUCATION: A PILOT STUDY
Alankrita Raghavan1; Joshua Woo2; Alexander Suarez1; Katherine McDaniel1; Brandon Smith1; 1Duke University Hospital; 2Duke University School of Medicine
Mastery of microsurgical skills is a core competency for a training neurosurgeon and relies on significant dexterity and regular practice under high powered magnification. Historically, microsurgical training has largely relied on the apprenticeship model where trainees acquire skills and gain experience in the operating room. However, due to a confluence of factors including restrictions in work hours, a greater awareness of patient safety, as well as a decrease in case volumes due to improvements in endovascular and radiosurgical technology, it is becoming increasingly challenging to achieve adequate training in microsurgery (Kirkman et al.). Due to the limited operative experience for trainees, it is imperative that microsurgical training is efficient, thoughtful, and easily accessible.
Numerous studies in athletics as well as recent studies in general surgery demonstrate that effective feedback is essential to improvement in psychomotor outcomes (Sakamoto et al). However, the nature of neurosurgery often makes scheduling sessions challenging. Videos have proven valuable both for expert and self-feedback in multiple surgical fields and provide a valuable mechanism for asynchronous expert feedback and self-assessment. We established a graduated curriculum for neurosurgical residents to practice microsurgical skills to teach dural closure, arachnoid dissection, and nerve and vessel coaptation using chicken thigh.
7 junior residents (PGY1-3s) signed up to participate in the curriculum. All participating residents completed a survey regarding their confidence with microsurgical skills. They then completed a one-on-one 20-minute microsurgery session with the senior author after which they were asked to close a 6 cm incision on the chicken skin (mimicking dural closure) with 6-0 Maxon (with at least 20 throws) and coapt chicken sciatic nerve with 10-0 Nylon. This initial test session was recorded on video and the times for each task were noted. The participating residents were then asked to complete a series of 6 tasks including dural closure, arachnoid dissection, and nerve coaptations over the course of the next 6 months and send 3-minute recordings of their videos under the scope to the senior author for review. The senior author was asked to give feedback on each of the videos. At the end of the 6 months, the residents will be asked to complete the two test tasks again and their efficiency will be compared. They will also be asked to complete a post-intervention survey assessing their confidence with microsurgical skills.
This pilot program assessing the utility and feasibility of an asynchronous curriculum on microsurgical skills and confidence represents just one of the applications of asynchronous video feedback in neurosurgery. The results from this pilot can inform asynchronous programs in other aspects of neurosurgery such as endoscopic surgery as well as advanced skills in microsurgery.