Validating a Scalable Approach to Microsurgery Education in Resource-Limited Countries

Introduction: Microsurgery, a fundamental component of reconstructive surgery, remains largely nonexistent in sub-Saharan Africa due to 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 objective skills acquisition over time. 

Methods: A cohort of Ethiopian plastic surgery attendings and residents were selected to participate in a 3-day microsurgery training workshop. Before and after the workshop, participants were surveyed and recorded performing an anterior wall repair on a 3 mm silicone vessel using a smartphone for magnification. Video recordings were and graded by four microsurgeons using the Stanford Microsurgery and Resident Training (SMaRT) scale, a validated instrument for assessing microsurgical skill. 

Results: 13 participants were recorded pre-and-post workshop training. Overall microsurgical performance scores significantly improved (1.92 vs 2.57 on a 5-point scale; p=0.006) following the workshop. Improvement was noted in all SMaRT scale domains, which were statistically significant in five of the nine SMaRT domains. Participants also reported statistically significant increased comfort levels with instrument handling, suture handling, and knot-tying. 

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.