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Novel Approach to Microsurgical Training: Adaptation of Fundamentals of Laparoscopic Surgery and the NASA Task Load Stress Score
Christopher Ingersol, MD, Ruvi Chauhan, MD, Aladdin H. Hassanein, MD, MMSc, Mary Lester, MD
Indiana University
2020-02-15
Presenter: Ruvi Chauhan
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Teaching complex technical skills such as microsurgery is enhanced by surgical simulation. General surgery implemented the Fundamentals of Laparoscopic Surgery (FLS), a validated curriculum required for board certification that ensures mastery of basic laparoscopic maneuvers by assessing five tasks. Some parallels have been drawn between laparoscopic techniques and microsurgery. Fatigue and mental workload are important aspects of microsurgical training which have not been quantified. We have designed a novel microsurgical simulation curriculum which adapts FLS and evaluates the NASA Task Load Index (NASA-TLX).
Methods: A competency-based curriculum was created to evaluate skills through 5 stepwise tasks (rubber band transfer, tine grasping, glove laceration repair, synthetic vessel anastomosis, and suturing in a deep cavity) using the microscope. Evaluation includes time to completion of tasks and quality of performance based on self and attending evaluation. Trainees complete the NASA-TLX survey to measure stress levels with a given task. Data are collected and stored.
Results: Mean time to complete task one for senior residents was 15:56 (min:sec), n=10, compared to 10:42 (min:sec) for attendings, n=2. Senior residents found the tasks five times more stressful than attendings with mean task one NASA-TLX scores of 6.75 versus 1.34, respectively (p=0.02).
Conclusion: Our pilot novel microsurgical curriculum adopts validated general surgical simulation tools to practice a series of relevant tasks and quantifies fatigue and mental workload. We found significant gap between senior resident scores and attendings. Repeated simulation may decrease task times and stress.
