A Low-Cost, High-Fidelity Microsurgery Curriculum for Orthopedic Trainees
David M. Whitehead, MD, MS.; Marci D. Jones, MD
University of Massachusetts, Worcester, MA
Background and Significance
Microsurgical skills are an important part of any hand surgeon's toolkit - if not for replantation, then for small nerve coaptation. Unfortunately, orthopedic resident education often has limited microsurgical training. It was our goal to develop a microsurgery curriculum at low-cost, now included in the hand surgery rotation for residents in our program.
Materials and Methods
Residents at the PGY-4 and PGY-2 level were chosen as participants, to augment their experience on the Hand Surgery service. An iterative approach was used to determine equipment needed, and a low-cost, quality dissecting scope as acquired specifically for this curriculum. A cost analysis was performed to determine optimal choice of materials and to determine impact on faculty productivity and resident participation.
Results
Chicken thigh vessels and nerves from bone-in chicken thighs were identified as the most cost-effective model for nerve coaptation and small vessel anastomosis. Final cost analysis demonstrated an up-front cost of $400 for the microscope, as well as $107 per resident per year of participation, with suture costs the most significant contributor. Faculty time required was noted to be 0.5 hours per resident per year, with a 10-hour resident time commitment which could easily be fit into the resident Hand Surgery rotation.
Conclusion
We have been able to implement a low-cost, moderate-to-high-fidelity microsurgery curriculum for orthopedic residents at our institution, which is expected to greatly improve residents' ability to assist in digital nerve cases as well as work under a microscope in general. In the future, we will likely need to also investigate the impact of OR instrument use for this curriculum, and may need to fold in the cost of dedicated instruments.
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