95. Improving Microsurgical Training Through Spaced Learning

PURPOSE: Microsurgery requires hours of countless training and cannot be learned simply by observation. There is no standardized curriculum for the teaching of microsurgery and very little research as to the best methods to do so in trainees. Studies on the concept of skill decay and spaced learning suggest that short bursts of learning are more effective than longer periods but this has not been demonstrated in microsurgical education. Our hypothesis was that a spaced learning curriculum when applied to novice microsurgery learners would produce better microsurgical skills and trainee confidence in comparison to traditional longer learning periods. METHODS: Medical students and surgical interns were recruited to participate in a four-week microsurgery training course performing microvascular anastomosis on rat femoral arteries. Participants were randomized into either the spaced learning (experimental) or bulk practice cohort (control). Both cohorts received a total of one hour per week of hands-on microsurgical training; a single one-hour/week session for the bulk practice group and four 15-minute sessions/week for the spaced learning group. A survey was administered to participants to assess their confidence in microsurgery both pre-course and at course completion. Video recordings of pre-course and final microvascular anastomosis were performed for each participant. These videos were analyzed using the validated Stanford Microsurgery and Resident Training (SMaRT) scale by a single microsurgeon blinded to the study groups. Additional data was gathered including time to completion, bleeding, and need for revision. RESULTS: 24 participants completed the study (13 bulk practice; 11 spaced learning). Both groups were equivalent in their pre-course scores with no statistical difference in SMaRT scale measures. Spaced learners had significantly higher increases in all measures of the SMaRT scale from pre to post assessment, completed their anastomoses faster, with equivalent confidence scores, when compared to the bulk practice group. CONCLUSION: A spaced learning microsurgical curriculum is a more effective way to train microsurgical skills, as opposed to longer periods of less-frequent training. This produces trainees more adept at performing microsurgery by accelerating their development of microsurgical skills. Training curriculums such as this should be implemented to novice residents to enhance patient outcomes.