(356) Microsurgical Training in a High-volume Academic Infertility Practice. What we Learn from the Residents
Authors: Hawksworth D 
Published: May 2023

Abstract

Introduction
Surgical education has been traditionally rooted in the apprenticeship model, where the experts teach the surgeons-in-training during real-time surgeries. With the advent of robotics, the emphasis on simulation and virtual reality training is upon us.

Objective
The goal of this study is to examine lessons learned from the first few years of our institution’s microsurgical training.

Methods
A structured resident male infertility microsurgical training program was devised and multiple attempts at implementing it were made. When resident lack of interest/ time availability as well as COVID pandemic factored in, adjustments were made. And the devised assessment was applied to real-time surgeries. A structured assessment of the trainee’s skills was used by the faculty surgeon at initiation of the training, and throughout. All aspects of the assessment were evaluated on the scale of 1-5, with 1 being the lowest and 5 the highest. (Table 1) According to the individual improvement, the difficulty of the skills and steps of the procedure were advanced accordingly. This evaluation was not communicated with the trainees in order to avoid their undue stress/ intimidation.

Results
A total of 78 microscopic vasectomy reversal surgeries were performed by one staff surgeon and four consecutive resident surgeons between January 2020 and May 2022. All residents were in their 2nd year of Urology training (PGY-2). On average, each of the trainees participated in 17 vasectomy reversals (13-21), with similar amount of surgical time spent (about 3-4 hrs/ case). At initiation of their training, each individual had similar basic and microscopic surgical skills, procedure knowledge, economy of motion and tissue/ instrument/ needle handling ability (scores of 2-3 out of 5). Two of the trainees displayed higher level of interest and better listening skills, which resulted in willingness to correct their errors and ultimately improve on their surgical techniques. The resident with initial poor skill set and poor interest/ listening skills did not progress to more advanced stages of training and was relegated to initial dissection/ exposure and placement of adventitial sutures. The resident with slightly better surgical skills but unwilling to make corrections to his technique, progressed to the next level of placing occasional luminal sutures. The remaining two residents displayed the most interest, involvement and receptiveness to the feedback. They both progressed to the final stages of the training, with one of them performing the entire operation as a primary surgeon, with the staff assisting. (Table 2).

Conclusions
While the structured residency microsurgical training program is of utmost importance, competing professional and personal interests of the resident-surgeons may affect its full execution. Careful observation of the trainees, their skills, ability to receive and process the feedback in combination with teaching faculty’s patience and flexibility are paramount to the safe and effective “real-life” training. When devising a surgical training program it is important to keep in mind that surgical residents prefer hands-on operating experiences.

Disclosure
No