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mSTAR
Micro-Surgical Training at Residence

Mohsan M Malik
Muaaz Tahir & Musab Hussein
Dhalia Masud & Nadine Haram
Ms. Pari-Naz Mohanna
 Introduction

Time for
Training
Foundation for
Excellence
Sir John Temple
Prof. John Collins

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Current Training

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Proposed Model

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Tablet Trainer

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Low Cost Microscope

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Comparison

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 Validating the Concept
RCT to assess construct validity of home based
training modalities on basic microsurgery skills
learning

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 40 novices recruited
Enrolment
Enrolment

Blocked randomisation into 4

groups
(1:1 ratio)
Randomisation
Randomisation

Theory and
Baseline skills testing   demonstration; Chicken
vessel anastomosis

Drop out
n=1

Lab-based Home Home iPAD

training (n=10) microscope training (n=10)
Control (n=9) training (n=10)
Training at
Allocation

Once weekly
Allocation

No training Training at home for 1

training
sessions home for 1 month
sessions for 1
month month  
 

Chicken vessel
Post training assessment
anastomosis
 Primary outcome measures
Performance in chicken vessel anastomosis,
assessed before and after training

1. Objective markers:
• Time taken
• Suture Efficiency - Number of sutures placed/time taken

2. Quality markers:
• Global Rating Scale – Structured Assessment of
Microsurgery Skills (SAMS); including presence of leak
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 Results

• No inter-group differences at baseline in

– Time taken (p = 0.170)
– Suture Efficiency (p = 0.762)
– SAMS (p = 0.204)

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Total time taken to complete

p = 0.98 p = 0.06 p = 0.02

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Suture Efficiency

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Global Rating Score: SAMS

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Discussion

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 Take Home Message

Training at home (using tablet computer OR low-specification microscope)

produces comparable outcomes on an end-to-end
arterial anastomosis model, when compared with
a 4-week laboratory based training programme;

Thus being a cost-effective, accessible method for

training

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Thank you

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 Acknowledgements
Mi4 Team
• Ms Pari-Naz Mohanna
• Ms Dhalia Masud
• Ms Nadine Hachach Haram
• Mr Muaaz Tahir & Mr Musab Hussein

and
• Mr Matt James
• Dr Sonia Panchal
• Health Education England

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 Training sessions:
Rotate between 4 basic tasks

Multiple repetitions of each of the following:

1. ‘Round the clock’

– Time taken to complete

2. ‘In-out, up-down’
– Time taken to complete

3. ‘Star’s the limit’

– Time taken to complete

4. Glove suturing task

– Number of sutures placed in 20 minutes
• Time taken to place a suture

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Home Curriculum

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