Peripheral Nerve Surgical Competence of Senior Plastic Surgery and Neurosurgery Residents
Curtis Budden, MD MEd1; Andrew Jack, MD MSc FRCSC2; Jaret Olson, MD3; Vivek Mehta, MD MSc FRCSC2
1Plastic Surgery, University of Alberta, Edmonton, AB, Canada, 2University of Alberta, Edmonton, AB, Canada, 3Division of Plastic and Reconstructive Surgery, University of Alberta, Edmonton, AB, Canada
Postgraduate medical training programs worldwide are implementing competency based training. The objectives and assessments of trainees are being re-evaluated to enhance the quality of training and the resultant skill of the graduating surgeon. The level of skill required for a general trainee to complete peripheral nerve surgery has not been explored. A study in 2016 found that there was significant variability amongst training programs in peripheral nerve surgery1. The purpose of this study is to examine the resident perceived ability and operative exposure in peripheral nerve surgery. A cross sectional survey was distributed to all senior plastic and neurosurgical residents in Canada. The survey utilized a validated competency scale for respondents to rate their perceived competence with skills deemed as objectives from the Royal College of Surgeons of Canada. Data was analyzed using descriptive statistics to capture trends in training. In total, 28 neurosurgery residents (96%) and 25 senior plastic surgery residents (42%) responded to the survey. All programs were represented by the respondents. There were thirteen procedures listed as core procedures for the residents. Of these, senior residents in plastic surgery felt they could independently perform carpal tunnel release, cubital tunnel release and primary nerve repair. When examining only final year plastic surgery residents, there were 7 procedures which received a 100% independent rating. The remainder of cases showed much variability. There was a significant difference in competence as trainees progressed through training with exception to treatment of malignant nerve sheath tumors and exposure of the brachial plexus. In Neurosurgery, over 50% of residents said they could independently perform carpal tunnel release, cubital tunnel release without transposition, sural nerve biopsy and resection of a simple nerve tumor. The specialty which performs peripheral nerve surgery at each site was variable but all performed by either plastic surgery or neurosurgery. With regards to operative volume, residents experience with brachial plexus was lacking in both groups. This study would suggest that residents do not feel adequately trained to comfortably perform peripheral nerve surgery beyond common nerve compression and basic nerve tumors. A change in objectives or an increase in exposure to peripheral nerve study is needed to improve competence. The use of educational adjuncts to improve competency may be of vital importance in peripheral nerve surgery. 1. Gil JA, Daniels AH, Akelman E. (2016). Resident exposure to peripheral nerve surgical procedures during residency training. J Grad Med Ed. May: 173-9
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