A qualitative study of the construction of a microsurgical chief surgeon training course

A qualitative study of the construction of a microsurgical chief surgeon training course | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A qualitative study of the construction of a microsurgical chief surgeon training course Yawen Li, Yuzhe Kong, Xiaohong Tang, Qiang Guo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8260361/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Microsurgery, a cornerstone in modern surgery, facilitates precise interventions through the use of advanced microscopes and micro-instruments.. It has transformed practices in neurosurgery, reconstructive surgery, and otolaryngology. Innovations such as intraoperative MRI and tissue regeneration research have improved procedural accuracy and recovery. However, persistent shortcomings in surgical training curtail these advancements. Conventional programs place excessive emphasis on theoretical instruction, overlooking the development of practical skills and stress-management training, which are essential for complex operations. While tools such as virtual reality (VR) simulations demonstrate efficacy in skill acquisition, their limited integration into curricula leaves trainees ill-equipped for real-world challenges. Concurrently, the rise of minimally invasive methods and novel surgical devices demands adaptive expertise and continuous learning—competencies rarely prioritized in current education frameworks. This study employs grounded theory and qualitative analysis to determine the educational requirements of trainees and instructors, proposing a standardized, competency-based microsurgery curriculum. By bridging gaps between technological progress and training inadequacies, this framework aims to enhance technical proficiency, clinical decision-making, and patient safety outcomes. Method This qualitative study adhered to the COREQ guidelines, using semi-structured interviews and grounded theory to analyze microsurgical training needs. Data was collected in July 2024, with two trained interviewers conducting interviews. Transcripts, including non-verbal cues, were analyzed using NVivo 12. Grounded theory guided the analysis through open, axial, and selective coding, with team discussions resolving coding discrepancies. The study followed Kerns six-step approach, developing an interview guide validated by expert panels and pilot interviews. The guide covered six areas: training necessity, curriculum content, learning methods, assessment, duration, and resources. Data saturation determined the sample size of eight participants (five trainers, three trainees). Result This study conducted qualitative interviews with participants from the Third Xiangya Hospital, who were divided into teacher and student groups, revealed six key themes in microsurgical training: (1) necessity, (2) methods, (3) content, (4) evaluation, (5) duration, and (6) resources. Conclusion This study highlights the need to modernize microsurgical training by integrating advanced technologies and diverse methods. The integration of theory with practice, especially through simulation and virtual reality (VR) training, effectively enhances technical skill acquisition. As surgical demands grow, incorporating new techniques and materials is essential to meet patient needs. Balancing functional recovery with aesthetic outcomes is also a key focus. Optimizing microsurgical training is crucial for better surgical results and patient safety. By addressing current gaps and adopting innovations, these programs can more effectively equip surgeons to confront multifaceted challenges of modern-day surgical practice and drive the progress of the microsurgery field forward. microsurgical training qualitative research grounded theory Figures Figure 1 1 Introduction Microsurgery, which utilizes high-resolution microscopes and delicate instruments, has emerged as an indispensable component in modern surgical practice [1][2][3][4] . It is especially crucial for procedures requiring small incisions and intricate techniques within various specialties, such as neurosurgery, plastic surgery, and otolaryngology Research in microsurgery has also undergone significant deepening, particularly in tissue regeneration, nerve regeneration, and vascular regeneration [5][6] . Additionally, advancements in imaging technologies, such as intraoperative ultrasound and magnetic resonance imaging (MRI), have further refined surgical accuracy and safety by providing real-time visualization of anatomical structures, which in turn minimizes operative complications and improves patient outcomes [7][8] . Despite these remarkable advancements in microsurgery, which have been vital for reconstructive procedures, several limitations still remain, requiring further exploration and improvement [9] . The complexity of microsurgical procedures has imposed high demands on physician training [10] . Numerous medical institutions are deficient in comprehensive training programs. As a result, young surgeons are left bereft of essential experience and skills, which has adversely affected patient outcomes [11][12] . Current training models frequently depend on traditional lecture-based approaches. This offers trainees an insufficient amount of hands-on practice opportunities, leaving them inadequately prepared to handle complex surgical scenarios [13] . Although emerging technologies, such as simulation-based training and virtual reality (VR), have demonstrated potential in improving technical proficiency, their adoption remains limited. This lack of widespread implementation impedes surgeons' capabilities to make quick and accurate decisions during intricate procedures. Furthermore, microsurgery requires delicate manipulation skills in high-pressure environments. Nevertheless, traditional training frequently fails to adequately address these crucial aspects, leaving practitioners insufficiently prepared for real-world difficulties. Additionally, the rapid development of minimally invasive techniques and new surgical instruments has presented new challenges. It demands surgeons not only to acquire greater adaptability but also to cultivate the capacity for lifelong learning [14] . However, the content of current training courses often fails to stay up-to-date. As a result, doctors are placed at a disadvantage when it comes to applying new technologies. Therefore, re-examining and optimizing the training mode, content, and evaluation system of microsurgery training has become an important approach to elevating the standards of microsurgery and safeguarding patient safety [15] . The purpose of this study is to identify the learning needs of both trainees and trainers for microsurgery training courses based on grounded theory and qualitative research methods. It also aims to elucidate the educational goals of microsurgery training [16][17] . This initiative is specifically intended to rectify the shortcomings inherent in existing frameworks.and provide a robust foundation for designing and implementing a comprehensive evidence-based microsurgical training curriculum. 2 Method 2.1 Study Design This qualitative study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines. We performed semi-structured interviews to gather in-depth insights from participants, and systematically analyzed the data based on the grounded theory. Interviewees included both trainers and trainees in microsurgery, which enabled the acquisition of a thorough and all-round comprehension of the training needs and the obstacles encountered in the field. . All participants were required to fill in an informed consent form. They were fully informed of their rights to withdraw from the study at any time and to decline video recording of their interviews. This ensured compliance with ethical standards and safeguarded participant autonomy. 2.2 Ethics Approval Ethical approval regarding human subject research was obtained from the Ethics Committee on the Third Xiangya Hospital of Central South University (approval number: Fast24971). Informed consent was obtained from each participant online by placing a question about their agreement to participate in the study at the beginning of the survey. Participants were guaranteed confidentiality and anonymity throughout the study, along with the right to withdraw at any point. We declare that the data were collected for academic use only. 2.3 Participants Recruiting Inclusion criteria of trainers: (1) serving as chief surgeons in microsurgical procedures, (2) having performed at least 50 microsurgical operations. Inclusion criteria of trainees: (1) residents, interns. The number of participants was determined based on the data saturation. Upon analyzing the data and conducting interviews, it was ascertained that eight participants were included in the study, comprising five trainers and three trainees. 2.4 Instrument The initial phases of Kern's six-step approach encompass (1) the identification of key educational challenges and a broad assessment of needs, succeeded by (2) a focused needs assessment. These preliminary steps are essential for constructing a curriculum that effectively addresses the identified educational requirements. Based on these preceding steps and a thorough literature review, we formulated an interview guide featuring open-ended questions designed to elicit comprehensive and in-depth responses. To validate the effectiveness of the interview guide, a panel discussion was conducted with seven experts in the field. Four of these experts possessed extensive knowledge of microsurgery and abundant experience in teaching clinical skills, which rendered them crucial in the process of refining the guide. The remaining experts had conducted numerous qualitative studies, which empowered them to provide meticulous qualitative supervision of the research instrument. To further assess the guide's feasibility, pilot interviews were carried out with three participants and necessary revisions were made. Ultimately, the finalized interview guide consisted of six sections: the necessity of training, curricular components, learning strategies, assessment methods, training duration, and instructional resources. This setup guaranteed a comprehensive framework to address educational needs in medical training. 2.5 Data Collection 2.5.1 Data collection process In July 2024, two trained interviewers carried out semi-structured interviews to gather participants' perspectives on the demand for microsurgery training. The average duration of the interviews was 17min21s, with a range from 11min22s to 30min53s. Each interview was transcribed verbatim from video recordings and meticulous attention was paid to participants' facial expressions. All transcripts underwent thorough verification to ensure accuracy and reliability. 2.5.2 Data Cleaning and Analysis The analytical process adhered to the grounded theory framework proposed by Corbin and Strauss. This analytical process consisted of three distinct stages: (1) open coding, which entailed a line-by-line identification of significant concepts; (2) axial coding, wherein themes were delineated from the derived codes; (3) selective coding, which involved synthesizing the identified themes into a cohesive conceptual framework. Utilizing grounded theory, two researchers independently coded the transcripts with NVivo version 12 software. The initial open codes were subsequently organized into primary themes. Discrepancies in coding were resolved through collaborative discussions within the research team until consensus was achieved. Furthermore, a comparative analysis was conducted to elucidate variations in training demands between trainers and trainees, as well as between senior and junior trainees. 3 Result 3.1 General Information Participants from the Third Xiangya Hospital of Central South University were recruited in our interview, with ages ranging from 29 to 49. For data analysis, participants were categorized into two distinct groups: the teacher group and the student group, based on the established validity criteria. The teacher group was composed of individuals with higher professional titles, advanced academic qualifications, and extensive clinical experience. Meanwhile, the student group was further divided into junior and senior subgroups according to the same set of criteria. A qualitative analysis of the interviews revealed six primary themes that encapsulated the current state and needs of microsurgical training: (1) training necessity, (2) training methods, (3) training content, (4) training evaluation, (5) training duration, and (6) training resources. These themes provide a comprehensive foundation for understanding and addressing the challenges in microsurgical education. The subsequent sections will elaborate on them in detail. 3.2 Training Necessity High-resolution microsurgery, highlighted for its minimal invasiveness and high degree of accuracy, has become increasingly recognized as a fundamental skill for surgeons, particularly in complex cases such as limb replantation [18][19] . Physicians emphasized that the application of high-resolution microsurgery effectively minimized trauma and enhanced surgical precision, leading to optimal patient recovery and reduced long-term complications. They also noted that the visual precision enabled by surgical microscopes significantly reduced error rates and improved surgical outcomes, including higher graft survival and success rates [20][21] . Additionally, they pointed out that microsurgical techniques have evolved into a crucial fundamental skill for doctors, particularly in intricate surgical procedures such as limb and finger replantation. For patients with complex conditions, the application of microsurgery was crucial as it enabled precise operations such as vascular anastomosis and nerve repair, thereby guaranteeing a greater likelihood of functional recovery Furthermore, microsurgery not only presented technical challenges but also brought about a tremendous sense of professional accomplishment. Through microsurgery, physicians were able to effectively restore the functionality of injured regions. This not only aided patients in reclaiming their quality of life but also bestowed a deep sense of professional fulfillment upon the doctors. Moreover, several participants noted that China, as an early adopter of microsurgical innovations, has established a prominent position in the global community. They emphasized China’s leading role in microsurgical techniques and highlighted the importance of leveraging this position to foster academic exchange and international collaboration. In addition, as technology progresses, microsurgery has been increasingly focusing on aesthetic outcomes. The technology has gradually transitioned from a sole focus on functional restoration to placing greater emphasis on both appearance and aesthetic repair, especially in fields such as plastic surgery and breast surgery. Such a development not only demonstrates the expanding scope of microsurgical applications but also mirrors a significant shift from merely treating traumas to achieving comprehensive aesthetic restoration. 3.3 Training Methods Most participants identified practical clinical operations as the most critical aspect of learning microsurgical techniques. Real-world clinical practice allowed trainees to face various unforeseen situations, rapidly improving their problem-solving skills. Additionally, mentorship played an essential role in microsurgical training. Senior surgeons not only provided verbal guidance but also led by example through practical demonstrations, enabling beginners to acquire and master the microsurgical techniques via hands-on training and direct guidance Most participants acknowledged the importance of models or animal tissues in microsurgical skill training [22][23][24][25][26] . Simulated surgical operations allowed trainees to practice intricate techniques without the risks associated with live patients. Specifically, using animal models such as chicken legs or pig trotters for vascular anastomosis and nerve repair training provided an environment close to real-life scenarios, helping trainees improve both their precision and confidence in surgical procedures [27][28][29] . Many participants also emphasized the use of head-mounted recording systems to document surgical procedures and conduct post-operative reviews as an effective method for improving surgical skills. By replaying the recorded surgeries, surgeons could review the entire procedure, identify problems in their techniques, and make self-corrections. Furthermore, these recordings served as valuable teaching tools. They empowered students to view the surgical procedures multiple times and acquire knowledge from them, thus contributing to the improvement of their surgical capabilities [30][31] . Additionally, many participants highlighted the possibilities of incorporating modern technologies such as virtual reality (VR) and augmented reality (AR) into microsurgical training [32][33][34][35] . These technologies could offer immersive and realistic simulations of surgical scenarios, enabling trainees to refine their techniques without the risks associated with live surgeries. Virtual simulations could provide immediate feedback during operations, allowing trainees to make adjustment and improvement based on their performance. The training supported by VR and AR technologies was anticipated to become a significant trend in the future of microsurgical training. Some participants suggested that modern technologies could be used to develop online learning platforms as a valuable supplement to microsurgical training. These platforms would allow trainees to engage in self-directed learning and surgical simulations, eliminating the risks of real surgery. Moreover, trainees could conduct simulations from home, flexibly arranging their learning schedules and overcoming the traditional constraints of time and space in training. 3.4 Training Contents Most participants agreed that having a solid grounding in the historical development and basic principles of microsurgery was of utmost importance [36][37] . Understanding the historical background of microsurgery, commencing with the evolution of replantation techniques in the early 1960s, was considered foundational knowledge for every trainee. This not only helped them remember the significance and developmental trajectory of microsurgical techniques but also laid solid theoretical groundwork for subsequent clinical practice. Anatomy was universally regarded as the cornerstone of microsurgical training, particularly familiarity with the anatomical structures of various parts of the human body. Mastery of both systemic and regional anatomy was identified as a prerequisite for performing microsurgery. A deep understanding of anatomy allowed surgeons to make precise decisions during operations, avoid damaging critical structures, and effectively repair injured areas. Anatomical knowledge has been recognized as a core competency for microsurgeons [38][39][40] . Most participants highlighted that the use of microsurgical instruments and microscopes was an essential component of microsurgical training. Understanding the characteristics and operational techniques of different microscopes and mastering their use could enhance the precision of surgical procedures. Additionally, learning how to select and operate microsurgical instruments, such as microsurgical scissors and sutures, was critical to practical operations. Only when trainees have achieved a high level of proficiency in these microscopes can they guarantee the seamless and successful execution of surgical procedures. Many participants pointed out that the acquisition of fundamental microsurgery knowledge—encompassing familiarity with surgical procedures, comprehension of indications and contraindications, error prevention, and patient evaluations—was essential in the training process. This knowledge was essential for ensuring surgical success, minimizing risks, and avoiding unnecessary harm to patients. Finally, most participants stressed that theoretical learning must be integrated with clinical practice. Through simulation training, animal model operations, and clinical practice, trainees could translate theoretical knowledge into practical skills. In clinical practice, trainees had to not only master surgical techniques but also adapt to the individual differences of patients and respond to unexpected situations. This required trainees to possess a high level of adaptability and flexible problem-solving skills. 3.5 Training Evaluation Most participants recognized theoretical examinations as the principal means of evaluating trainees' foundational knowledge.. Via approaches such as closed-book exams, trainees’ basic knowledge of microsurgery was evaluated to ensure they possessed a sufficient theoretical understanding before engaging in practical operations. This form of assessment effectively guaranteed that trainees had a firm understanding of microsurgical principles, a comprehensive knowledge of anatomy, and a sound comprehension of surgical theories. As a result, it furnished them with a robust knowledge foundation essential for practical application. Simulated surgical procedures on animal cadavers, including vascular anastomosis and flap delay, were highlighted as critical components of practical assessment. Trainees practiced those procedures through simulation and their performance was then assessed in light of aspects such as vascular patency and tissue survival.. These factors provided an initial measure of their skill level and technical proficiency. The animal models offered a risk-free environment for trainees to practice. By mimicking actual surgical situations, they furnished trainees with abundant chances to refine their skills. Regarding specific evaluation criteria for training outcomes, most participants mentioned that surgical proficiency and task completion were key indicators. During practical assessments, trainees had to demonstrate mastery of microsurgical techniques, particularly core skills such as vascular and nerve anastomosis. Additionally, the evaluation included whether the outcomes of their procedures met clinical standards. The final assessment of microsurgical training also incorporated trainees’ performance in clinical practice, especially the effectiveness of their surgeries. After completing procedures, trainees were evaluated based on clinical indicators such as limb viability and blood supply restoration [41] . These metrics not only reflected the trainees’ ability to apply microsurgical techniques in real-world scenarios but also directly measured their level of technical expertise. 3.6 Training Duration Most participants have agreed that microsurgical training should prioritize practical operations over theoretical learning. They generally believed that since trainees already had a foundation in theoretical knowledge, the emphasis of the training ought to be redirected towards enhancing technical proficiencies. Particularly in short-term training programs, trainees needed extensive hands-on practice to enhance their proficiency. The time allocated for theoretical learning should be relatively minimized, as excessive focus on theory might impede the development of practical skills. The length of the practice sessions had a direct bearing on the trainees' ability to master techniques both efficiently and effectively Given that clinical doctors usually were unable to be away from their responsibilities for an extended duration, the training sessions should be restricted to a span of 3 to 5 days, and in no case should they exceed one week Intensive short-term training efficiently reinforced skills while minimizing disruption to routine work. For the majority of clinicians, the primary goal of training was to strengthen and improve their technical abilities rather than to receive an all-encompassing basic education. 3.7 Training Resources Most participants believed that the foundational stage of microsurgical training should begin with theoretical learning to establish a solid knowledge base. Theoretical learning resources included both electronic and printed materials. The theoretical curriculum typically covered the fundamentals of microsurgery, surgical procedures, and anatomical knowledge. By studying these materials and attending theoretical courses, trainees could grasp the framework and key points of surgical techniques, which provided essential theoretical support for subsequent practical training. Moreover, surgical videos and VR-based instructing tools were considered essential for demonstrating procedural details and offering immersive practice environments. Despite the growing availability of advanced technologies, participants reiterated the irreplaceable value of in-person mentorship and hands-on practice. Through mentorship, trainees could perform surgical operations under the supervision of instructors and master the detailed techniques required in practical scenarios. In this process, the instructors’ hands-on teaching, real-time feedback, and detailed guidance played a critical role in helping trainees acquire crucial skills. Simulated practice resources have been increasingly recognized for their importance in microsurgical training. Simulation-based training allowed trainees to repeatedly practice in a risk-free environment, which enabled them to steadily improve their skills, particularly in delicate and precise operations. Animal models, such as pig trotters and chicken legs, were commonly used simulation resources. These models replicated real surgical situations, helping trainees familiarize themselves with specific procedures. A few participants mentioned that high-quality teaching instruments and equipment were essential for microsurgical training. These included microscopes and microsurgical instruments, which have served as the bedrock for guaranteeing that trainees were able to obtain top-notch practical training. 4 Discussion Microsurgical training, which is of utmost importance in modern surgical practice, still encounters significant challenges. These difficulties include insufficient operational proficiency, poorly structured training durations, and delayed adoption of new technologies. Through a qualitative research approach, this study has explored the current state of microsurgical training, focusing on key aspects such as training necessity, content, methods, evaluation, duration, and resources. By identifying critical issues in the training process, the study has intended to provide a theoretical basis for optimizing future curriculum designs. The core objective of microsurgical training has been unanimously regarded as improving operational skills. Most participants have emphasized that theoretical learning should serve as a supplementary component. Instead, more time should be dedicated to practical exercises, especially those carried out via simulation and using animal models. The complexity of microsurgical techniques requires repetitive practice to achieve precision, a view that was widely shared by participants. Regarding training duration, most participants advocated for intensive short-term training programs, typically lasting 3–5 days. Such programs allow trainees to focus exclusively on skill development without significantly disrupting their clinical responsibilities. Advancements in technology have introduced new opportunities for improving microsurgical training. From traditional surgical videos to the integration of VR and AR technologies, these emerging tools have enhanced trainees’ learning experiences and operational precision. In particular, virtual simulations have provided immersive learning environments that prove invaluable for practicing complex surgical scenarios. Most participants believed that the integration of these technologies would significantly improve training efficiency, especially in the development of surgical skills and clinical adaptability. Despite the common requirements for skill enhancement and intensive short-term training, the disparities in the participants' viewpoints in specific aspects have been quite remarkable. A minority of participants stressed the importance of tailoring training content to trainees' individual backgrounds and pre-existing knowledge bases. For more experienced surgeons, foundational knowledge and basic skills training were redundant, whereas advanced skills—such as minimally invasive surgery and complex organ repair techniques—were prioritized. Personalized course designs could thus enhance the relevance and effectiveness of training. Although the application of VR and AR technologies has been mentioned, their adoption remains limited. These technologies are regarded as pivotal for the future of microsurgical training. They hold great promise in crafting surgical simulations that closely mimic real-life scenarios. Despite the growing availability of advanced technologies, the traditional mentorship model continues to be an irreplaceable component of microsurgical training. Many participants highlighted that, for complex surgical procedures, real-time guidance and personalized feedback from mentors would be critical for skill enhancement. This underscores that while modern technologies can improve training efficiency, clinical mentorship and hands-on practice still remain essential for trainees to master high-precision surgical operations. Overall, the core needs of microsurgical training have centered on skill development, intensive short-term training, and the effective integration of new technologies. Nevertheless, personalized course designs, the application of VR technologies, and the retention of traditional mentorship models have remained vital components for future training programs. To keep pace with the rapid evolution of microsurgical techniques, future training curricula must continuously be refined in terms of content, format, and evaluation systems. Such improvements are intended to enhance surgeons’ adaptability and technical expertise, ensure patient safety, and optimize surgical outcomes. 5 Conclusion This study highlights the pressing need to integrate advancements in modern medical technology and diversify training methodologies to address the challenges of microsurgical education. The combination of theoretical learning with clinical practice, particularly through simulation training and the incorporation of virtual reality technologies—has significantly enhanced trainees’ practical skills. As technology continues to innovate, the integration of emerging techniques and materials will become an essential addition to the current training curricula. This will aptly deal with the mounting complexity of surgical demands and the changing needs of patients. Additionally, the need to strike a balance between functional recovery and aesthetic results has been spotlighted as a fresh direction in microsurgical training. In conclusion, the optimization of microsurgical training programs is a critical step toward improving surgical outcomes and ensuring patient safety. By bridging the gaps in current training methods and incorporating modern innovations, these programs can better prepare surgeons to meet the demands of contemporary practice and propel the ongoing development of the field. Declarations Ethics approval and consent to participate In accordance with the Declaration of Helsinki, written informed consent was obtained from all participants. Ethic approval received from the Third Xiangya Hospital of Central South University (Protocol Fast24971). Consent for publication Not applicable. Availability of data and materials Data were available on reasonable request. Competing interests All authors declared no potential competing interests. Funding This work was supported by “The 13th Five-Year Plan” of Educational Science in Hunan Province (No. XJK19AGD001). Authors' contributions YW.L. conducted the formal analyses, and drafted the manuscript. YZ.K prepared the tables and figures, and analyzed the data. Q.G. and XH.T. critically reviewed the manuscript and made necessary revisions. All authors reviewed the final manuscript. Acknowledgements Not applicable. Clinical trial number Not applicable. References Tibbetts LS, Shanelec DA. An overview of periodontal microsurgery. Curr Opin Periodontol. 1994:187-93. PMID: 8032459. 9Kobayashi E. New trends in translational microsurgery. 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Microsurgical training with porcine thigh infusion model. J Reconstr Microsurg. 2013 Jun;29(5):303-6. doi: 10.1055/s-0033-1333623. Epub 2013 Feb 7. PMID: 23393048. Passiatore M, Taccardo G, D'Orio M, Stomeo D, Starnoni M, De Vitis R. Microsurgical training in vein anastomoses: the use of systemic heparin in a rat model. Acta Biomed. 2023 Jun 23;94(S2):e2023088. doi: 10.23750/abm.v94iS2.13819. PMID: 37366185. Couceiro J, Castro R, Tien H, Ozyurekoglu T. Step by step: microsurgical training method combining two nonliving animal models. J Vis Exp. 2015 May 9;(99):e52625. doi: 10.3791/52625. PMID: 25992633; PMCID: PMC4542602. Terakawa Y, Ishibashi K, Goto T, Ohata K. Three-dimensional video presentation of microsurgery by the cross-eyed viewing method using a high-definition video system. Neurol Med Chir (Tokyo). 2011;51(6):467-71. doi: 10.2176/nmc.51.467. PMID: 21701116. Campero A, Baldoncini M, Villalonga JF, Abarca-Olivas J. Three-Dimensional Microscopic Surgical Videos: A Novel and Low-cost System. World Neurosurg. 2019 Dec;132:188-196. doi: 10.1016/j.wneu.2019.08.139. Epub 2019 Aug 30. PMID: 31476454. Huang TC, Sabbagh MD, Adabi K, Moran SL, Lu CK, Roh SG, Cheng HT, Huang CR, Manrique OJ. Compact and Economical Microsurgical Training Made Possible with Virtual Reality. Plast Reconstr Surg. 2018 Dec;142(6):993e-995e. doi: 10.1097/PRS.0000000000005059. PMID: 30212422. Choque-Velasquez J, Colasanti R, Collan J, Kinnunen R, Rezai Jahromi B, Hernesniemi J. Virtual Reality Glasses and "Eye-Hands Blind Technique" for Microsurgical Training in Neurosurgery. World Neurosurg. 2018 Apr;112:126-130. doi: 10.1016/j.wneu.2018.01.067. Epub 2018 Jan 31. PMID: 29360589. Boaro A, Moscolo F, Feletti A, Polizzi GMV, Nunes S, Siddi F, Broekman MLD, Sala F. Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon. Brain Spine. 2022 Aug 17;2:100926. doi: 10.1016/j.bas.2022.100926. PMID: 36248169; PMCID: PMC9560703. Tamura S, Yoshizumi K, Netsu T, Azuma R. Microsurgery Training Using AR Glasses. Microsurgery. 2024 Oct;44(7):e31244. doi: 10.1002/micr.31244. PMID: 39360576. McFadden JT. History of the operating microscope: from magnifying glass to microneurosurgery. Neurosurgery. 2000 Feb;46(2):511. doi: 10.1097/00006123-200002000-00059. PMID: 10690747. Savitz MH. History of the operating microscope: from magnifying glass to microneurosurgery. Neurosurgery. 1999 Aug;45(2):418. doi: 10.1097/00006123-199908000-00052. PMID: 10449093. Hoyt RF Jr, Clevenger RR, McGehee JA. Microsurgical instrumentation and suture material. Lab Anim (NY). 2001 Oct;30(9):38-45. doi: 10.1038/5000108. PMID: 11687782. Ng ZY, Honeyman C, Lellouch AG, Pandya A, Papavasiliou T. Smartphone-Based DIY Home Microsurgical Training with 3D Printed Microvascular Clamps and Japanese Noodles. Eur Surg Res. 2023;64(2):301-303. doi: 10.1159/000521439. Epub 2021 Dec 15. PMID: 34915484; PMCID: PMC10273871. Passiatore M, Taccardo G, D'Orio M, Stomeo D, Starnoni M, De Vitis R. Microsurgical training in vein anastomoses: the use of systemic heparin in a rat model. Acta Biomed. 2023 Jun 23;94(S2):e2023088. doi: 10.23750/abm.v94iS2.13819. PMID: 37366185. Bao B, Gao T, Li X, Wei H, Lin J, Sun Y, Shen J, Zhu H, Zheng X. Breaking the technical barrier of microvascular anastomosis with high-speed videography: A prospective cohort study. Int J Surg. 2022 Feb;98:106214. doi: 10.1016/j.ijsu.2021.106214. Epub 2022 Jan 4. PMID: 34995808. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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1","display":"","copyAsset":false,"role":"figure","size":217722,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Results section.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8260361/v1/654b40523f3779ccda02083a.png"},{"id":100787306,"identity":"efa59bfd-2e46-4a1d-8b28-df30230ac3d0","added_by":"auto","created_at":"2026-01-21 12:01:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":796700,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8260361/v1/26c55814-5eb0-49a5-8ab7-3b7e9176d510.pdf"},{"id":98424964,"identity":"9b268045-0909-449e-9984-ae172b966750","added_by":"auto","created_at":"2025-12-17 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It is especially crucial for procedures requiring small incisions and intricate techniques within various specialties, such as neurosurgery, plastic surgery, and otolaryngology Research in microsurgery has also undergone significant deepening, particularly in tissue regeneration, nerve regeneration, and vascular regeneration\u003csup\u003e[5][6]\u003c/sup\u003e. Additionally, advancements in imaging technologies, such as intraoperative ultrasound and magnetic resonance imaging (MRI), have further refined surgical accuracy and safety by providing real-time visualization of anatomical structures, which in turn minimizes operative complications and improves patient outcomes\u003csup\u003e[7][8]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eDespite these remarkable advancements in microsurgery, which have been vital for reconstructive procedures, several limitations still remain, requiring further exploration and improvement\u003csup\u003e[9]\u003c/sup\u003e. The complexity of microsurgical procedures has imposed high demands on physician training\u003csup\u003e[10]\u003c/sup\u003e. Numerous medical institutions are deficient in comprehensive training programs. As a result, young surgeons are left bereft of essential experience and skills, which has adversely affected patient outcomes\u003csup\u003e[11][12]\u003c/sup\u003e. Current training models frequently depend on traditional lecture-based approaches. This offers trainees an insufficient amount of hands-on practice opportunities, leaving them inadequately prepared to handle complex surgical scenarios\u003csup\u003e[13]\u003c/sup\u003e. Although emerging technologies, such as simulation-based training and virtual reality (VR), have demonstrated potential in improving technical proficiency, their adoption remains limited. This lack of widespread implementation impedes surgeons' capabilities to make quick and accurate decisions during intricate procedures. Furthermore, microsurgery requires delicate manipulation skills in high-pressure environments. Nevertheless, traditional training frequently fails to adequately address these crucial aspects, leaving practitioners insufficiently prepared for real-world difficulties. Additionally, the rapid development of minimally invasive techniques and new surgical instruments has presented new challenges. It demands surgeons not only to acquire greater adaptability but also to cultivate the capacity for lifelong learning\u003csup\u003e[14]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, the content of current training courses often fails to stay up-to-date. As a result, doctors are placed at a disadvantage when it comes to applying new technologies. Therefore, re-examining and optimizing the training mode, content, and evaluation system of microsurgery training has become an important approach to elevating the standards of microsurgery and safeguarding patient safety\u003csup\u003e[15]\u003c/sup\u003e. The purpose of this study is to identify the learning needs of both trainees and trainers for microsurgery training courses based on grounded theory and qualitative research methods. It also aims to elucidate the educational goals of microsurgery training\u003csup\u003e[16][17]\u003c/sup\u003e. This initiative is specifically intended to rectify the shortcomings inherent in existing frameworks.and provide a robust foundation for designing and implementing a comprehensive evidence-based microsurgical training curriculum.\u003c/p\u003e"},{"header":"2 Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study Design\u003c/h2\u003e\u003cp\u003e This qualitative study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) reporting guidelines. We performed semi-structured interviews to gather in-depth insights from participants, and systematically analyzed the data based on the grounded theory. Interviewees included both trainers and trainees in microsurgery, which enabled the acquisition of a thorough and all-round comprehension of the training needs and the obstacles encountered in the field.\u003c/p\u003e\u003cp\u003e.\u003c/p\u003e\u003cp\u003e All participants were required to fill in an informed consent form. They were fully informed of their rights to withdraw from the study at any time and to decline video recording of their interviews. This ensured compliance with ethical standards and safeguarded participant autonomy.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Ethics Approval\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e regarding human subject research was obtained from the Ethics Committee on the Third Xiangya Hospital of Central South University (approval number: Fast24971). Informed consent was obtained from each participant online by placing a question about their agreement to participate in the study at the beginning of the survey. Participants were guaranteed confidentiality and anonymity throughout the study, along with the right to withdraw at any point. We declare that the data were collected for academic use only.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Participants Recruiting\u003c/h2\u003e\u003cp\u003eInclusion criteria of trainers: (1) serving as chief surgeons in microsurgical procedures, (2) having performed at least 50 microsurgical operations.\u003c/p\u003e\u003cp\u003eInclusion criteria of trainees: (1) residents, interns.\u003c/p\u003e\u003cp\u003eThe number of participants was determined based on the data saturation. Upon analyzing the data and conducting interviews, it was ascertained that eight participants were included in the study, comprising five trainers and three trainees.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Instrument\u003c/h2\u003e\u003cp\u003eThe initial phases of Kern's six-step approach encompass (1) the identification of key educational challenges and a broad assessment of needs, succeeded by (2) a focused needs assessment. These preliminary steps are essential for constructing a curriculum that effectively addresses the identified educational requirements. Based on these preceding steps and a thorough literature review, we formulated an interview guide featuring open-ended questions designed to elicit comprehensive and in-depth responses.\u003c/p\u003e\u003cp\u003eTo validate the effectiveness of the interview guide, a panel discussion was conducted with seven experts in the field. Four of these experts possessed extensive knowledge of microsurgery and abundant experience in teaching clinical skills, which rendered them crucial in the process of refining the guide.\u003c/p\u003e\u003cp\u003eThe remaining experts had conducted numerous qualitative studies, which empowered them to provide meticulous qualitative supervision of the research instrument. To further assess the guide's feasibility, pilot interviews were carried out with three participants and necessary revisions were made. Ultimately, the finalized interview guide consisted of six sections: the necessity of training, curricular components, learning strategies, assessment methods, training duration, and instructional resources. This setup guaranteed a comprehensive framework to address educational needs in medical training.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data Collection\u003c/h2\u003e\u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\u003ch2\u003e2.5.1 Data collection process\u003c/h2\u003e\u003cp\u003e In July 2024, two trained interviewers carried out semi-structured interviews to gather participants' perspectives on the demand for microsurgery training. The average duration of the interviews was 17min21s, with a range from 11min22s to 30min53s. Each interview was transcribed verbatim from video recordings and meticulous attention was paid to participants' facial expressions. All transcripts underwent thorough verification to ensure accuracy and reliability.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u003ch2\u003e2.5.2 Data Cleaning and Analysis\u003c/h2\u003e\u003cp\u003eThe analytical process adhered to the grounded theory framework proposed by Corbin and Strauss. This analytical process consisted of three distinct stages: (1) open coding, which entailed a line-by-line identification of significant concepts; (2) axial coding, wherein themes were delineated from the derived codes; (3) selective coding, which involved synthesizing the identified themes into a cohesive conceptual framework.\u003c/p\u003e\u003cp\u003eUtilizing grounded theory, two researchers independently coded the transcripts with NVivo version 12 software. The initial open codes were subsequently organized into primary themes. Discrepancies in coding were resolved through collaborative discussions within the research team until consensus was achieved. Furthermore, a comparative analysis was conducted to elucidate variations in training demands between trainers and trainees, as well as between senior and junior trainees.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"3 Result","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.1 General Information\u003c/h2\u003e\u003cp\u003eParticipants from the Third Xiangya Hospital of Central South University were recruited in our interview, with ages ranging from 29 to 49. For data analysis, participants were categorized into two distinct groups: the teacher group and the student group, based on the established validity criteria. The teacher group was composed of individuals with higher professional titles, advanced academic qualifications, and extensive clinical experience. Meanwhile, the student group was further divided into junior and senior subgroups according to the same set of criteria. A qualitative analysis of the interviews revealed six primary themes that encapsulated the current state and needs of microsurgical training: (1) training necessity, (2) training methods, (3) training content, (4) training evaluation, (5) training duration, and (6) training resources. These themes provide a comprehensive foundation for understanding and addressing the challenges in microsurgical education. The subsequent sections will elaborate on them in detail.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Training Necessity\u003c/h2\u003e\u003cp\u003eHigh-resolution microsurgery, highlighted for its minimal invasiveness and high degree of accuracy, has become increasingly recognized as a fundamental skill for surgeons, particularly in complex cases such as limb replantation\u003csup\u003e[18][19]\u003c/sup\u003e. Physicians emphasized that the application of high-resolution microsurgery effectively minimized trauma and enhanced surgical precision, leading to optimal patient recovery and reduced long-term complications. They also noted that the visual precision enabled by surgical microscopes significantly reduced error rates and improved surgical outcomes, including higher graft survival and success rates\u003csup\u003e[20][21]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAdditionally, they pointed out that microsurgical techniques have evolved into a crucial fundamental skill for doctors, particularly in intricate surgical procedures such as limb and finger replantation. For patients with complex conditions, the application of microsurgery was crucial as it enabled precise operations such as vascular anastomosis and nerve repair, thereby guaranteeing a greater likelihood of functional recovery Furthermore, microsurgery not only presented technical challenges but also brought about a tremendous sense of professional accomplishment. Through microsurgery, physicians were able to effectively restore the functionality of injured regions. This not only aided patients in reclaiming their quality of life but also bestowed a deep sense of professional fulfillment upon the doctors.\u003c/p\u003e\u003cp\u003eMoreover, several participants noted that China, as an early adopter of microsurgical innovations, has established a prominent position in the global community. They emphasized China\u0026rsquo;s leading role in microsurgical techniques and highlighted the importance of leveraging this position to foster academic exchange and international collaboration. In addition, as technology progresses, microsurgery has been increasingly focusing on aesthetic outcomes. The technology has gradually transitioned from a sole focus on functional restoration to placing greater emphasis on both appearance and aesthetic repair, especially in fields such as plastic surgery and breast surgery. Such a development not only demonstrates the expanding scope of microsurgical applications but also mirrors a significant shift from merely treating traumas to achieving comprehensive aesthetic restoration.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Training Methods\u003c/h2\u003e\u003cp\u003eMost participants identified practical clinical operations as the most critical aspect of learning microsurgical techniques. Real-world clinical practice allowed trainees to face various unforeseen situations, rapidly improving their problem-solving skills. Additionally, mentorship played an essential role in microsurgical training. Senior surgeons not only provided verbal guidance but also led by example through practical demonstrations, enabling beginners to acquire and master the microsurgical techniques via hands-on training and direct guidance\u003c/p\u003e\u003cp\u003eMost participants acknowledged the importance of models or animal tissues in microsurgical skill training\u003csup\u003e[22][23][24][25][26]\u003c/sup\u003e. Simulated surgical operations allowed trainees to practice intricate techniques without the risks associated with live patients. Specifically, using animal models such as chicken legs or pig trotters for vascular anastomosis and nerve repair training provided an environment close to real-life scenarios, helping trainees improve both their precision and confidence in surgical procedures\u003csup\u003e[27][28][29]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMany participants also emphasized the use of head-mounted recording systems to document surgical procedures and conduct post-operative reviews as an effective method for improving surgical skills. By replaying the recorded surgeries, surgeons could review the entire procedure, identify problems in their techniques, and make self-corrections. Furthermore, these recordings served as valuable teaching tools. They empowered students to view the surgical procedures multiple times and acquire knowledge from them, thus contributing to the improvement of their surgical capabilities\u003csup\u003e[30][31]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAdditionally, many participants highlighted the possibilities of incorporating modern technologies such as virtual reality (VR) and augmented reality (AR) into microsurgical training\u003csup\u003e[32][33][34][35]\u003c/sup\u003e. These technologies could offer immersive and realistic simulations of surgical scenarios, enabling trainees to refine their techniques without the risks associated with live surgeries. Virtual simulations could provide immediate feedback during operations, allowing trainees to make adjustment and improvement based on their performance. The training supported by VR and AR technologies was anticipated to become a significant trend in the future of microsurgical training.\u003c/p\u003e\u003cp\u003eSome participants suggested that modern technologies could be used to develop online learning platforms as a valuable supplement to microsurgical training. These platforms would allow trainees to engage in self-directed learning and surgical simulations, eliminating the risks of real surgery. Moreover, trainees could conduct simulations from home, flexibly arranging their learning schedules and overcoming the traditional constraints of time and space in training.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Training Contents\u003c/h2\u003e\u003cp\u003eMost participants agreed that having a solid grounding in the historical development and basic principles of microsurgery was of utmost importance\u003csup\u003e[36][37]\u003c/sup\u003e. Understanding the historical background of microsurgery, commencing with the evolution of replantation techniques in the early 1960s, was considered foundational knowledge for every trainee. This not only helped them remember the significance and developmental trajectory of microsurgical techniques but also laid solid theoretical groundwork for subsequent clinical practice.\u003c/p\u003e\u003cp\u003eAnatomy was universally regarded as the cornerstone of microsurgical training, particularly familiarity with the anatomical structures of various parts of the human body. Mastery of both systemic and regional anatomy was identified as a prerequisite for performing microsurgery. A deep understanding of anatomy allowed surgeons to make precise decisions during operations, avoid damaging critical structures, and effectively repair injured areas. Anatomical knowledge has been recognized as a core competency for microsurgeons\u003csup\u003e[38][39][40]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMost participants highlighted that the use of microsurgical instruments and microscopes was an essential component of microsurgical training. Understanding the characteristics and operational techniques of different microscopes and mastering their use could enhance the precision of surgical procedures. Additionally, learning how to select and operate microsurgical instruments, such as microsurgical scissors and sutures, was critical to practical operations. Only when trainees have achieved a high level of proficiency in these microscopes can they guarantee the seamless and successful execution of surgical procedures.\u003c/p\u003e\u003cp\u003eMany participants pointed out that the acquisition of fundamental microsurgery knowledge\u0026mdash;encompassing familiarity with surgical procedures, comprehension of indications and contraindications, error prevention, and patient evaluations\u0026mdash;was essential in the training process. This knowledge was essential for ensuring surgical success, minimizing risks, and avoiding unnecessary harm to patients.\u003c/p\u003e\u003cp\u003eFinally, most participants stressed that theoretical learning must be integrated with clinical practice. Through simulation training, animal model operations, and clinical practice, trainees could translate theoretical knowledge into practical skills. In clinical practice, trainees had to not only master surgical techniques but also adapt to the individual differences of patients and respond to unexpected situations. This required trainees to possess a high level of adaptability and flexible problem-solving skills.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.5 Training Evaluation\u003c/h2\u003e\u003cp\u003eMost participants recognized theoretical examinations as the principal means of evaluating trainees' foundational knowledge.. Via approaches such as closed-book exams, trainees\u0026rsquo; basic knowledge of microsurgery was evaluated to ensure they possessed a sufficient theoretical understanding before engaging in practical operations. This form of assessment effectively guaranteed that trainees had a firm understanding of microsurgical principles, a comprehensive knowledge of anatomy, and a sound comprehension of surgical theories. As a result, it furnished them with a robust knowledge foundation essential for practical application.\u003c/p\u003e\u003cp\u003eSimulated surgical procedures on animal cadavers, including vascular anastomosis and flap delay, were highlighted as critical components of practical assessment. Trainees practiced those procedures through simulation and their performance was then assessed in light of aspects such as vascular patency and tissue survival.. These factors provided an initial measure of their skill level and technical proficiency. The animal models offered a risk-free environment for trainees to practice. By mimicking actual surgical situations, they furnished trainees with abundant chances to refine their skills.\u003c/p\u003e\u003cp\u003eRegarding specific evaluation criteria for training outcomes, most participants mentioned that surgical proficiency and task completion were key indicators. During practical assessments, trainees had to demonstrate mastery of microsurgical techniques, particularly core skills such as vascular and nerve anastomosis. Additionally, the evaluation included whether the outcomes of their procedures met clinical standards.\u003c/p\u003e\u003cp\u003eThe final assessment of microsurgical training also incorporated trainees\u0026rsquo; performance in clinical practice, especially the effectiveness of their surgeries. After completing procedures, trainees were evaluated based on clinical indicators such as limb viability and blood supply restoration\u003csup\u003e[41]\u003c/sup\u003e. These metrics not only reflected the trainees\u0026rsquo; ability to apply microsurgical techniques in real-world scenarios but also directly measured their level of technical expertise.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.6 Training Duration\u003c/h2\u003e\u003cp\u003eMost participants have agreed that microsurgical training should prioritize practical operations over theoretical learning. They generally believed that since trainees already had a foundation in theoretical knowledge, the emphasis of the training ought to be redirected towards enhancing technical proficiencies. Particularly in short-term training programs, trainees needed extensive hands-on practice to enhance their proficiency. The time allocated for theoretical learning should be relatively minimized, as excessive focus on theory might impede the development of practical skills. The length of the practice sessions had a direct bearing on the trainees' ability to master techniques both efficiently and effectively Given that clinical doctors usually were unable to be away from their responsibilities for an extended duration, the training sessions should be restricted to a span of 3 to 5 days, and in no case should they exceed one week Intensive short-term training efficiently reinforced skills while minimizing disruption to routine work. For the majority of clinicians, the primary goal of training was to strengthen and improve their technical abilities rather than to receive an all-encompassing basic education.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e3.7 Training Resources\u003c/h2\u003e\u003cp\u003eMost participants believed that the foundational stage of microsurgical training should begin with theoretical learning to establish a solid knowledge base. Theoretical learning resources included both electronic and printed materials. The theoretical curriculum typically covered the fundamentals of microsurgery, surgical procedures, and anatomical knowledge. By studying these materials and attending theoretical courses, trainees could grasp the framework and key points of surgical techniques, which provided essential theoretical support for subsequent practical training.\u003c/p\u003e\u003cp\u003eMoreover, surgical videos and VR-based instructing tools were considered essential for demonstrating procedural details and offering immersive practice environments.\u003c/p\u003e\u003cp\u003eDespite the growing availability of advanced technologies, participants reiterated the irreplaceable value of in-person mentorship and hands-on practice. Through mentorship, trainees could perform surgical operations under the supervision of instructors and master the detailed techniques required in practical scenarios. In this process, the instructors\u0026rsquo; hands-on teaching, real-time feedback, and detailed guidance played a critical role in helping trainees acquire crucial skills.\u003c/p\u003e\u003cp\u003eSimulated practice resources have been increasingly recognized for their importance in microsurgical training. Simulation-based training allowed trainees to repeatedly practice in a risk-free environment, which enabled them to steadily improve their skills, particularly in delicate and precise operations. Animal models, such as pig trotters and chicken legs, were commonly used simulation resources. These models replicated real surgical situations, helping trainees familiarize themselves with specific procedures.\u003c/p\u003e\u003cp\u003eA few participants mentioned that high-quality teaching instruments and equipment were essential for microsurgical training. These included microscopes and microsurgical instruments, which have served as the bedrock for guaranteeing that trainees were able to obtain top-notch practical training.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eMicrosurgical training, which is of utmost importance in modern surgical practice, still encounters significant challenges. These difficulties include insufficient operational proficiency, poorly structured training durations, and delayed adoption of new technologies. Through a qualitative research approach, this study has explored the current state of microsurgical training, focusing on key aspects such as training necessity, content, methods, evaluation, duration, and resources. By identifying critical issues in the training process, the study has intended to provide a theoretical basis for optimizing future curriculum designs.\u003c/p\u003e\u003cp\u003eThe core objective of microsurgical training has been unanimously regarded as improving operational skills. Most participants have emphasized that theoretical learning should serve as a supplementary component. Instead, more time should be dedicated to practical exercises, especially those carried out via simulation and using animal models. The complexity of microsurgical techniques requires repetitive practice to achieve precision, a view that was widely shared by participants. Regarding training duration, most participants advocated for intensive short-term training programs, typically lasting 3\u0026ndash;5 days. Such programs allow trainees to focus exclusively on skill development without significantly disrupting their clinical responsibilities.\u003c/p\u003e\u003cp\u003eAdvancements in technology have introduced new opportunities for improving microsurgical training. From traditional surgical videos to the integration of VR and AR technologies, these emerging tools have enhanced trainees\u0026rsquo; learning experiences and operational precision. In particular, virtual simulations have provided immersive learning environments that prove invaluable for practicing complex surgical scenarios. Most participants believed that the integration of these technologies would significantly improve training efficiency, especially in the development of surgical skills and clinical adaptability.\u003c/p\u003e\u003cp\u003eDespite the common requirements for skill enhancement and intensive short-term training, the disparities in the participants' viewpoints in specific aspects have been quite remarkable. A minority of participants stressed the importance of tailoring training content to trainees' individual backgrounds and pre-existing knowledge bases. For more experienced surgeons, foundational knowledge and basic skills training were redundant, whereas advanced skills\u0026mdash;such as minimally invasive surgery and complex organ repair techniques\u0026mdash;were prioritized. Personalized course designs could thus enhance the relevance and effectiveness of training.\u003c/p\u003e\u003cp\u003eAlthough the application of VR and AR technologies has been mentioned, their adoption remains limited. These technologies are regarded as pivotal for the future of microsurgical training. They hold great promise in crafting surgical simulations that closely mimic real-life scenarios.\u003c/p\u003e\u003cp\u003eDespite the growing availability of advanced technologies, the traditional mentorship model continues to be an irreplaceable component of microsurgical training. Many participants highlighted that, for complex surgical procedures, real-time guidance and personalized feedback from mentors would be critical for skill enhancement. This underscores that while modern technologies can improve training efficiency, clinical mentorship and hands-on practice still remain essential for trainees to master high-precision surgical operations.\u003c/p\u003e\u003cp\u003eOverall, the core needs of microsurgical training have centered on skill development, intensive short-term training, and the effective integration of new technologies. Nevertheless, personalized course designs, the application of VR technologies, and the retention of traditional mentorship models have remained vital components for future training programs. To keep pace with the rapid evolution of microsurgical techniques, future training curricula must continuously be refined in terms of content, format, and evaluation systems. Such improvements are intended to enhance surgeons\u0026rsquo; adaptability and technical expertise, ensure patient safety, and optimize surgical outcomes.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThis study highlights the pressing need to integrate advancements in modern medical technology and diversify training methodologies to address the challenges of microsurgical education. The combination of theoretical learning with clinical practice, particularly through simulation training and the incorporation of virtual reality technologies\u0026mdash;has significantly enhanced trainees\u0026rsquo; practical skills. As technology continues to innovate, the integration of emerging techniques and materials will become an essential addition to the current training curricula. This will aptly deal with the mounting complexity of surgical demands and the changing needs of patients. Additionally, the need to strike a balance between functional recovery and aesthetic results has been spotlighted as a fresh direction in microsurgical training.\u003c/p\u003e\u003cp\u003eIn conclusion, the optimization of microsurgical training programs is a critical step toward improving surgical outcomes and ensuring patient safety. By bridging the gaps in current training methods and incorporating modern innovations, these programs can better prepare surgeons to meet the demands of contemporary practice and propel the ongoing development of the field.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn accordance with the Declaration of Helsinki, written informed consent was obtained from all participants. Ethic approval received from\u0026nbsp;the Third Xiangya Hospital of Central South University (Protocol Fast24971).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were available on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declared no potential competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by\u0026nbsp;\u0026ldquo;The 13th Five-Year Plan\u0026rdquo;\u0026nbsp;of Educational Science in Hunan Province (No. XJK19AGD001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYW.L. conducted the formal analyses, and drafted the manuscript. YZ.K prepared the tables and figures, and analyzed the data. Q.G. and XH.T. critically reviewed the manuscript and made necessary revisions. All authors reviewed the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eTibbetts LS, Shanelec DA. An overview of periodontal microsurgery. Curr Opin Periodontol. 1994:187-93. PMID: 8032459.\u003c/li\u003e\n \u003cli\u003e9Kobayashi E. New trends in translational microsurgery. Acta Cir Bras. 2018 Sep;33(9):862-867. doi: 10.1590/s0102-865020180090000015. PMID: 30328919.\u003c/li\u003e\n \u003cli\u003eMavrogenis AF, Markatos K, Saranteas T, Ignatiadis I, Spyridonos S, Bumbasirevic M, Georgescu AV, Beris A, Soucacos PN. 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Smartphone-Based DIY Home Microsurgical Training with 3D Printed Microvascular Clamps and Japanese Noodles. Eur Surg Res. 2023;64(2):301-303. doi: 10.1159/000521439. Epub 2021 Dec 15. PMID: 34915484; PMCID: PMC10273871.\u003c/li\u003e\n \u003cli\u003ePassiatore M, Taccardo G, D\u0026apos;Orio M, Stomeo D, Starnoni M, De Vitis R. Microsurgical training in vein anastomoses: the use of systemic heparin in a rat model. Acta Biomed. 2023 Jun 23;94(S2):e2023088. doi: 10.23750/abm.v94iS2.13819. PMID: 37366185.\u003c/li\u003e\n \u003cli\u003eBao B, Gao T, Li X, Wei H, Lin J, Sun Y, Shen J, Zhu H, Zheng X. Breaking the technical barrier of microvascular anastomosis with high-speed videography: A prospective cohort study. Int J Surg. 2022 Feb;98:106214. doi: 10.1016/j.ijsu.2021.106214. Epub 2022 Jan 4. PMID: 34995808.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"microsurgical training, qualitative research, grounded theory","lastPublishedDoi":"10.21203/rs.3.rs-8260361/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8260361/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMicrosurgery, a cornerstone in modern surgery, facilitates precise interventions through the use of advanced microscopes and micro-instruments.. It has transformed practices in neurosurgery, reconstructive surgery, and otolaryngology. Innovations such as intraoperative MRI and tissue regeneration research have improved procedural accuracy and recovery. However, persistent shortcomings in surgical training curtail these advancements. Conventional programs place excessive emphasis on theoretical instruction, overlooking the development of practical skills and stress-management training, which are essential for complex operations. While tools such as virtual reality (VR) simulations demonstrate efficacy in skill acquisition, their limited integration into curricula leaves trainees ill-equipped for real-world challenges. Concurrently, the rise of minimally invasive methods and novel surgical devices demands adaptive expertise and continuous learning—competencies rarely prioritized in current education frameworks. This study employs grounded theory and qualitative analysis to determine the educational requirements of trainees and instructors, proposing a standardized, competency-based microsurgery curriculum. By bridging gaps between technological progress and training inadequacies, this framework aims to enhance technical proficiency, clinical decision-making, and patient safety outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis qualitative study adhered to the COREQ guidelines, using semi-structured interviews and grounded theory to analyze microsurgical training needs.\u003c/p\u003e\n\u003cp\u003eData was collected in July 2024, with two trained interviewers conducting interviews. Transcripts, including non-verbal cues, were analyzed using NVivo 12. Grounded theory guided the analysis through open, axial, and selective coding, with team discussions resolving coding discrepancies.\u003c/p\u003e\n\u003cp\u003eThe study followed Kerns six-step approach, developing an interview guide validated by expert panels and pilot interviews. The guide covered six areas: training necessity, curriculum content, learning methods, assessment, duration, and resources. Data saturation determined the sample size of eight participants (five trainers, three trainees).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study conducted qualitative interviews with participants from the Third Xiangya Hospital, who were divided into teacher and student groups, revealed six key themes in microsurgical training: (1) necessity, (2) methods, (3) content, (4) evaluation, (5) duration, and (6) resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study highlights the need to modernize microsurgical training by integrating advanced technologies and diverse methods. The integration of theory with practice, especially through simulation and virtual reality (VR) training, effectively enhances technical skill acquisition. As surgical demands grow, incorporating new techniques and materials is essential to meet patient needs. Balancing functional recovery with aesthetic outcomes is also a key focus.\u003c/p\u003e\n\u003cp\u003eOptimizing microsurgical training is crucial for better surgical results and patient safety. By addressing current gaps and adopting innovations, these programs can more effectively equip surgeons to confront multifaceted challenges of modern-day surgical practice and drive the progress of the microsurgery field forward.\u003c/p\u003e","manuscriptTitle":"A qualitative study of the construction of a microsurgical chief surgeon training course","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 14:29:33","doi":"10.21203/rs.3.rs-8260361/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3f77a96f-fbb6-4513-a681-938c8664cbd9","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-21T11:38:54+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 14:29:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8260361","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8260361","identity":"rs-8260361","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}