Abstract
Background: Microsurgical skill acquisition and development are complex processes, due to the often complex learning curve, limited training possibilities, and growing restrictions on working hours. Simulation-based training programmes, employing various models, have been proposed. Nevertheless, the extent to which these training programmes are supported by scientific evidence is unclear. The aim of this systematic review is to evaluate the extent and quality of the scientific evidence backing validated microsurgical training programmes. Methods: A systematic literature review was conducted, following a study protocol established a priori and in accordance with the PRISMA guidelines. The databases searched were the Web of Science Core Collection (Web of Knowledge), Medline (Ovid), Embase (Embase.com), and ERIC (Ovid). Studies were included if they described microsurgical training programmes and presented a form of validation of training effectiveness. Data extraction included the number of participants, training duration and frequency, validation type, assessment methods, outcomes, study limitations, and a detailed training regimen. The risk of bias and quality were assessed using the Medical Education Research Study Quality Instrument (MERSQI). Validity was assessed using an established validity framework (content, face, construct, and criterion encompassing both concurrent and predictive validity). The Level of Evidence (LoE) and Recommendation (LoR) were evaluated using the Oxford Centre for Evidence-Based Medicine (OCEBM). Results: A total of 25 studies met the inclusion criteria. Training programmes were classified into one-time intensive courses or longitudinal curricula. Face, content, and construct validity were the most commonly assessed aspects, while predictive validity was the least frequently assessed and not properly evaluated. Training models ranged from low-fidelity (silicone tubes, synthetic vessels) to high-fidelity (live animal models). The Global Rating Scale (GRS), the Structured Assessment of Microsurgery Skills (SAMS), and the Objective Structured Assessment of Technical Skills (OSATS) were the most frequently used objective assessment tools for evaluation methods within the programmes. The risk of bias MERSQI score was 12.96, ranging from 10.5 to 15.5, and LoE and LoR scores were moderated. Across the studies, 96% reported significant improvement in microsurgical skills among participants. However, most studies were limited by small sample sizes, heterogeneity in baseline skills, and a lack of long-term follow-up. Conclusions: While validated microsurgical training programmes improve skill acquisition, challenges remain in terms of standardisation and best cost-effective methods. Future research should prioritise evaluating predictive validity, creating standardised objective assessment tools, and focus on skill maintenance.