Face and construct validity of a novel simulator for microsurgical education: Microsurgery Arena

Simulation in microsurgery is essential for skill acquisition and maintenance. This study evaluated the construct and face validity of the Microsurgery Arena, a low-fidelity simulator designed to improve hand and wrist movements under the microscope, enhance instrument handling and knot-tying skills, and consistently assess user performance. Twenty-one surgical trainees participated in 3-day introductory microsurgical skills courses. Participants performed 2 predefined coordination exercises, "slalom" and "tie-the-knot," before and after the course. The time required to complete the exercises was recorded. The videos of the exercises were anonymized, randomized, and evaluated by 3 independent raters-a senior experimental microsurgeon, a senior clinical microsurgeon, and a junior resident-using the Stanford Microsurgery Residents Training Scale. Participants also completed demographic and face validity questionnaires at the end of the course. Quantitative analysis of pre-course scores vs post-course scores showed a statistically significant improvement in all examined skills. Moreover, the face validity assessment revealed highly positive feedback from the participants. The vast majority of candidates found the device extremely or very useful as an initial training model in microsurgery. Moreover, the model demonstrated its ability to discriminate between skill levels before and after training, supporting its construct validity. As a low-cost and accessible model, it provides a standardized approach for developing essential microsurgical skills. This simulator has the potential to serve as an effective assessment and training tool for students, residents, and microsurgical novices, contributing to improved skill acquisition in microsurgical training programs.