Randomized Control Trial of Smartphones as Microscope Simulators in Early Microsurgical Education

Microsurgery is an important discipline with a steep learning curve. The gold standard for training is on traditional operative-level microscopes (TM), although they are expensive, large, and immobile. Smartphones as microscope simulators (SMS) pose a promising alternative due to their ubiquity, affordability, and portability, yet existing studies are limited.Students and surgical residents were recruited and randomized to three groups: Test-Only (no interval training), SMS (remote training on smartphone), or TM (training on hospital TM). Participants completed identical initial and final suture tests 1-week apart on the TM that were filmed, then blindly evaluated by two microsurgery fellowship-trained plastic surgeons. During the week in between, SMS and TM participants had four training sessions. One and five suture completion, suture quality (using the Stanford Microsurgery and Resident Training [SMART] Score), speed, self-confidence, and training completion rate were evaluated. Paired t-tests and multivariate analysis of variance were performed in R Studio.A total of 58 participants completed the study. Compared with no training, SMS (n = 20) significantly improved single suture and five suture completion (p = 0.004), SMART Score (p = 0.0002), and self-confidence (p = 0.001). Test-Only (n = 20) had significant improvement for self-confidence (p = 0.039) but not suturing. TM (n = 18) had higher SMART Scores (p = 0.006) and training completion rate compared with SMS (89 vs. 45%, respectively [p = 0.012]). Between SMS and TM, there was no difference in five suture completion (p = 0.178), speed (p = 0.289), or self-confidence (p = 0.632). Students after SMS training had similar SMART Scores as residents at baseline (p = 0.260).SMS is an effective training modality for achieving basic suture competency, speed, and self-confidence, whereas TM remains superior for suturing quality. SMS may be particularly well suited for acquisition of basic microsurgical skills in training situations with limited TM access, or as an adjunct to TM in early training to establish basic skills, instrument familiarity, and increase repetitions.