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P438: ESTABLISHING AN ASYNCHRONOUS CURRICULUM FOR VASCULAR ANASTOMOSIS FOR NEUROSURGICAL RESIDENTS
Alankrita Raghavan, MD; Kennedy Carpenter; Caroline Folz, MD; Brandon Smith, MD; Ali Zomorodi, MD; Duke University

Mastery of advanced microsurgical skills is a critical milestone for senior neurosurgical residents preparing for independent practice. Traditional surgical training has relied heavily on the apprenticeship model; however, recent restrictions on work hours, heightened attention to patient safety, and decreased open vascular case volumes have limited residents' opportunities to gain proficiency in technically demanding open vascular skills such as bypass surgery. These limitations necessitate structured, reproducible, and efficient training methods outside of the operating room that provide both repetition and meaningful feedback.

To address this gap, we developed a graduated, asynchronous, video-based microsurgical curriculum, designed specifically for senior neurosurgical residents to learn and refine vascular anastomosis skills (Figure 1). Prior studies in general surgery, as well as numerous studies in athletics, demonstrate that effective, formative feedback leads to improved psychomotor outcomes. We have previously implemented a microsurgery curriculum for junior residents and introduced a staged progression to learning bypass techniques. The program emphasizes both technical precision and deliberate practice, supported by longitudinal mentorship and asynchronous feedback from expert faculty.

Prior to enrollment in the advanced microsurgery curriculum, residents (n=6) completed an entrance task involving tying ten consecutive knots with 10-0 nylon suture around two adjacent strands of gauze. Participants then attended an in-person teaching session with a senior neurovascular faculty mentor, followed by a structured pre-test that includes timed knot-tying and an end-to-side anastomosis on a 2 mm biovessel model. Residents were then guided through five sequential tasks over five months: (1) preparation of the donor and recipient vessels (chicken femoral artery), (2) placement of heel and toe stitches, (3) placement of additional anchoring stitches, and (4) completion of a full end-to-side anastomosis of synthetic biovessels (Table 1). Each task requires the submission of high-resolution photographs of the completed work and short video segments (≤3 minutes) capturing key aspects of the procedure. 

Upon successful completion of the curriculum, residents will be expected to complete a structured post-test to evaluate efficiency of knot tying and completing an end-to-side anastomosis. Their pre- and post-test data will be compared to determine the efficacy of an asynchronous curriculum in enhancing advanced microsurgical skills. If successful, this model could be expanded to other neurosurgical techniques and serve as a framework for teaching advanced techniques outside of the operating room.

Figure 1.

Table 1.

Month	Task
1	Preparation of the donor and recipient vessels (chicken femoral artery)
2	Placement of heel and toe stitches
3	Placement of additional anchoring stitches
4	Completion of a full end-to-side anastomosis of synthetic biovessels

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