During the last decades and still nowadays the practical teaching of surgical residents was
only evaluated, guided and taught through the expertise of a senior surgeon, which is highly
subjective and unequal between experts (Ramachandran, 2013). This training based on the
Halstedian model depended on the opportunities and relationship the residents build with
their mentor and could lead to an unfair and heterogeneous training. Consequently, only
little objectives elements is known about what makes a surgical gesture optimal. Indeed, the
resident performs and modifies his/her gesture as taught by his mentor. No objective
technique, data or knowledge underlie his/her new learning to ensure him/her that the
applied gesture is the best. Another issue brought by the Halstedian model is that a lot of
what improves a surgeon’s gesture (e.g the pressure applied on the clamps, muscle activity,
etc) cannot be assessed by direct observation.
However, these last few years, more objective types of assessments have been studied to
fill the lack of objective and updated training. Most of the recent studies focus on a few
data, such as width of movement and time, but none have been interested by other data
such as cerebral activity or muscular activity. Nevertheless, no study has yet compared
measurements to find out which parameter is the most discriminative, nor the most efficient
to use in pedagogical tools.
The aim of this pilot project has been to create a microsurgery-connected clamp enabling to
measure the prehension force during a microsurgical gesture and to compare it according to
the subject experience (expert, intermediate, novice).