The use of simulation in neurosurgical education and training

Abstract

Object There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty. To their knowledge this is the first systematic review published on this topic to date. Methods The authors searched the Ovid MEDLINE, Embase, and PsycINFO databases and identified 4101 articles; 195 abstracts were screened by 2 authors for inclusion. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations. Results Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon's disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures. Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The mean Medical Education Research Study Quality Instrument score of included studies was 9.21 ± 1.95 (± SD) out of a possible score of 18. Conclusions The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design. Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes.

Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study

“…There were no significant differences in the answers between groups for the question of how successful the participant was in accomplishing the task (p = 0.38), which contradicts the results obtained by the objective measurements (see construct validity). With regard to questions about the ability of the model to improve microsurgical techniques and instrument handling, 30 of 30 (100%) participants answered positively (within the interval of [15][16][17][18][19][20]. In addition, 30 of 30 participants considered the model to be able to improve surgical technique when the skills were applied to patients (scores within the interval of [15][16][17][18][19][20].…”

“…18 Previous studies noted that for evidence-based medicine techniques, the face, content, and construct validities should be examined as the first step for evaluating the benefit of a surgical simulation model before integrating the model into a training curriculum. 10 Validity measures reveal the instructive value of the simulation.…”

História da simulação cirúrgica e sua aplicação em Neurocirurgia

“…Numerosos estudos relatam métodos modernos de simulação e recentes revisões resumem essas informações [25][26][27]. Indubitavelmente, no futuro, os simuladores se tornarão uma parte integrante do currículo da maioria dos programas cirúrgicos.…”

On resident duty hour restrictions and neurosurgical training: review of the literature

“…Neurosurgery programs are implementing strategies to improve technical skill training within the confines of the DHR; many programs are including simulators as an integral portion of their training. A large percentage (83%) of US program director respondents believe that simulation, as fidelity and complexity increase, 23 will play a large role in training in the future, especially for preparation in complex cases and in early training. 13,26,37 We believe that simulators are an excellent adjunct to surgical training, but cannot replace operative experience, which requires time that is diminishingly available to trainees as a result of the DHR.…”