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Thiong'o GM, Looi T, Rutka JT, Kulkarni AV, Drake JM. Design and validation of a hemispherectomy simulator for neurosurgical education. J Neurosurg 2023; 138:1-8. [PMID: 35901759 DOI: 10.3171/2022.5.jns22545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/04/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Early adaptors of surgical simulation have documented a translation to improved intraoperative surgical performance. Similar progress would boost neurosurgical education, especially in highly nuanced epilepsy surgeries. This study introduces a hands-on cerebral hemispheric surgery simulator and evaluates its usefulness in teaching epilepsy surgeries. METHODS Initially, the anatomical realism of the simulator and its perceived effectiveness as a training tool were evaluated by two epilepsy neurosurgeons. The surgeons independently simulated hemispherotomy procedures and provided questionnaire feedback. Both surgeons agreed on the anatomical realism and effectiveness of this training tool. Next, construct validity was evaluated by modeling the proficiency (task-completion time) of 13 participants, who spanned the experience range from novice to expert. RESULTS Poisson regression yielded a significant whole-model fit (χ2 = 30.11, p < 0.0001). The association between proficiency when using the training tool and the combined effect of prior exposure to hemispherotomy surgery and career span was statistically significant (χ2 = 7.30, p = 0.007); in isolation, pre-simulation exposure to hemispherotomy surgery (χ2 = 6.71, p = 0.009) and career length (χ2 = 14.21, p < 0.001) were also significant. The mean (± SD) task-completion time was 25.59 ± 9.75 minutes. Plotting career length against task-completion time provided insights on learning curves of epilepsy surgery. Prediction formulae estimated that 10 real-life hemispherotomy cases would be needed to approach the proficiency seen in experts. CONCLUSIONS The cerebral hemispheric surgery simulator is a reasonable epilepsy surgery training tool in the quest to increase preoperative practice opportunities for neurosurgical education.
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Affiliation(s)
- Grace M Thiong'o
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
| | - Thomas Looi
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and
| | - James T Rutka
- 2Department of Surgery, University of Toronto, Ontario, Canada
| | | | - James M Drake
- 1The Hospital for Sick Children, Posluns Center for Image Guided Innovation and Therapeutic Intervention; and.,2Department of Surgery, University of Toronto, Ontario, Canada
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Advanced Manufacturing in the Fabrication of a Lifelike Brain Glioblastoma Simulator for the Training of Neurosurgeons. Polymers (Basel) 2022; 14:polym14061072. [PMID: 35335403 PMCID: PMC8948645 DOI: 10.3390/polym14061072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/26/2022] Open
Abstract
Neurosurgeons require considerable expertise and practical experience to deal with the critical situations commonly encountered in complex surgical operations such as cerebral cancer; however, trainees in neurosurgery seldom have the opportunity to develop these skills in the operating room. Physical simulators can give trainees the experience they require. In this study, we adopted advanced molding and replication techniques in the fabrication of a physical simulator for use in practicing the removal of cerebral tumors. Our combination of additive manufacturing and molding technology with elastic material casting made it possible to create a simulator that realistically mimics the skull, brain stem, soft brain lobes, and cerebral cancer with cerebral tumors located precisely where they are likely to appear. Multiple and systematic experiments were conducted to prove that the elastic material used herein was appropriated for building professional medical physical simulator. One neurosurgical trainee reported that under the guidance of a senior neurosurgeon, the physical simulator helped to elucidate the overall process of cerebral cancer removal and provided a realistic impression of the tactile feelings involved in craniotomy. The trainee also learned how to make decisions when facing the infiltration of a cerebral tumor into normal brain lobes. Our results demonstrate the efficacy of the proposed physical simulator in preparing trainees for the rigors involved in performing highly delicate surgical operations.
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Batjer HH, Kim J, El Ahmadieh TY, Aoun SG, Corona Ruiz JM, Purdy P, Awad IA. Cerebrovascular surgery: from the Wild West through the endovascular revolution. The M. Gazi Yaşargil Lecture at the American Association of Neurological Surgeons 2021 Annual Scientific Meeting. J Neurosurg 2022; 137:599-603. [PMID: 34996043 DOI: 10.3171/2021.10.jns211412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- H Hunt Batjer
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jun Kim
- 2Department of Neurological Surgery, Westmead Hospital, Sydney, Australia; and
| | - Tarek Y El Ahmadieh
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Salah G Aoun
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Juan Mario Corona Ruiz
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Phillip Purdy
- 1Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Issam A Awad
- 3Department of Neurological Surgery, University of Chicago Medical Center, Chicago, Illinois
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Davids J, Manivannan S, Darzi A, Giannarou S, Ashrafian H, Marcus HJ. Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance. Neurosurg Rev 2021; 44:1853-1867. [PMID: 32944808 PMCID: PMC8338820 DOI: 10.1007/s10143-020-01378-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI - 0.482; - 0.167, p < 0.001), and speed by 25% (ES - 0.25, CI - 0.399; - 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.
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Affiliation(s)
- Joseph Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK.
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK.
| | - Susruta Manivannan
- Department of Neurosurgery, Southampton University NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Stamatia Giannarou
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hutan Ashrafian
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
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Microsurgical suturing assessment scores: a systematic review. Neurosurg Rev 2021; 45:119-124. [PMID: 34075509 DOI: 10.1007/s10143-021-01569-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/06/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
Several scoring scales for the assessment of microsurgical skills have been established and validated with the same basic parameters. The study aims to review the existing scales to highlight those parameters, which can be utilized uniformly across all neurosurgical training centers. An online search was conducted and all the surgical scores pertinent to microsurgical suturing were reviewed. The scales were compared to identify parameters, which were important for skill development and assessment in neurosurgical trainees. Seven assessment scales were identified which assessed the trainee's proficiency in microsurgical suturing. The objective structured assessment of technical skills (OSATS) and Northwestern Objective Microanastomosis Assessment Tool (NOMAT) were identified as the most widely used and validated assessment scales. The newer scales University of Western Ontario microsurgical skills acquisition/assessment (UWOMSA) and structured assessment of microsurgery (SAMS) were notable for the division of the skills. The knot strength, suture separation, and suture intervals were the most important parameters in all scales. Each scale has its strength in the assessment of the microsurgical proficiency of neurosurgical trainees. However, a more uniform scale that can be applied as per the level of the neurosurgical trainee is necessary.
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Byvaltsev V, Polkin R, Bereznyak D, Giers MB, Hernandez PA, Shepelev V, Aliyev M. 3D-printed cranial models simulating operative field depth for microvascular training in neurosurgery. Surg Neurol Int 2021; 12:213. [PMID: 34084640 PMCID: PMC8168712 DOI: 10.25259/sni_849_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The skills required for neurosurgical operations using microsurgical techniques in a deep operating field are difficult to master in the operating room without risk to patients. Although there are many microsurgical training models, most do not use a skull model to simulate a deep field. To solve this problem, 3D models were created to provide increased training in the laboratory before the operating room, improving patient safety. METHODS A patient's head was scanned using computed tomography. The data were reconstructed and converted into a standard 3D printing file. The skull was printed with several openings to simulate common surgical approaches. These models were then used to create a deep operating field while practicing on a chicken thigh (femoral artery anastomosis) and on a rat (abdominal aortic anastomosis). RESULTS The advantages of practicing with the 3D printed models were clearly demonstrated by our trainees, including appropriate hand position on the skull, becoming comfortable with the depth of the anastomosis, and simulating proper skull angle and rigid fixation. One limitation is the absence of intracranial structures, which is being explored in future work. CONCLUSION This neurosurgical model can improve microsurgery training by recapitulating the depth of a real operating field. Improved training can lead to increased accuracy and efficiency of surgical procedures, thereby minimizing the risk to patients.
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Affiliation(s)
- Vadim Byvaltsev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Roman Polkin
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Dmitry Bereznyak
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Morgan B. Giers
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon, United States
| | - Phillip A. Hernandez
- School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon, United States
| | - Valery Shepelev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
| | - Marat Aliyev
- Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University, Irkutsk, Russia
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Davids J, Makariou SG, Ashrafian H, Darzi A, Marcus HJ, Giannarou S. Automated Vision-Based Microsurgical Skill Analysis in Neurosurgery Using Deep Learning: Development and Preclinical Validation. World Neurosurg 2021; 149:e669-e686. [PMID: 33588081 DOI: 10.1016/j.wneu.2021.01.117] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND/OBJECTIVE Technical skill acquisition is an essential component of neurosurgical training. Educational theory suggests that optimal learning and improvement in performance depends on the provision of objective feedback. Therefore, the aim of this study was to develop a vision-based framework based on a novel representation of surgical tool motion and interactions capable of automated and objective assessment of microsurgical skill. METHODS Videos were obtained from 1 expert, 6 intermediate, and 12 novice surgeons performing arachnoid dissection in a validated clinical model using a standard operating microscope. A mask region convolutional neural network framework was used to segment the tools present within the operative field in a recorded video frame. Tool motion analysis was achieved using novel triangulation metrics. Performance of the framework in classifying skill levels was evaluated using the area under the curve and accuracy. Objective measures of classifying the surgeons' skill level were also compared using the Mann-Whitney U test, and a value of P < 0.05 was considered statistically significant. RESULTS The area under the curve was 0.977 and the accuracy was 84.21%. A number of differences were found, which included experts having a lower median dissector velocity (P = 0.0004; 190.38 ms-1 vs. 116.38 ms-1), and a smaller inter-tool tip distance (median 46.78 vs. 75.92; P = 0.0002) compared with novices. CONCLUSIONS Automated and objective analysis of microsurgery is feasible using a mask region convolutional neural network, and a novel tool motion and interaction representation. This may support technical skills training and assessment in neurosurgery.
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Affiliation(s)
- Joseph Davids
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Savvas-George Makariou
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom
| | - Hani J Marcus
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom; Imperial College Healthcare NHS Trust, St. Mary's Praed St., Paddington, London, United Kingdom; Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Stamatia Giannarou
- Department of Surgery and Cancer, Hamlyn Centre for Robotic Surgery, Imperial College London, London, United Kingdom.
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Chen PC, Lin JC, Chiang CH, Chen YC, Chen JE, Liu WH. Engineering Additive Manufacturing and Molding Techniques to Create Lifelike Willis' Circle Simulators with Aneurysms for Training Neurosurgeons. Polymers (Basel) 2020; 12:polym12122901. [PMID: 33287397 PMCID: PMC7761873 DOI: 10.3390/polym12122901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022] Open
Abstract
Neurosurgeons require considerable expertise and practical experience in dealing with the critical situations commonly encountered during difficult surgeries; however, neurosurgical trainees seldom have the opportunity to develop these skills in the operating room. Therefore, physical simulators are used to give trainees the experience they require. In this study, we created a physical simulator to assist in training neurosurgeons in aneurysm clipping and the handling of emergency situations during surgery. Our combination of additive manufacturing with molding technology, elastic material casting, and ultrasonication-assisted dissolution made it possible to create a simulator that realistically mimics the brain stem, soft brain lobes, cerebral arteries, and a hollow transparent Circle of Willis, in which the thickness of vascular walls can be controlled and aneurysms can be fabricated in locations where they are likely to appear. The proposed fabrication process also made it possible to limit the error in overall vascular wall thickness to just 2–5%, while achieving a Young’s Modulus closely matching the characteristics of blood vessels (~5%). One neurosurgical trainee reported that the physical simulator helped to elucidate the overall process of aneurysm clipping and provided a realistic impression of the tactile feelings involved in this delicate operation. The trainee also experienced shock and dismay at the appearance of leakage, which could not immediately be arrested using the clip. Overall, these results demonstrate the efficacy of the proposed physical simulator in preparing trainees for the rigors involved in performing highly delicate neurological surgical operations.
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Affiliation(s)
- Pin-Chuan Chen
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
- High Speed 3D Printing Research Center, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Chung-Hsuan Chiang
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
| | - Yi-Chin Chen
- Department of Mechanical Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (P.-C.C.); (C.-H.C.); (Y.-C.C.)
| | - Jia-En Chen
- Medical 3D Printing Center, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan;
- Department of Biomedical Engineering, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Hsiu Liu
- Department of Neurological Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
- Department of Surgery, School of Medicine, National Defense Medical Center, Taipei 114, Taiwan
- Correspondence: ; Tel.: +886-2-87927177; Fax: +886-2-87927178
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Doron O, Paldor I, Moscovisci S, Spektor S, Chalif DJ, Langer DJ, Nossek E. Acquisition of Basic Microsurgical Skills Using Low-Cost, Readily Available Models: The Orange Model. World Neurosurg 2020; 146:189-196. [PMID: 33220480 DOI: 10.1016/j.wneu.2020.11.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Attainment of basic microsurgical skills in neurosurgery presents a departmental challenge worldwide. Models for teaching are either not readily available or expensive and are incompatible with a resident's busy schedule, requiring lengthy and proper setup. We present a model and a set of measurable tasks, based on a fruit (orange) that is cheap, easy to set up instantly when desired, and useful for training of basic microsurgical skills. METHODS Basic microsurgical skills were identified, necessitating hand-eye coordination working with the microscope. The goal was to dissect an orange segment while preserving adjacent segments. Assessment was based on the number of side tears and task completion duration. The task was repeated in a sequential manner (n = 10), for validation purposes, for 3 operators at different seniority levels. RESULTS An improvement in the number of side tears (mean of 12.66 ± 9.01 in the first trial vs. 4 ± 4.35 in the 10th trial, P < 0.01), as well as duration of time required for task completion (mean initial duration of 28:16 ± 19:00 minutes to a duration of 16:33 ± 10:50 minutes in the last attempt, P < 0.01), was observed. Daily practice scores and time gradually improved, and the seniority level of operators was correlated with scoring between individuals. CONCLUSIONS The orange model is an easily accessible, cheap model that enables the acquisition of basic microneurosurgical skills. In this work, we validated and defined reproducible tasks that can be scored and tracked, correlated with operator's proficiency and experience. This model can be incorporated into a resident's workflow environment and provides a platform for attainment of elementary microsurgical skills for neurosurgical residents.
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Affiliation(s)
- Omer Doron
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, Jerusalem, Israel.
| | - Iddo Paldor
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Samuel Moscovisci
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - Sergey Spektor
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, Jerusalem, Israel
| | - David J Chalif
- Department of Neurosurgery, Northwell Health North Shore University Hospital, Manhasset, New York, New York, USA
| | - David J Langer
- Department of Neurosurgery, Northwell Health Lenox Hill Hospital, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, New York University Langone Health, New York, New York, USA
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Abecassis IJ, Sen RD, Ellenbogen RG, Sekhar LN. Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory. J Neurosurg 2020; 135:194-204. [PMID: 32886917 DOI: 10.3171/2020.5.jns201590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A variety of factors contribute to an increasingly challenging environment for neurological surgery residents to develop psychomotor skills in microsurgical technique solely from operative training. While adjunct training modalities such as cadaver dissection and surgical simulation are embraced and practiced at our institution, there are no formal educational milestones defined to help residents develop, measure, and advance their microsurgical psychomotor skills in a stepwise fashion when outside the hospital environment. The objective of this report is to describe an efficient and convenient "home microsurgery lab" (HML) assembled and tested by the authors with the goal of supporting a personalized stepwise advancement of microsurgical psychomotor skills. METHODS The authors reviewed the literature on previously published simulation practice models and designed adjunct learning modules utilizing the HML. Five milestones were developed for achieving proficiency with each graduated exercise, referencing the Accreditation Council for Graduate Medical Education (ACGME) guidelines. The HML setup was then piloted with 2 neurosurgical trainees. RESULTS The total cost for assembling the HML was approximately $850. Techniques for which training was provided included microinstrument handling, tissue dissection, suturing, and microanastomoses. Five designated competency levels were developed, and training exercises were proposed for each competency level. CONCLUSIONS The HML offers a unique, entirely home-based, affordable adjunct to the operative neurosurgical education mandated by the ACGME operative case logs, while respecting resident hospital-based education hours. The HML provides surgical simulation with specific milestones, which may improve confidence and the microsurgical psychomotor skills required to perform microsurgery, regardless of case type.
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Nonbiological Microsurgery Simulators in Plastic Surgery Training: A Systematic Review. Plast Reconstr Surg 2020; 144:496e-507e. [PMID: 31461050 DOI: 10.1097/prs.0000000000005990] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Simulation has gained notable recognition for its role as an effective training and assessment modality in the present era of competency-based medical education. Despite the well-documented efficacy of both live and cadaveric animal models, several ethical, financial, and accessibility issues persist with their use. Lower fidelity nonbiological simulators have gained recognition for their ability to circumvent these challenges. This systematic review reports on all prosthetic and virtual reality simulators in use for microsurgery training, with an emphasis on each model's complexity, characteristics, advantages, disadvantages, and validation measures taken. METHODS A systematic search was performed using the National Library of Medicine (PubMed), MEDLINE, and Embase databases. Search terms were those pertaining to prosthetic and virtual reality models with relevance to microsurgical training in plastic surgery. Three independent reviewers evaluated all articles retrieved based on strict inclusion and exclusion criteria. RESULTS Fifty-seven articles met the inclusion criteria for review, reporting on 20 basic prosthetic models, 20 intermediate models, 13 advanced models, and six virtual reality simulators. CONCLUSIONS A comprehensive summary has been compiled of all nonbiological simulators in use for microsurgery training in plastic surgery, demonstrating efficacy for the acquisition and retention of microsurgical skills. Metrics-based validation efforts, however, were often lacking in the literature. As plastic surgery programs continue to innovate, ensure accountability, and safely meet today's training standards, prosthetic simulators are set to play a larger role in the development of a standardized, ethical, accessible, and objectively measurable microsurgery training curriculum for the modern-day plastic and reconstructive surgery resident.
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Muriel-Fernández J, Alonso CP, López-Valverde N, López-Millán JM, Juánes Méndez JA, Sánchez-Ledesma MJ. Results of the Use of a Simulator for Training in Anesthesia and Regional Analgesia Guided by Ultrasound. J Med Syst 2019; 43:79. [DOI: 10.1007/s10916-019-1196-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/01/2019] [Indexed: 11/29/2022]
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13
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Kazan R, Viezel-Mathieu A, Cyr S, Hemmerling TM, Gilardino MS. The Montreal Augmentation Mammaplasty Operation (MAMO) Simulator: An Alternative Method to Train and Assess Competence in Breast Augmentation Procedures. Aesthet Surg J 2018; 38:835-849. [PMID: 29506205 DOI: 10.1093/asj/sjx267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical residents' exposure to aesthetic procedures remains limited in residency training. The development of the Montreal augmentation mammaplasty operation (MAMO) simulator aims to provide an adjunctive training method and assessment tool to complement the evolving competency-based surgical curriculum. OBJECTIVES To perform face, content, and construct validations of the MAMO simulator for subpectoral breast augmentation procedures and assess the reliability of the assessment scales used. METHODS Plastic surgery staff and residents were recruited to perform a subpectoral breast augmentation on the simulator. Video recordings of their performance were blindly evaluated using the objective structured assessment of technical skills (OSATS) system consisting of the global rating scale (GRS), mammaplasty objective assessment tool (MOAT), and a surgery-specific Checklist score. RESULTS Fourteen plastic surgery residents and seven expert plastic surgeons were enrolled. Experts' performance was significantly higher than residents' according to each of GRS, MOAT, and Checklist scores. Mean values of residents and experts were 23.4 (2.5) vs 36.9 (3.1) (P < 0.0001) for GRS score, 30.4 (2.2) vs 40 (3.2) (P < 0.0001) for MOAT scores, and 9.7 (1.5) vs 12 (1) (P < 0.001) for Checklist scores, respectively. Face and content validations showed excellent results among parameters evaluated, with an overall mean score of 4.8 (0.3) on 5. Cronbach's alpha was 0.96 and 0.83 for GRS and MOAT scores, respectively. Intraclass correlation coefficients for interrater reliability were excellent at 0.93, 0.92, and 0.89 for the GRS, MOAT, and Checklist scores, respectively. CONCLUSIONS This study proves the construct simulator to be valid and the assessment scales to be reliable.
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Affiliation(s)
- Roy Kazan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Viezel-Mathieu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Shantale Cyr
- Intelligence Technologies of Anesthesia Group Laboratory, Department of Anesthesia, McGill University
| | | | - Mirko S Gilardino
- Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada
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Cikla U, Sahin B, Hanalioglu S, Ahmed AS, Niemann D, Baskaya MK. A novel, low-cost, reusable, high-fidelity neurosurgical training simulator for cerebrovascular bypass surgery. J Neurosurg 2018; 130:1663-1671. [PMID: 29749910 DOI: 10.3171/2017.11.jns17318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 11/14/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Cerebrovascular bypass surgery is a challenging yet important neurosurgical procedure that is performed to restore circulation in the treatment of carotid occlusive diseases, giant/complex aneurysms, and skull base tumors. It requires advanced microsurgical skills and dedicated training in microsurgical techniques. Most available training tools, however, either lack the realism of the actual bypass surgery (e.g., artificial vessel, chicken wing models) or require special facilities and regulations (e.g., cadaver, live animal, placenta models). The aim of the present study was to design a readily accessible, realistic, easy-to-build, reusable, and high-fidelity simulator to train neurosurgeons or trainees on vascular anastomosis techniques even in the operating room. METHODS The authors used an anatomical skull and brain model, artificial vessels, and a water pump to simulate both extracranial and intracranial circulations. They demonstrated the step-by-step preparation of the bypass simulator using readily available and affordable equipment and consumables. RESULTS All necessary steps of a superficial temporal artery-middle cerebral artery bypass surgery (from skin opening to skin closure) were performed on the simulator under a surgical microscope. The simulator was used by both experienced neurosurgeons and trainees. Feedback survey results from the participants of the microsurgery course suggested that the model is superior to existing microanastomosis training kits in simulating real surgery conditions (e.g., depth, blood flow, anatomical constraints) and holds promise for widespread use in neurosurgical training. CONCLUSIONS With no requirement for specialized laboratory facilities and regulations, this novel, low-cost, reusable, high-fidelity simulator can be readily constructed and used for neurosurgical training with various scenarios and modifications.
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Ghizoni E, de Souza JPSAS, Raposo-Amaral CE, Denadai R, de Aquino HB, Raposo-Amaral CA, Joaquim AF, Tedeschi H, Bernardes LF, Jardini AL. 3D-Printed Craniosynostosis Model: New Simulation Surgical Tool. World Neurosurg 2017; 109:356-361. [PMID: 29061457 DOI: 10.1016/j.wneu.2017.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Craniosynostosis is a complex disease once it involves deep anatomic perception, and a minor mistake during surgery can be fatal. The objective of this report is to present novel 3-dimensional-printed polyamide craniosynostosis models that can improve the understanding and treatment complex pathologies. METHODS The software InVesalius was used for segmentation of the anatomy image (from 3 patients between 6 and 9 months old). Afterward, the file was transferred to a 3-dimensional printing system and, with the use of an infrared laser, slices of powder PA 2200 were consecutively added to build a polyamide model of cranial bone. RESULTS The 3 craniosynostosis models allowed fronto-orbital advancement, Pi procedure, and posterior distraction in the operating room environment. All aspects of the craniofacial anatomy could be shown on the models, as well as the most common craniosynostosis pathologic variations (sphenoid wing elevation, shallow orbits, jugular foramen stenosis). Another advantage of our model is its low cost, about 100 U.S. dollars or even less when several models are produced. CONCLUSIONS Simulation is becoming an essential part of medical education for surgical training and for improving surgical safety with adequate planning. This new polyamide craniosynostosis model allowed the surgeons to have realistic tactile feedback on manipulating a child's bone and permitted execution of the main procedures for anatomic correction. It is a low-cost model. Therefore our model is an excellent option for training purposes and is potentially a new important tool to improve the quality of the management of patients with craniosynostosis.
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Affiliation(s)
- Enrico Ghizoni
- Department of Neurology, University of Campinas, São Paulo, Brazil.
| | | | | | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, São Paulo, Brazil
| | | | | | | | - Helder Tedeschi
- Department of Neurology, University of Campinas, São Paulo, Brazil
| | - Luís Fernando Bernardes
- National Institute of Biofabrication, Department of Chemical Engineering, University of Campinas, São Paulo, Brazil
| | - André Luiz Jardini
- National Institute of Biofabrication, Department of Chemical Engineering, University of Campinas, São Paulo, Brazil
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The Evolution of Surgical Simulation: The Current State and Future Avenues for Plastic Surgery Education. Plast Reconstr Surg 2017; 139:533e-543e. [PMID: 28121895 DOI: 10.1097/prs.0000000000002956] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Alongside the ongoing evolution of surgical training toward a competency-based paradigm has come the need to reevaluate the role of surgical simulation in residency. Simulators offer the ability for trainees to acquire specific skills and for educators to objectively assess the progressive development of these skills. In this article, the authors discuss the historical evolution of surgical simulation, with a particular focus on its past and present role in plastic surgery education. The authors also discuss the future steps required to further advance plastic surgery simulation in an effort to continue to train highly competent plastic surgery graduates.
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Belykh E, Lei T, Safavi-Abbasi S, Yagmurlu K, Almefty RO, Sun H, Almefty KK, Belykh O, Byvaltsev VA, Spetzler RF, Nakaji P, Preul MC. Low-flow and high-flow neurosurgical bypass and anastomosis training models using human and bovine placental vessels: a histological analysis and validation study. J Neurosurg 2016; 125:915-928. [DOI: 10.3171/2015.8.jns151346] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE
Microvascular anastomosis is a basic neurosurgical technique that should be mastered in the laboratory. Human and bovine placentas have been proposed as convenient surgical practice models; however, the histologic characteristics of these tissues have not been compared with human cerebral vessels, and the models have not been validated as simulation training models. In this study, the authors assessed the construct, face, and content validities of microvascular bypass simulation models that used human and bovine placental vessels.
METHODS
The characteristics of vessel segments from 30 human and 10 bovine placentas were assessed anatomically and histologically. Microvascular bypasses were performed on the placenta models according to a delineated training module by “trained” participants (10 practicing neurosurgeons and 7 residents with microsurgical experience) and “untrained” participants (10 medical students and 3 residents without experience). Anastomosis performance and impressions of the model were assessed using the Northwestern Objective Microanastomosis Assessment Tool (NOMAT) scale and a posttraining survey.
RESULTS
Human placental arteries were found to approximate the M2–M4 cerebral and superficial temporal arteries, and bovine placental veins were found to approximate the internal carotid and radial arteries. The mean NOMAT performance score was 37.2 ± 7.0 in the untrained group versus 62.7 ± 6.1 in the trained group (p < 0.01; construct validity). A 50% probability of allocation to either group corresponded to 50 NOMAT points. In the posttraining survey, 16 of 17 of the trained participants (94%) scored the model's replication of real bypass surgery as high, and 16 of 17 (94%) scored the difficulty as “the same” (face validity). All participants, 30 of 30 (100%), answered positively to questions regarding the ability of the model to improve microsurgical technique (content validity).
CONCLUSIONS
Human placental arteries and bovine placental veins are convenient, anatomically relevant, and beneficial models for microneurosurgical training. Microanastomosis simulation using these models has high face, content, and construct validities. A NOMAT score of more than 50 indicated successful performance of the microanastomosis tasks.
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Affiliation(s)
- Evgenii Belykh
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
| | - Ting Lei
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Sam Safavi-Abbasi
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaan Yagmurlu
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rami O. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Hai Sun
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kaith K. Almefty
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Olga Belykh
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Vadim A. Byvaltsev
- 2Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology; and
- 3Irkutsk State Medical University, Irkutsk, Russia
| | - Robert F. Spetzler
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Peter Nakaji
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Pannell JS, Santiago-Dieppa DR, Wali AR, Hirshman BR, Steinberg JA, Cheung VJ, Oveisi D, Hallstrom J, Khalessi AA. Simulator-Based Angiography and Endovascular Neurosurgery Curriculum: A Longitudinal Evaluation of Performance Following Simulator-Based Angiography Training. Cureus 2016; 8:e756. [PMID: 27733961 PMCID: PMC5045334 DOI: 10.7759/cureus.756] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study establishes performance metrics for angiography and neuroendovascular surgery procedures based on longitudinal improvement in individual trainees with differing levels of training and experience. Over the course of 30 days, five trainees performed 10 diagnostic angiograms, coiled 10 carotid terminus aneurysms in the setting of subarachnoid hemorrhage, and performed 10 left middle cerebral artery embolectomies on a Simbionix Angio Mentor™ simulator. All procedures were nonconsecutive. Total procedure time, fluoroscopy time, contrast dose, heart rate, blood pressures, medications administered, packing densities, the number of coils used, and the number of stent-retriever passes were recorded. Image quality was rated, and the absolute value of technically unsafe events was recorded. The trainees’ device selection, macrovascular access, microvascular access, clinical management, and the overall performance of the trainee was rated during each procedure based on a traditional Likert scale score of 1=fail, 2=poor, 3=satisfactory, 4=good, and 5=excellent. These ordinal values correspond with published assessment scales on surgical technique. After performing five diagnostic angiograms and five embolectomies, all participants demonstrated marked decreases in procedure time, fluoroscopy doses, contrast doses, and adverse technical events; marked improvements in image quality, device selection, access scores, and overall technical performance were additionally observed (p < 0.05). Similarly, trainees demonstrated marked improvement in technical performance and clinical management after five coiling procedures (p < 0.05). However, trainees with less prior experience deploying coils continued to experience intra-procedural ruptures up to the eighth embolization procedure; this observation likely corresponded with less tactile procedural experience to an exertion of greater force than appropriate for coil placement. Trainees across all levels of training and prior experience demonstrated a significant performance improvement after completion of our simulator curriculum consisting of five diagnostic angiograms, five embolectomy cases, and 10 aneurysm coil embolizations.
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Affiliation(s)
- J Scott Pannell
- Department of Neurosurgery, University of California, San Diego
| | | | - Arvin R Wali
- Department of Neurosurgery, University of California, San Diego
| | | | | | | | - David Oveisi
- Department of Internal Medicine, University of California, Los Angeles
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Development and content validation of performance assessments for endoscopic third ventriculostomy. Childs Nerv Syst 2015; 31:1247-59. [PMID: 25930722 DOI: 10.1007/s00381-015-2716-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aims to develop and establish the content validity of multiple expert rating instruments to assess performance in endoscopic third ventriculostomy (ETV), collectively called the Neuro-Endoscopic Ventriculostomy Assessment Tool (NEVAT). METHODS The important aspects of ETV were identified through a review of current literature, ETV videos, and discussion with neurosurgeons, fellows, and residents. Three assessment measures were subsequently developed: a procedure-specific checklist (CL), a CL of surgical errors, and a global rating scale (GRS). Neurosurgeons from various countries, all identified as experts in ETV, were then invited to participate in a modified Delphi survey to establish the content validity of these instruments. In each Delphi round, experts rated their agreement including each procedural step, error, and GRS item in the respective instruments on a 5-point Likert scale. RESULTS Seventeen experts agreed to participate in the study and completed all Delphi rounds. After item generation, a total of 27 procedural CL items, 26 error CL items, and 9 GRS items were posed to Delphi panelists for rating. An additional 17 procedural CL items, 12 error CL items, and 1 GRS item were added by panelists. After three rounds, strong consensus (>80% agreement) was achieved on 35 procedural CL items, 29 error CL items, and 10 GRS items. Moderate consensus (50-80% agreement) was achieved on an additional 7 procedural CL items and 1 error CL item. The final procedural and error checklist contained 42 and 30 items, respectively (divided into setup, exposure, navigation, ventriculostomy, and closure). The final GRS contained 10 items. CONCLUSIONS We have established the content validity of three ETV assessment measures by iterative consensus of an international expert panel. Each measure provides unique assessment information and thus can be used individually or in combination, depending on the characteristics of the learner and the purpose of the assessment. These instruments must now be evaluated in both the simulated and operative settings, to determine their construct validity and reliability. Ultimately, the measures contained in the NEVAT may prove suitable for formative assessment during ETV training and potentially as summative assessment measures during certification.
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Zammar SG, El Tecle NE, El Ahmadieh TY, Adelson PD, Veznedaroglu E, Surdell DL, Harrop JS, Benes V, Rezai AR, Resnick DK, Bendok BR. Impact of a Vascular Neurosurgery Simulation-Based Course on Cognitive Knowledge and Technical Skills in European Neurosurgical Trainees. World Neurosurg 2015; 84:197-201. [DOI: 10.1016/j.wneu.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/31/2014] [Accepted: 12/01/2014] [Indexed: 11/29/2022]
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Ghobrial GM, Balsara K, Maulucci CM, Resnick DK, Selden NR, Sharan AD, Harrop JS. Simulation Training Curricula for Neurosurgical Residents: Cervical Foraminotomy and Durotomy Repair Modules. World Neurosurg 2015; 84:751-5.e1-7. [PMID: 25957725 DOI: 10.1016/j.wneu.2015.04.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Since 2010, the Congress of Neurological Surgeons (CNS) has offered a neurosurgical skills simulation course for residents and medical students. The authors describe their experience with incorporation of two neurosurgical skills simulation modules into the dedicated resident training curriculum of a single ACGME-accredited training program, using lumbar dural repair (5) and posterior cervical laminoforaminotomy modules from the CNS simulation initiative (6). METHODS Each of the available 22 neurosurgery residents at a single residency program was given two 20-question pretests for a cervical laminoforaminotomy and durotomy repair module as a basic test of regional anatomy, general disease knowledge, surgical decision making, and recently published literature. This was followed by a faculty-directed skills simulation course and concluded with a final 20 question post-test. RESULTS Posterior cervical laminoforaminotomy was performed once by each resident, and grading was conducted using the predetermined OSATs. The overall score was 56.1 (70%, range 26-76, maximum 80 points) with a trend towards higher scores with advanced levels of training. All residents completed the durotomy repair OSATs for a total of three trials. Of a maximum composite score of 60, a mean 37.2 (62%, range 15-58) was scored by the residents (Table 3). The mean OSAT scores for each durotomy trial was 2.66, 3.15, and 3.48 on each success test. A trend towards higher scores in advanced years of training was observed, but did not reach statistical significance (Figure 3). CONCLUSIONS Duty hour limitations and regulatory pressure for enhanced quality and outcomes may limit access of neurosurgical residents to fundamental skills training. Fundamental skills training as part of a validated simulation curriculum can mitigate this challenge to residency education. National development of effective technical simulation modules for use in individual residency training programs is a promising strategy to achieve these goals.
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Affiliation(s)
- George M Ghobrial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| | - Karl Balsara
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | - Daniel K Resnick
- Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nathan R Selden
- Campagna Professor of Pediatric Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Ashwini D Sharan
- Professor of Neurological Surgery, Thomas Jefferson University Hospital, Department of Neurological Surgery, Philadlephia, Pennsylvania, USA
| | - James S Harrop
- Professor of Neurological Surgery, Thomas Jefferson University Hospital, Department of Neurological Surgery, Philadlephia, Pennsylvania, USA
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The Cognitive and Technical Skills Impact of the Congress of Neurological Surgeons Simulation Curriculum on Neurosurgical Trainees at the 2013 Neurological Society of India Meeting. World Neurosurg 2015; 83:419-23. [DOI: 10.1016/j.wneu.2014.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
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Aoun SG, El Ahmadieh TY, El Tecle NE, Daou MR, Adel JG, Park CS, Batjer HH, Bendok BR. A pilot study to assess the construct and face validity of the Northwestern Objective Microanastomosis Assessment Tool. J Neurosurg 2015; 123:103-9. [PMID: 25658787 DOI: 10.3171/2014.12.jns131814] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Microsurgical skills remain an integral component of neurosurgical education. There is a need for an objective scale to assess microsurgical skills. The objective of this study was to assess the face and construct validity of a bench training microanastomosis module and an objective assessment scale, i.e., the Northwestern Objective Microanastomosis Assessment Tool (NOMAT). METHODS Medical students, neurosurgical residents, and postdoctoral research fellows at Northwestern University were enrolled in the study. Trainees were divided into 3 groups based on microsurgical experience: 1) experienced, 2) exposed, and 3) novices. Each trainee completed two end-to-end microanastomoses using a 1-mm and a 3-mm synthetic vessel. Two cameras were installed to capture procedural footage. One neurosurgeon blindly graded the performance of trainees using both objective and subjective methods to assess construct validity. Two neurosurgeons reviewed the contents of the simulation module to assess face validity. RESULTS Twenty-one trainees participated in the study, including 6 experienced, 6 exposed, and 9 novices. The mean NOMAT score for experienced trainees on the 1-mm module was 47.3/70 compared with 26.0/70 and 25.8/70 for exposed and novice trainees, respectively (p = 0.02). Using subjective grading, experienced trainees performed significantly better on the 1-mm module (64.2/100) compared with exposed or novice trainees (23.3/100 and 25.0/100, respectively; p = 0.02). No statistical difference between groups was noted for the 3-mm module with both NOMAT and subjective grading. Experienced trainees took less time to perform both tasks compared with the others. CONCLUSIONS Face and construct validities of the microanastomosis module were established. The scale and the microanastomosis module could help assess the microsurgical skills of neurosurgical trainees and serve as a basis for the creation of a microsurgical curriculum.
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Affiliation(s)
- Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | | | | | | | | | - H Hunt Batjer
- Department of Neurological Surgery, University of Texas Southwestern, Dallas, Texas; and
| | - Bernard R Bendok
- Departments of 2 Neurological Surgery.,Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Ghobrial GM, Hamade YJ, Bendok BR, Harrop JS. Technology and simulation to improve patient safety. Neurosurg Clin N Am 2014; 26:239-43, ix. [PMID: 25771279 DOI: 10.1016/j.nec.2014.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Improving the quality and efficiency of surgical techniques, reducing technical errors in the operating suite, and ultimately improving patient safety and outcomes through education are common goals in all surgical specialties. Current surgical simulation programs represent an effort to enhance and optimize the training experience, to overcome the training limitations of a mandated 80-hour work week, and have the overall goal of providing a well-balanced resident education in a society with a decreasing level of tolerance for medical errors.
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Affiliation(s)
- George M Ghobrial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Youssef J Hamade
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James S Harrop
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC. The Role of Laboratory Dissection Training in Neurosurgical Residency: Results of a National Survey. World Neurosurg 2014; 82:554-9. [DOI: 10.1016/j.wneu.2014.05.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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El Ahmadieh TY, Harrop J, Batjer HH, Resnick DK, Bendok BR. Blinded Peer Assessment of Surgical Skill is Feasible and Can Predict Complication Rates. Neurosurgery 2014; 74:N12-4. [DOI: 10.1227/01.neu.0000450232.06740.ef] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Belykh E, Byvaltsev V. Off-the-job microsurgical training on dry models: Siberian experience. World Neurosurg 2014; 82:20-4. [PMID: 24495474 DOI: 10.1016/j.wneu.2014.01.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Microsurgical training has become an obligatory part of many neurosurgical training programs. OBJECTIVE To assess the cost and effectiveness of acquiring and maintaining microneurosurgical skills by training on an off-the-job basis using dry models. METHODS A dry off-the-job microneurosurgical training module was set up. Training exercises involved microdissection in a deep operation field, suturing and tying on gauze, untying, pushing of thread end, and microanastomosis. The time to complete the task and success rate were evaluated. The total cost of all necessary equipment and expendables for the training module was US$910. RESULTS Fifteen residents participated in the continuous off-the-job training. The average time taken to perform the anastomosis decreased after the month of training from 90 to 20 minutes. Authors revealed that at 2 months, the total time and time to complete anastomosis increased significantly for the participants who discontinued practice after the first month, compared with those who just practiced suturing on gauze after the first month (P < 0.01). The average Northwestern Objective Microanastomosis Assessment Tool score was 36 for novice and 65 for experienced participants. CONCLUSION The dry off-the-job training showed to be readily available and can be helpful for microsurgical training in the low-income regions of the world. Our data suggest that microsurgical training should be continuous and repetitive. Simulation training may benefit from models for repetitive training of relevant technical part-skills.
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Affiliation(s)
- Evgenii Belykh
- Scientific Center of Reconstructive and Restorative Surgery, RAMS, Siberian Branch, Irkutsk, East Siberia, Russia.
| | - Vadim Byvaltsev
- Scientific Center of Reconstructive and Restorative Surgery, RAMS, Siberian Branch, Irkutsk, East Siberia, Russia; Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Continuous Education, Irkutsk, East Siberia, Russia; Department of Hospital Surgery and Neurosurgery, Irkutsk State Medical University, Irkutsk, East Siberia, Russia; Department of Neurosurgery, Irkutsk Rail Road Clinical Hospital, Irkutsk, East Siberia, Russia
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