Simulation Based Skills Training in Neurosurgery and Contemporary Surgical Practices

Abstract

SUMMARYNeurosurgery training is based on a time-bound apprenticeship model, resulting in mentor-dependent, non-uniform, anecdotal, slow skills acquisition, sometimes with morbid consequences. The complexity of neurosurgical procedures and constraints of present education have demands for alternative methods of training. The use of simulation in surgical skills training was pioneered by work in laparoscopy, which began only in the last 25 years. Existing neurosurgery training model should be supplemented with efficient skills training curricula.The present study illustrates formulation, standardization, validation and evaluation of efficacy of neurosurgery skills training modules using formative and summative assessment. 160 regular residents and short-term trainees were trained over 3096 skills training sessions under formative assessment; 176 'graduate neurosurgeons' were trained with 12 skills training programs under summative assessment. Training involved skills development in micro-neurosurgery, high-speed drilling, neuroendoscopy and spine-instrumentation by practice on structured low and high-fidelity simulation models. The effectiveness of content, course modules, and teaching faculty on skills development were assessed using spot and gap-based evaluation.Seven basic, 7 intermediate and 14 advanced skills training modules have been developed. Trainees rated 71% of overall training sessions as excellent quality content with 69·8%, 70·1%, and 71% respectively for micro-suturing and high-speed drilling, neuro-endoscopy and spine-instrumentation modules. Faculty with higher ratings was included as program instructors. On gap-based evaluation, >80% of responded trainees reported better orientation with high speed drilling followed by micro-neurosurgery and spine-instrumentation. Neuro-endoscopy training scored low assimilation into clinical practice.We suggest structured modular validated skills training curriculum to supplement the existing neurosurgery training. This would help in improving learning curve outside operation-rooms, at convenience and individualized needs of trainees under supervision, and would thus help in skills translation without endangering patients.