EANS Basic Brain Course (ABC): combining simulation to cadaver lab for a new concept of neurosurgical training

Moiraghi, Alessandro; Perin, Alessandro; Sicky, Nicolas; Godjevac, Jelena; Carone, Giovanni; Ayadi, Roberta; Galbiati, Tommaso Francesco; Gambatesa, Enrico; Rocca, Alessandra; Fanizzi, Claudia; Schaller, Karl; DiMeco, Francesco; Meling, Torstein R.

doi:10.1007/s00701-020-04216-w

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…Neurosurgery residency is characterized by high levels of competence and an intense hands-on experience. Due to monetary restrictions, infrastructure conditions, and recent work time restrictions ( 11 ), it is hard for a resident to reach an adequate operative case volume over the education program ( 3 ). To counter these drawbacks in neurosurgical training, cadaveric specimen ( 12 ) and animal model courses ( 13 ) are some of the common alternatives for the improvement of surgical skills in neurosurgery, even if their high maintenance costs and ethical issues represent some of the principal limitations to date ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

et al. 2022

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BackgroundIn the recent years, growing interest in simulation-based surgical education has led to various practical alternatives for medical training. More recently, courses based on virtual reality (VR) and three-dimensional (3D)-printed models are available. In this paper, a hybrid (virtual and physical) neurosurgical simulator has been validated, equipped with augmented reality (AR) capabilities that can be used repeatedly to increase familiarity and improve the technical skills in human brain anatomy and neurosurgical approaches.MethodsThe neurosurgical simulator used in this study (UpSurgeOn Box, UpSurgeOn Srl, Assago, Milan) combines a virtual component and a physical component with an intermediate step to provide a hybrid solution. A first reported and evaluated practical experience on the anatomical 3D-printed model has been conducted with a total of 30 residents in neurosurgery. The residents had the possibility to choose a specific approach, focus on the correct patient positioning, and go over the chosen approach step-by-step, interacting with the model through AR application. Next, each practical surgical step on the 3D model was timed and qualitatively evaluated by 3 senior neurosurgeons. Quality and usability-grade surveys were filled out by participants.ResultsMore than 89% of the residents assessed that the application and the AR simulator were very helpful in improving the orientation skills during neurosurgical approaches. Indeed, 89.3% of participants found brain and skull anatomy highly realistic during their tasks. Moreover, workshop exercises were considered useful in increasing the competency and technical skills required in the operating room by 85.8 and 84.7% of residents, respectively. Data collected confirmed that the anatomical model and its application were intuitive, well-integrated, and easy to use.ConclusionThe hybrid AR and 3D-printed neurosurgical simulator could be a valid tool for neurosurgical training, capable of enhancing personal technical skills and competence. In addition, it could be easy to imagine how patient safety would increase and healthcare costs would be reduced, even if more studies are needed to investigate these aspects. The integration of simulators for training in neurosurgery as preparatory steps for the operating room should be recommended and further investigated given their huge potential.

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Section: Discussionmentioning

confidence: 99%

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

et al. 2022

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“…Over the past few decades, there has been increasing interest in simulation technology in the field of surgery. There are multiple reasons for this, among them are technological advances that allow for increasing fidelity [53], residency work hour restrictions necessitating a shift of surgical education to outside ORs [9,10,12,13,54], and a changing medico-legal landscape concerning treatment standards [5]. However, the question is whether the enthusiasm in the field has translated to robust evidence regarding the benefits of simulation training.…”

Section: Discussionmentioning

confidence: 99%

The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis

Meling

2020

Neurosurg Rev

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The use of simulation in surgical training is ever growing. Evidence suggests such training may have beneficial clinically relevant effects. The objective of this research is to investigate the effects of surgical simulation training on clinically relevant patient outcomes by evaluating randomized controlled trials (RCT). PubMed was searched using PRISMA guidelines: "surgery" [All Fields] AND "simulation" [All Fields] AND "patient outcome" [All Fields]. Of 119 papers identified, 100 were excluded for various reasons. Meta-analyses were conducted using the inverse-variance random-effects method. Nineteen papers were reviewed using the CASP RCT Checklist. Sixteen studies looked at surgical training, two studies assessed patient-specific simulator practice, and one paper focused on warming-up on a simulator before performing surgery. Median study population size was 22 (range 3-73). Most articles reported outcome measures such as post-intervention Global Rating Scale (GRS) score and/or operative time. On average, the intervention group scored 0.42 (95% confidence interval 0.12 to 0.71, P = 0.005) points higher on a standardized GRS scale of 1-10. On average, the intervention group was 44% (1% to 87%, P = 0.04) faster than the control group. Four papers assessed the impact of simulation training on patient outcomes, with only one finding a significant effect. We found a significant effect of simulation training on operative performance as assessed by GRS, albeit a small one, as well as a significant reduction to operative time. However, there is to date scant evidence from RCTs to suggest a significant effect of surgical simulation training on patient outcomes.

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“…To address this, a recent European Association of Neurosurgical Societies course for early-stage trainees combined VR with cadaveric simulation [28]. This course employed a low tutor to delegate ratio and received excellent feedback on the small group learning with immediate feedback model similar to that of our workshop [28]. Conversely, another VR simulator study confirmed that simulator performance reflects surgeons' ability to place an EVD correctly [30].…”

Section: Discussionmentioning

confidence: 99%

“…This proprioceptive and true tactile learning input is not possible during the use of current VR systems. To address this, a recent European Association of Neurosurgical Societies course for early-stage trainees combined VR with cadaveric simulation [28]. This course employed a low tutor to delegate ratio and received excellent feedback on the small group learning with immediate feedback model similar to that of our workshop [28].…”

Section: Discussionmentioning

confidence: 99%

The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data

et al. 2020

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Background The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment. Methods A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop. Two assessors used a novel modified Objective Structured Assessment of Technical Skills (mOSATS) assessment tool, comprising 5 domains ranked according to a 5-point scale to rate delegates’ ability to create a burr hole. Qualitative data from previous workshops were collected, consisting of open-ended, closed-ended and 5-point Likert scale responses to pre- and post-workshop questionnaires. Data were analysed using SPSS® software. Results Delegates scored a mean total of 62.1% (21.75/35) and 85.1% (29.8/35) in pre- and post-workshop assessments respectively revealing a statistically significant improvement. Regarding percentage of improvement, no significant difference was shown amongst candidates when comparing the number of neurosurgical cases observed and/or assisted in the past. There was no significant difference in the overall rating between the last two workshops (4.89 and 4.8 out of 5, respectively). One hundred percent of the attendees reported feeling more confident in assisting in theatre after the last two workshops. Conclusion We show that a simulation workshop cannot only objectively quantify the improvement of surgical skill acquisition but can also be beneficial regardless of the extent of prior experience.

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EANS Basic Brain Course (ABC): combining simulation to cadaver lab for a new concept of neurosurgical training

Cited by 13 publications

References 27 publications

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis

The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data

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