Evaluation of simulation models in neurosurgical training according to face, content, and construct validity: a systematic review

Abstract

Background Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees’ operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. Methods PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. Results Neurosurgical skills assessed included aneurysm clipping ( n = 6), craniotomy and burr hole drilling ( n = 2), tumour resection ( n = 4), and vessel suturing ( n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models ( n = 5), synthetic models ( n = 7), and VR models ( n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. Conclusion Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05003-x.

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

“…An increased use of simulation models in neurosurgical training was found. Currently, synthetic models have been found to be the most convenient and practical, especially during the pandemic breakdown, but VR models are found promising due to the visual realism and improved haptic feedback technology ( 20 ).…”

Virtual neurosurgery anatomy laboratory: A collaborative and remote education experience in the metaverse

“…In this pilot study, a virtual meeting space was developed for multiuser neurosurgery training purposes using photogrammetry-developed immersive anatomy models with predefined learning objectives [ Table 1 ]. Neurosurgical simulation using VR for surgical skill training has been reported[ 7 , 16 , 21 ] for different types of procedures, such as tumor resection,[ 11 ] aneurysm clipping,[ 1 ] and ventriculostomy. [ 22 ] These experiences were based on the use of a physical VR simulator (Immersive Touch, Chicago, IL) that offers haptic feedback and a stereoscopic display for a local use.…”

Key role of microsurgical dissections on cadaveric specimens in neurosurgical training: Setting up a new research anatomical laboratory and defining neuroanatomical milestones

“…Similarly, the evolution of simulation technology applied to surgery has assumed an important role in learning anatomy, completing procedural tasks, and improving accuracy and hand–eye coordination. In recent years, 3D inert models and virtual and augmented reality have been popularized among universities and through courses to train young residents ( 110 , 111 ). Nevertheless, the use of a real human specimen gives the possibility to reproduce the real procedure starting from the head positioning to the step-by-step surgery facing narrow corridors, fragile neurovascular structures, and a delicate brain surface that can give an idea of how gentle and accurate the dissection has to be during the live surgery.…”