Simulator based angiography education in neurosurgery: results of a pilot educational program: Table 1

Abstract

IntroductionThe use of simulators in medical training has been on the rise over the past decade as a means to teach procedural skills to trainees in a risk free environment. The goal of this study was to pilot a simulator based skills course for inexperienced neurosurgical residents to teach the fundamentals of cervicocerebral catheterization and angiography, with the ultimate goal of defining a universal simulator based curriculum that could be incorporated into neurosurgical resident training in the future.MethodsSeven neurosurgery residents with no prior angiographic experience served as the pilot participants for this 2 day course. Four neurointerventional trained neurosurgeons served as faculty for instruction and evaluation. The majority of the course focused on hands-on simulator practice with close mentoring by faculty. Participants were evaluated with pre-course and post-course assessments.ResultsPost-course written test scores were significantly higher than pre-course scores (p<0.001). Faculty assessments of participants' technical skills with angiography (graded 0–10, with 10 being best) also improved significantly from pre-course to post-course (pre 2.1; post 5.9; p<0.001). Objective simulator recorded assessments demonstrated a significant decrease in the time needed to complete a four vessel angiogram (p<0.001) and total fluoroscopic time (p<0.001).ConclusionsParticipant angiography skills, based on both faculty and simulator assessments, as well as participant knowledge, improved after this didactic, hands-on simulator course. Neuroendovascular simulator training appears to be a viable means of training inexperienced neurosurgery residents in the early learning stages of basic endovascular neurosurgery. Further studies evaluating the translation of procedural skills learned on the simulator to actual clinical skills in the angiography suite is necessary.

The use of simulation in neurosurgical education and training

“…Utilizing VIST to simulate cerebral angiography 12,38 and CAS (including in 1 randomized controlled study) 9,18 resulted in improvements in anatomical and procedural knowledge, 12 faculty assessment of technical skills, 12 time taken to complete the procedure, 9,12,18,38 duration of fluoroscopy exposure, 9,12,38 contrast volume administered, 38 and catheter handling errors. 38 The ANGIO Mentor was used to simulate CAS 52 and diagnostic cerebral angiography 47 with evidence of significantly improved performance following training.…”

“…13 The validation evidence from the studies was presented predominantly in the form of face validity, with participant feedback reporting realism when using the following: ImmersiveTouch, 57 ANGIO Mentor, 47,52 VIST, 9,12,18,37 ROBO-SIM, 41 SIMONT, 13,59 the cadaveric deer head and spine model, 56 in vivo rodent model, 1,20 in vivo swine model, 43 human cadaveric model with SRSP to simulate a tumor, 14 and boundary element-based virtual reality (VR) simulator with haptic feedback. 55 Construct validation, predominantly through the successful differentiation of novices and experts, or individuals pre-and postintervention, has been demonstrated when using the following simulators/devices: cadaveric porcine skull, 10 cadaveric deer head and spine, 56 EasyGuide Neuro, 26 ImmersiveTouch, 6,27-30,57 ANGIO Men tor, 47,52 VIST, 9,12,18,38 in vivo rodent model, 39 human patient simulator, 36 cast model of ventricular system with Model Magic, 11 and SIMONT. 13 Predictive validity was reported in a study using the ImmersiveTouch simulator for ventriculostomy training, as simulator practice resulted in significantly higher chance of ventriculostomy success at first attempt in real patients in the operating room.…”

“…36 Table 6 shows the variety of assessment tools used in the reviewed studies, which comprised the following 3 broad categories: 1) subjective evaluation or feedback surveys; 2) performance at a surgical task assessed either by a rater 10,39 (including self-rating 56 ), simulator-derived metrics, 5,6,[26][27][28][29][30]38,47,57 or both; 9,12,13,18,52 and 3) knowledge-based written tests. 11,12,36 Therefore, a significant number of studies reported participant feedback without objective evidence for efficacy of the simulator. None of the written assessment tools, knowledge or evaluation based, have been used more than once in the studies identified; this makes comparisons between studies difficult.…”

Experience With a Simulator-Based Angiography Course for Neurosurgical Residents

“…We previously presented a curriculum-based cerebral angiography simulator pilot course as a first step in evaluating the benefits of angiographic simulator training for neurosurgical residents. 4 A second simulator-based pilot training course for neurosurgical residents has also been published. 5 Although different in course specifics, these pilot programs independently demonstrated the feasibility of such efforts.…”

Editorial: International rotations and resident education

“…The benefits of simulation include skin closure, 15 computer-assisted pedicle screw placement, 6 endovascular catheter navigation, 8 and clipping of aneurysms in a cadaveric flow model.…”