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Farah GJ, Rogers JL, Lopez AM, Brown NJ, Pennington Z, Kuo C, Gold J, Bui NE, Koester SW, Gendreau JL, Diaz-Aguilar LD, Oh MY, Pham MH. Resident Training in Spine Surgery: A Systematic Review of Simulation-Based Educational Models. World Neurosurg 2023; 174:81-115. [PMID: 36921712 DOI: 10.1016/j.wneu.2023.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE With the increasing prevalence of spine surgery, ensuring effective resident training is becoming of increasing importance. Training safe, competent surgeons relies heavily on effective teaching of surgical indications and adequate practice to achieve a minimum level of technical proficiency before independent practice. American Council of Graduate Medical Education work-hour restrictions have complicated the latter, forcing programs to identify novel methods of surgical resident training. Simulation-based training is one such method that can be used to complement traditional training. The present review aims to evaluate the educational success of simulation-based models in the spine surgical training of residents. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Web of Science, and Google Scholar databases were systematically screened for English full-text studies examining simulation-based spine training curricula. Studies were categorized based on simulation model class, including animal-cadaveric, human-cadaveric, physical/3-dimensional, and computer-based/virtual reality. Outcomes studied included participant feedback regarding the simulator and competency metrics used to evaluate participant performance. RESULTS Seventy-two studies were identified. Simulators displayed high face validity and were useful for spine surgery training. Objective measures used to evaluate procedural performance included implant placement evaluation, procedural time, and technical skill assessment, with numerous simulators demonstrating a learning effect. CONCLUSIONS While simulation-based educational models are one potential means of training residents to perform spine surgery, traditional in-person operating room training remains pivotal. To establish the efficacy of simulators, future research should focus on improving study quality by leveraging longitudinal study designs and correlating simulation-based training with clinical outcome measures.
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Affiliation(s)
- Ghassan J Farah
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - James L Rogers
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alexander M Lopez
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Zach Pennington
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Cathleen Kuo
- Department of Neurological Surgery, University at Buffalo Jacobs SOM, Buffalo, New York, USA
| | - Justin Gold
- Department of Neurological Surgery, Cooper Medical of Rowan University, Camden, New Jersey, USA
| | - Nicholas E Bui
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Julian L Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA
| | - Michael Y Oh
- Department of Neurosurgery, University of California, Irvine, Orange, California, USA
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, California, USA.
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Reich A, Mirchi N, Yilmaz R, Ledwos N, Bissonnette V, Tran DH, Winkler-Schwartz A, Karlik B, Del Maestro RF. Artificial Neural Network Approach to Competency-Based Training Using a Virtual Reality Neurosurgical Simulation. Oper Neurosurg (Hagerstown) 2022; 23:31-39. [PMID: 35726927 DOI: 10.1227/ons.0000000000000173] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The methodology of assessment and training of surgical skills is evolving to deal with the emergence of competency-based training. Artificial neural networks (ANNs), a branch of artificial intelligence, can use newly generated metrics not only for assessment performance but also to quantitate individual metric importance and provide new insights into surgical expertise. OBJECTIVE To outline the educational utility of using an ANN in the assessment and quantitation of surgical expertise. A virtual reality vertebral osteophyte removal during a simulated surgical spine procedure is used as a model to outline this methodology. METHODS Twenty-one participants performed a simulated anterior cervical diskectomy and fusion on the Sim-Ortho virtual reality simulator. Participants were divided into 3 groups, including 9 postresidents, 5 senior residents, and 7 junior residents. Data were retrieved from the osteophyte removal component of the scenario, which involved using a simulated burr. The data were manipulated to initially generate 83 performance metrics spanning 3 categories (safety, efficiency, and motion) of which only the most relevant metrics were used to train and test the ANN. RESULTS The ANN model was trained on 6 safety metrics to a testing accuracy of 83.3%. The contributions of these performance metrics to expertise were revealed through connection weight products and outlined 2 identifiable learning patterns of technical skills. CONCLUSION This study outlines the potential utility of ANNs which allows a deeper understanding of the composites of surgical expertise and may contribute to the paradigm shift toward competency-based surgical training.
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Affiliation(s)
- Aiden Reich
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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Patel S, Alkadri S, Driscoll M. Development and Validation of a Mixed Reality Configuration of a Simulator for a Minimally Invasive Spine Surgery Using the Workspace of a Haptic Device and Simulator Users. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2435126. [PMID: 35005014 PMCID: PMC8741356 DOI: 10.1155/2021/2435126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/07/2021] [Indexed: 11/18/2022]
Abstract
Most surgical simulators leverage virtual or bench models to simulate reality. This study proposes and validates a method for workspace configuration of a surgical simulator which utilizes a haptic device for interaction with a virtual model and a bench model to provide additional tactile feedback based on planned surgical manoeuvers. Numerical analyses were completed to determine the workspace and position of a haptic device, relative to the bench model, used in the surgical simulator, and the determined configuration was validated using device limitations and user data from surgical and nonsurgical users. For the validation, surgeons performed an identical surgery on a cadaver prior to using the simulator, and their trajectories were then compared to the determined workspace for the haptic device. The configuration of the simulator was determined appropriate through workspace analysis and the collected user trajectories. Statistical analyses suggest differences in trajectories between the participating surgeons which were not affected by the imposed haptic workspace. This study, therefore, demonstrates a method to optimally position a haptic device with respect to a bench model while meeting the manoeuverability needs of a surgical procedure. The validation method identified workspace position and user trajectory towards ideal configuration of a mixed reality simulator.
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Affiliation(s)
- Sneha Patel
- Department of Mechanical Engineering, McGill University, MacDonald Engineering Building, 817 Rue Sherbrooke Ouest #270, Montréal, Québec, Canada H3A 0C3
| | - Sami Alkadri
- Department of Mechanical Engineering, McGill University, MacDonald Engineering Building, 817 Rue Sherbrooke Ouest #270, Montréal, Québec, Canada H3A 0C3
| | - Mark Driscoll
- Department of Mechanical Engineering, McGill University, MacDonald Engineering Building, 817 Rue Sherbrooke Ouest #270, Montréal, Québec, Canada H3A 0C3
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4
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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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Gough M, Solomou G, Khan DZ, Kamel M, Fountain D, Kumaria A, Ashpole R, Sinha S, Mendoza N. The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data. Acta Neurochir (Wien) 2020; 162:2323-2334. [PMID: 32358655 PMCID: PMC7496022 DOI: 10.1007/s00701-020-04325-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/02/2020] [Indexed: 11/22/2022]
Abstract
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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Meling TR, Meling TR. The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis. Neurosurg Rev 2020; 44:843-854. [PMID: 32399730 PMCID: PMC8035110 DOI: 10.1007/s10143-020-01314-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022]
Abstract
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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Affiliation(s)
- Trym R Meling
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torstein R Meling
- Faculty of Medicine, University of Oslo, Oslo, Norway. .,Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Rue Gabriel-Perret-Gentil 5, 1205, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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The perceived efficacy and utility of spine bioskills curricula for resident and fellow education. J Orthop 2020; 20:87-91. [PMID: 32042235 DOI: 10.1016/j.jor.2020.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/06/2020] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study is to assess the role of bioskills in orthopaedic and neurosurgical resident education. A survey of the utilization and perceived efficacy of bioskills was submitted to Lumbar Spine Research Society (LSRS) members. 36/104 surgeons responded, including 25 orthopaedic, 7 neurosurgical, and 4 integrated respondents. 63% of orthopaedic and 83% of neurosurgery faculty, reported using bioskills. When asked if completion of bioskills modules would encourage advancing trainees' participation (1-10 scale, 10 greatly increase), neurosurgical faculty reported 4.00 versus orthopaedics 6.43. Although orthopaedic faculty perceive greater efficacy of bioskills, the clinical impact of this difference remains uncertain.
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Lubelski D, Mukherjee D, Theodore N. Commentary: Simulation of Dural Repair in Minimally Invasive Spine Surgery With the Use of a Perfusion-Based Cadaveric Model. Oper Neurosurg (Hagerstown) 2019; 17:E231-E233. [PMID: 31120106 DOI: 10.1093/ons/opz111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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Kumaria A, Bateman AH, Eames N, Fehlings MG, Goldstein C, Meyer B, Paquette SJ, Yee AJM. Advancing spinal fellowship training: an international multi-centre educational perspective. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:2437-2443. [PMID: 31407164 DOI: 10.1007/s00586-019-06098-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/19/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this article is to review the importance of contemporary spine surgery fellowships and educational strategies to assist with fellowship design and delivery. METHODS Spine surgery fellowship includes trainees from orthopaedic and neurosurgical backgrounds and is increasingly indicated for individuals wishing to pursue spine surgery as a career, recognizing how spinal surgery evolved significantly in scope and complexity. We combine expert opinion with a review of the literature and international experience to expound spine fellowship training. RESULTS Contemporary learning techniques include boot camps at the start of fellowship which may reinforce previous clinical learning and help prepare fellows for their new clinical roles. There is good evidence that surgical specialty training boot camps improve clinical skills, knowledge and trainee confidence prior to embarking upon new clinical roles with increasing levels of responsibility. Furthermore, as simulation techniques and technologies take on an increasing role in medical and surgical training, we found evidence that trainees' operative skills and knowledge can improve with simulated operations, even if just carried out briefly. Finally, we found evidence to suggest a role for establishing competence-based objectives for training in specific operative and technical procedures. Competence-based objectives are helpful for trainees and trainers to highlight gaps in a trainee's skill set that may then be addressed during training. CONCLUSIONS Spinal fellowships may benefit from certain contemporary strategies that assist design and delivery of training in a safe environment. Interpersonal factors that promote healthy teamwork may contribute to an environment conducive to learning. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Ashwin Kumaria
- Royal Derby Spinal Centre, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK
| | - Antony H Bateman
- Royal Derby Spinal Centre, Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
| | - Niall Eames
- Belfast Health and Social Care Trust, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, University of Toronto, Toronto, ON, Canada
| | - Christina Goldstein
- Missouri Orthopaedic Institute, University of Missouri, 1100 Virginia Ave, Columbia, MO, 65212, USA
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | | | - Albert J M Yee
- Department of Surgery, University of Toronto, Toronto, Canada
- University of Toronto Spine Program, Toronto, Canada
- Marvin Tile Chair, Division Head of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Rm MG 371-B, Toronto, ON, M4N 3M5, Canada
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Morone PJ, Bekelis K, Root BK, Singer RJ. Development and Validation of a Mobile Device-based External Ventricular Drain Simulator. Oper Neurosurg (Hagerstown) 2019; 13:603-608. [PMID: 28922878 DOI: 10.1093/ons/opx022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/27/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Multiple external ventricular drain (EVD) simulators have been created, yet their cost, bulky size, and nonreusable components limit their accessibility to residency programs. OBJECTIVE To create and validate an animated EVD simulator that is accessible on a mobile device. METHODS We developed a mobile-based EVD simulator that is compatible with iOS (Apple Inc., Cupertino, California) and Android-based devices (Google, Mountain View, California) and can be downloaded from the Apple App and Google Play Store. Our simulator consists of a learn mode, which teaches users the procedure, and a test mode, which assesses users' procedural knowledge. Twenty-eight participants, who were divided into expert and novice categories, completed the simulator in test mode and answered a postmodule survey. This was graded using a 5-point Likert scale, with 5 representing the highest score. Using the survey results, we assessed the module's face and content validity, whereas construct validity was evaluated by comparing the expert and novice test scores. RESULTS Participants rated individual survey questions pertaining to face and content validity a median score of 4 out of 5. When comparing test scores, generated by the participants completing the test mode, the experts scored higher than the novices (mean, 71.5; 95% confidence interval, 69.2 to 73.8 vs mean, 48; 95% confidence interval, 44.2 to 51.6; P < .001). CONCLUSION We created a mobile-based EVD simulator that is inexpensive, reusable, and accessible. Our results demonstrate that this simulator is face, content, and construct valid.
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Affiliation(s)
- Peter J Morone
- Vanderbilt University Medical Center, Department of Neurological Surgery, Nashville, Tennessee
| | - Kimon Bekelis
- Dartmouth-Hitchcock Medical Center, Section of Ne-urosurgery, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire
| | - Brandon K Root
- Dartmouth-Hitchcock Medical Center, Section of Ne-urosurgery, Lebanon, New Hampshire
| | - Robert J Singer
- Dartmouth-Hitchcock Medical Center, Section of Ne-urosurgery, Lebanon, New Hampshire
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Emergency glioma resection but not hours of operation predicts perioperative complications: A single center study. Clin Neurol Neurosurg 2019; 182:11-16. [PMID: 31054423 DOI: 10.1016/j.clineuro.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Physical and mental status of neurosurgeons may vary with emergency status and hours of operation, which may impact the outcome of patients undergoing surgery. This study aims to clarify the influence of these parameters on outcome after surgery in glioma patients. PATIENTS AND METHODS A total of 477 nonemergency surgery (NES) and 30 emergency surgery (ES) were enrolled in this study. Using propensity score matching (PSM) analysis, 97 pairs of procedures from NES group were generated and then classified as group M (morning procedures, 8:00 a.m-1:00 p.m) or group A (afternoon or night procedures, 1:00 p.m-8:00 p.m). 30 emergency procedures were classified into group ESa (daytime emergency surgery, 8:00 a.m-6:00 p.m) and group ESb (nighttime surgery procedures, 6:00 p.m-8:00 a.m the next day). Differences in intraoperative risk factors and postoperative complications were analyzed. RESULTS Postoperative complications, including death within 30 days (p = 0.004), neurological function deficit (p = 0.012), systemic infection (p < 0.001) were significant higher in emergency procedures. Intraoperative risk factors including blood loss (p < 0.001), blood transfusion (p = 0.036) were also higher in emergency procedures than nonemergency procedures, although both procedures had comparable time duration (p = 0.337). By PSM analysis, patients in group M and group A were well matched and no significant difference of intraoperative risk factors and postoperative complications (all p > 0.05) were found. Furthermore, incidence of intraoperative risk factors and postoperative complications were similar in both groups ESa and ESb (all p > 0.05). CONCLUSION Emergency glioma resection is a very important risk factors of perioperative mortality and morbidity for patients. However, hours of operation did not necessarily predict postoperative mortality or morbidity, either in emergency or nonemergency glioma resection.
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Yang I, Udawatta M, Prashant GN, Lagman C, Bloch O, Jensen R, Sheehan J, Kalkanis S, Warnick R. Stereotactic Radiosurgery for Neurosurgical Patients: A Historical Review and Current Perspectives. World Neurosurg 2018; 122:522-531. [PMID: 30399473 DOI: 10.1016/j.wneu.2018.10.193] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 12/09/2022]
Abstract
Today, stereotactic radiosurgery is an effective therapy for a variety of intracranial pathology that were treated solely with open neurosurgery in the past. The technique was developed from the combination of therapeutic radiation and stereotactic devices for the precise localization of intracranial targets. Although stereotactic radiosurgery was originally performed as a partnership between neurosurgeons and radiation oncologists, this partnership has weakened in recent years, with some procedures being performed without neurosurgeons. At the same time, neurosurgeons across the United States and Canada have found their stereotactic radiosurgery training during residency inadequate. Although neurosurgeons, residency directors, and department chairs agree that stereotactic radiosurgery education and exposure during neurosurgery training could be improved, a limited number of resources exist for this kind of education. This review describes the history of stereotactic radiosurgery, assesses the state of its use and education today, and provides recommendations for the improvement of neurosurgical education in stereotactic radiosurgery for the future.
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Affiliation(s)
- Isaac Yang
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Office of the Patient Experience, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; UCLA Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute (LA BioMed) at Harbor-UCLA Medical Center, Torrance, California, USA.
| | - Methma Udawatta
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Giyarpuram N Prashant
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Carlito Lagman
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | - Orin Bloch
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Randy Jensen
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Steven Kalkanis
- Department of Neurosurgery, Hermelin Brain Tumor Center, Henry Ford Health System, Detroit, Michigan, USA
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Boody BS, Hashmi SZ, Rosenthal BD, Maslak JP, McCarthy MH, Patel AA, Savage JW, Hsu WK. The Effectiveness of Bioskills Training for Simulated Lumbar Pedicle Screw Placement. Global Spine J 2018; 8:557-562. [PMID: 30202708 PMCID: PMC6125934 DOI: 10.1177/2192568217743505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Prospective randomized study. OBJECTIVES To define the impact of an inexpensive, user-friendly, and reproducible lumbar pedicle screw instrumentation bioskills training module and evaluation protocol. METHODS Participants were randomized to control (n = 9) or intervention (n = 10) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 20-minute bioskills training module while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Pedicle Instrumentation Score metrics. In addition, identification of pedicle breach and breach anatomic location was measured pre- and posttest in lumbar spine models. RESULTS The intervention group showed a 30.8% improvement in PPDIS scores, compared with 13.4% for the control group (P = .01). The intervention group demonstrated statistically significant 66% decrease in breaches (P = .001) compared with 28% decrease in the control group (P = .06). Breach identification demonstrated no change in accuracy of the control group (incorrect identification from 32.2% pre- to posttest 35%; P = .71), whereas the intervention group's improvement was statistically significant (42% pre- to posttest 36.5%; P = .0047). CONCLUSIONS We conclude that a concise lumbar pedicle screw instrumentation bioskills training session can be a useful educational tool to augment clinical education.
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Affiliation(s)
- Barrett S. Boody
- Northwestern Memorial Hospital, Chicago, IL, USA
- Barrett S. Boody, Orthopaedic Surgery, Northwestern
Memorial Hospital, Suite 1350, 676 N St. Clair Street, Chicago, IL 60611, USA.
| | | | | | | | | | | | - Jason W. Savage
- Cleveland Clinic Center for Spine Health, Cleveland, OH, USA
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Shapiro M, Raz E, Litao M, Becske T, Riina H, Nelson PK. Toward a Better Understanding of Dural Arteriovenous Fistula Angioarchitecture: Superselective Transvenous Embolization of a Sigmoid Common Arterial Collector. AJNR Am J Neuroradiol 2018; 39:1682-1688. [PMID: 30115674 DOI: 10.3174/ajnr.a5740] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/06/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to propose a conceptually new angioarchitectural model of some dural arteriovenous fistulas based on subset analysis of transverse and sigmoid type lesions. The "common collector" notion argues for convergence of multiple smaller caliber arterial vessels on a common arterial collector vessel within the sinus wall. Communication of this single collector (or constellation of terminal collectors) with the sinus proper defines the site of arteriovenous fistula, which can be closed by highly targeted embolization, preserving the sinus and avoiding unnecessary permeation of indirect arterial feeders. MATERIALS AND METHODS One hundred consecutive dural arteriovenous shunts were examined. Thirty-six transverse/sigmoid fistulas were identified within this group and analyzed for the presence of a common arterial collector as well as other parameters, including demographics, grade, treatment approach, and outcome. RESULTS A common collector was identified in nearly all Cognard type I lesions (15 fistulas with 14 single collector vessels seen) and progressively less frequently in higher grade fistulas. Identification of the common collector requires careful angiographic analysis, including supraselective and intraprocedural angiographies during treatment, and final embolic material morphology. CONCLUSIONS Detailed evaluation of imaging studies allows frequent identification of a vascular channel in the sinus wall, which we argue reflects a compound, common arterial channel (rather than a venous collector) with 1 or several discrete fistulous points between this vessel and the sinus proper. Targeted closure of this channel is often feasible, with sinus preservation and avoidance of embolic material penetration into arteries remote from fistula site.
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Affiliation(s)
- M Shapiro
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.) .,Neurology (M.S., M.L.)
| | - E Raz
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.)
| | | | - T Becske
- Department of Neurology (T.B.), Rochester Regional Health, Rochester, New York
| | - H Riina
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.).,Neurosurgery (H.R., P.K.N.), NYU School of Medicine, New York, New York
| | - P K Nelson
- From the Departments of Radiology (M.S., E.R., H.R., P.K.N.).,Neurosurgery (H.R., P.K.N.), NYU School of Medicine, New York, New York
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McGrath JL, Taekman JM, Dev P, Danforth DR, Mohan D, Kman N, Crichlow A, Bond WF. Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners. Acad Emerg Med 2018; 25:186-195. [PMID: 28888070 DOI: 10.1111/acem.13308] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/05/2017] [Accepted: 09/06/2017] [Indexed: 01/13/2023]
Abstract
Immersive learning environments that use virtual simulation (VS) technology are increasingly relevant as medical learners train in an environment of restricted clinical training hours and a heightened focus on patient safety. We conducted a consensus process with a breakout group of the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes." This group examined the current uses of VS in training and assessment, including limitations and challenges in implementing VS into medical education curricula. We discuss the role of virtual environments in formative and summative assessment. Finally, we offer recommended areas of focus for future research examining VS technology for assessment, including high-stakes assessment in medical education. Specifically, we discuss needs for determination of areas of focus for VS training and assessment, development and exploration of virtual platforms, automated feedback within such platforms, and evaluation of effectiveness and validity of VS education.
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Affiliation(s)
- Jillian L. McGrath
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | | | - Parvati Dev
- Stanford University School of Medicine; Los Altos CA
| | - Douglas R. Danforth
- Department of Obstetrics and Gynecology; The Ohio State University Wexner Medical Center; Columbus OH
| | - Deepika Mohan
- Department of Surgery; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Nicholas Kman
- Department of Emergency Medicine; The Ohio State University Wexner Medical Center; Columbus OH
| | - Amanda Crichlow
- Department of Emergency Medicine; Drexel University College of Medicine; Philadelphia PA
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Competency Assessment in Virtual Reality-Based Simulation in Neurosurgical Training. COMPREHENSIVE HEALTHCARE SIMULATION: NEUROSURGERY 2018. [DOI: 10.1007/978-3-319-75583-0_12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Virtual Reality Simulation for the Spine. COMPREHENSIVE HEALTHCARE SIMULATION: NEUROSURGERY 2018. [DOI: 10.1007/978-3-319-75583-0_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Boody BS, Rosenthal BD, Jenkins TJ, Patel AA, Savage JW, Hsu WK. The Effectiveness of Bioskills Training for Simulated Open Lumbar Laminectomy. Global Spine J 2017; 7:794-800. [PMID: 29238645 PMCID: PMC5721999 DOI: 10.1177/2192568217703337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Randomized, prospective study within an orthopedic surgery resident program at a large urban academic medical center. OBJECTIVES To develop an inexpensive, user-friendly, and reproducible lumbar laminectomy bioskills training module and evaluation protocol that can be readily implemented into residency training programs to augment the clinical education of orthopedic and neurosurgical physicians-in-training. METHODS Twenty participants comprising senior medical students and orthopedic surgical residents. Participants were randomized to control (n = 9) or intervention (n = 11) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 40-minute bioskills training module, while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported by each participant (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Decompression Score metrics. RESULTS When compared with the control group, the intervention group yielded a significant mean improvement in OSATS (P = .022) and PPDIS (P = .0001) scores. The Objective Decompression Scores improved in the intervention group with a trend toward significance (P = .058). CONCLUSIONS We conclude that a concise lumbar laminectomy bioskills training session can be a useful educational tool for to augment clinical education. Although no direct clinical correlation can be concluded from this study, the improvement in trainee's technical and procedural skills suggests that Sawbones training modules can be an efficient and effective tool for teaching fundamental spine surgical skills outside of the operating room.
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Affiliation(s)
- Barrett S. Boody
- Northwestern Memorial Hospital, Chicago, IL, USA,Barrett S. Boody, Orthopaedic Surgery, Northwestern Memorial Hospital, 676 N St, Clair Street, Suite 1350, Chicago, IL 60611, USA.
| | | | | | | | - Jason W. Savage
- Cleveland Clinic Center for Spine Health, Cleveland, OH, USA
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Clark AD, Barone DG, Candy N, Guilfoyle M, Budohoski K, Hofmann R, Santarius T, Kirollos R, Trivedi RA. The Effect of 3-Dimensional Simulation on Neurosurgical Skill Acquisition and Surgical Performance: A Review of the Literature. JOURNAL OF SURGICAL EDUCATION 2017; 74:828-836. [PMID: 28341408 DOI: 10.1016/j.jsurg.2017.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/21/2017] [Accepted: 02/05/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In recent years, 3-dimensional (3D) simulation of neurosurgical procedures has become increasingly popular as an addition to training programmes. However, there remains little objective evidence of its effectiveness in improving live surgical skill. This review analysed the current literature in 3D neurosurgical simulation, highlighting remaining gaps in the evidence base for improvement in surgical performance and suggests useful future research directions. DESIGN An electronic search of the databases was conducted to identify studies investigating 3D virtual reality (VR) simulation for various types of neurosurgery. Eligible studies were those that used a combination of metrics to measure neurosurgical skill acquisition on a simulation trainer. Studies were excluded if they did not measure skill acquisition against a set of metrics or if they assessed skills that were not used in neurosurgical practice. This was not a systematic review however, the data extracted was tabulated to allow comparison between studies RESULTS: This study revealed that the average overall quality of the included studies was moderate. Only one study assessed outcomes in live surgery, while most other studies assessed outcomes on a simulator using a variety of metrics. CONCLUSIONS It is concluded that in its current state, the evidence for 3D simulation suggests it as a useful supplement to training programmes but more evidence is needed of improvement in surgical performance to warrant large-scale investment in this technology.
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Affiliation(s)
- Anna D Clark
- School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge CB2 0SP, United Kingdom
| | - Damiano G Barone
- Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Nicholas Candy
- Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mathew Guilfoyle
- Department of Clinical Neurosciences, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Karol Budohoski
- Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Riikka Hofmann
- Faculty of Education, University of Cambridge, Hills Road, Cambridge, CB2 8PQ, United Kingdom
| | - Thomas Santarius
- School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge CB2 0SP, United Kingdom; Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Ramez Kirollos
- Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Rikin A Trivedi
- Division of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
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de Castro-Afonso LH, Trivelato FP, Rezende MT, Ulhôa AC, Nakiri GS, Monsignore LM, Colli BO, Velasco-E-Cruz AA, Abud DG. Transvenous embolization of dural carotid cavernous fistulas: the role of liquid embolic agents in association with coils on patient outcomes. J Neurointerv Surg 2017; 10:461-462. [PMID: 28823989 DOI: 10.1136/neurintsurg-2017-013318] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Transvenous embolization is the standard treatment for dural carotid cavernous fistulas (DCCF). Although various embolic materials have been used, the best embolic material for the treatment of DCCF is still unknown. OBJECTIVE To assess the safety and efficacy of different embolic materials used for the endovascular treatment of DCCF. METHODS A retrospective data analysis of a consecutive series of 62 patients presenting DCCF was performed. Clinical and radiological data from patients were assessed, and the embolic material used-coils or liquids-were compared between two groups of patients. RESULTS Complete angiographic occlusion of DCCF after treatment was achieved in 83.9% of the patients (52/62). We found a higher rate of complete occlusion of DCCF when liquids were associated with coils than with coils alone (96.5% vs 71.8%, p=0.01), and no differences in complication rates or clinical outcomes were seen between the two groups. At the 6-month follow-up, we found a higher rate of improvement in ocular symptoms compared with cranial nerve palsy improvement (94.7% vs 77.7%, p=0.02). Two patients (3.2%) had treatment-related complications without clinical symptoms. CONCLUSION In this study, in comparison with the use of coils alone, the association of transvenous embolization with liquid embolic agents for DCCF treatment resulted in higher rates of complete occlusion without increasing complication rates. The clinical outcome at the 6-month follow-up showed significant improvement in ocular symptoms over cranial nerve palsy regression, which was independent of the embolic agent chosen for treatment.
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Affiliation(s)
- Luís Henrique de Castro-Afonso
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Padovani Trivelato
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Túlio Rezende
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Alexandre Cordeiro Ulhôa
- Department of Interventional Neuroradiology, Instituto Neurovascular, Felício Rocho Hospital, Mater Dei Hospital, University of Minas Gerais, Belo Horizonte, Brazil
| | - Guilherme Seizem Nakiri
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Lucas Moretti Monsignore
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Benedicto Oscar Colli
- Division of Neurosurgery, Department of Surgery, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Antônio Augusto Velasco-E-Cruz
- Department of Ophthalmology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniel Giansante Abud
- Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Supplementary Educational Models in Canadian Neurosurgery Residency Programs. Can J Neurol Sci 2016; 44:177-183. [DOI: 10.1017/cjn.2016.315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground: The proposed implementation of work hour restrictions has presented a significant challenge of maintaining the quality of resident education and ensuring adequate hands-on experience that is essential for novice surgeons. To maintain the level of resident surgical competency, revision of the apprentice model of surgical education to include supplementary educational methods, such as laboratory and virtual reality (VR) simulations, have become frequent topics of discussion. We aimed to better understand the role of supplementary educational methods in Canadian neurosurgery residency training. Methods: An online survey was sent to program directors of all 14 Canadian neurosurgical residency programs and active resident members of the Canadian Neurosurgical Society (N=85). We asked 16 questions focusing on topics of surgeon perception, current implementation and barriers to supplementary educational models. Results: Of the 99 surveys sent, 8 out of 14 (57%) program directors and 37 out of 85 (44%) residents completed the survey. Of the 14 neurosurgery residency programs across Canada, 7 reported utilizing laboratory-based teaching within their educational plan, while only 3 programs reported using VR simulation as a supplementary teaching method. The biggest barriers to implementing supplementary educational methods were resident availability, lack of resources, and cost. Conclusions: Work-hour restrictions threaten to compromise the traditional apprentice model of surgical training. The potential value of supplementary educational methods for surgical education is evident, as reported by both program directors and residents across Canada. However, availability and utilization of laboratory and VR simulations are limited by numerous factors such as time constrains and lack of resources.
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Pelargos PE, Nagasawa DT, Lagman C, Tenn S, Demos JV, Lee SJ, Bui TT, Barnette NE, Bhatt NS, Ung N, Bari A, Martin NA, Yang I. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery. J Clin Neurosci 2016; 35:1-4. [PMID: 28137372 DOI: 10.1016/j.jocn.2016.09.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/12/2016] [Indexed: 01/16/2023]
Abstract
Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery.
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Affiliation(s)
- Panayiotis E Pelargos
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Daniel T Nagasawa
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, United States
| | - Joanna V Demos
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Seung J Lee
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Timothy T Bui
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Natalie E Barnette
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nikhilesh S Bhatt
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nolan Ung
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Ausaf Bari
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Neil A Martin
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States.
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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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Impact of Resident Participation on Outcomes After Single-Level Anterior Cervical Diskectomy and Fusion: An Analysis of 3265 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database. Spine (Phila Pa 1976) 2016; 41:E289-96. [PMID: 26555830 DOI: 10.1097/brs.0000000000001230] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter retrospective cohort study. OBJECTIVE To investigate the relationship between resident involvement in the operating room and 30-day complication rates in patients undergoing single-level anterior cervical diskectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA Although an integral part of academic medicine, surgical resident participation in the operating room and its impact on patient outcomes have been a topic of debate. No large-scale study has been performed to examine this relationship in ACDF. METHODS The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed to identify all patients who underwent single-level ACDF procedures during 2006-2013. A propensity score-matching algorithm was employed to minimize baseline differences. Multivariate logistic regression analysis of unadjusted and propensity-matched cohorts was performed to examine the effect of resident participation on 30-day postoperative complication rates and length of hospital stay. RESULTS A total of 3265 patients met inclusion criteria. The propensity score-matching procedure yielded 1003 pairs of well-matched nonresident and resident pairs. The multivariate analysis of propensity score-matched population demonstrated that resident involvement was not associated with an increased risk for any of the complications analyzed, including overall complications, medical complications, surgical complications, mortality, cardiac arrest, deep venous thrombosis, or length of total hospital stay. CONCLUSION This large-scale, population-based study found that surgical resident participation in the operating room did not increase the risk of 30-day complications nor prolonged the length of hospital stay. Resident participation, however, was associated with an increased operative duration. Strategies to improve residents' technical proficiency outside of the operating room may enhance patient safety. LEVEL OF EVIDENCE 3.
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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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Ramos-Zúñiga R, Díaz-Guzmán LR, Velasquez S, Macías-Ornelas AM, Rodríguez-Vázquez M. A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study. J Neurosci Rural Pract 2015; 6:315-9. [PMID: 26167011 PMCID: PMC4481782 DOI: 10.4103/0976-3147.158748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma); and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.
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Affiliation(s)
- Rodrigo Ramos-Zúñiga
- Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico
| | - Laura Rocío Díaz-Guzmán
- Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico
| | | | - Ana Magdalena Macías-Ornelas
- Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico
| | - Martín Rodríguez-Vázquez
- Department of Neurosciences, Translational Neurosciences Institute, Centro Universitario de Ciencias de la Salud, University of Guadalajara, Guadalajara, Mexico
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Nossek E, Ram Z. Improving Vascular Neurosurgical Skills in an Era of Diminished Microsurgical Exposure. World Neurosurg 2015; 84:878-80. [PMID: 26118719 DOI: 10.1016/j.wneu.2015.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Erez Nossek
- Department of Neurological Surgery, New York University School of Medicine, New York, New York, USA
| | - Zvi Ram
- Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel.
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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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Bohm PE, Arnold PM. Simulation and resident education in spinal neurosurgery. Surg Neurol Int 2015; 6:33. [PMID: 25745588 PMCID: PMC4348802 DOI: 10.4103/2152-7806.152146] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/07/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A host of factors have contributed to the increasing use of simulation in neurosurgical resident education. Although the number of simulation-related publications has increased exponentially over the past two decades, no studies have specifically examined the role of simulation in resident education in spinal neurosurgery. METHODS We performed a structured search of several databases to identify articles detailing the use of simulation in spinal neurosurgery education in an attempt to catalogue potential applications for its use. RESULTS A brief history of simulation in medicine is given, followed by current trends of spinal simulation utilization in residency programs. General themes from the literature are identified that are integral for implementing simulation into neurosurgical residency curriculum. Finally, various applications are reported. CONCLUSION The use of simulation in spinal neurosurgery education is not as ubiquitous in comparison to other neurosurgical subspecialties, but many promising methods of simulation are available for augmenting resident education.
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Affiliation(s)
- Parker E Bohm
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 3021, Kansas City, KS, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Mail Stop 3021, Kansas City, KS, USA
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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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Hooten KG, Lister JR, Lombard G, Lizdas DE, Lampotang S, Rajon DA, Bova F, Murad GJ. Mixed Reality Ventriculostomy Simulation: Experience in Neurosurgical Residency. Oper Neurosurg (Hagerstown) 2014; 10 Suppl 4:576-81; discussion 581. [DOI: 10.1227/neu.0000000000000503] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Medicine and surgery are turning toward simulation to improve on limited patient interaction during residency training. Many simulators today use virtual reality with augmented haptic feedback with little to no physical elements. In a collaborative effort, the University of Florida Department of Neurosurgery and the Center for Safety, Simulation & Advanced Learning Technologies created a novel “mixed” physical and virtual simulator to mimic the ventriculostomy procedure. The simulator contains all the physical components encountered for the procedure with superimposed 3-D virtual elements for the neuroanatomical structures.
OBJECTIVE:
To introduce the ventriculostomy simulator and its validation as a necessary training tool in neurosurgical residency.
METHODS:
We tested the simulator in more than 260 residents. An algorithm combining time and accuracy was used to grade performance. Voluntary postperformance surveys were used to evaluate the experience.
RESULTS:
Results demonstrate that more experienced residents have statistically significant better scores and completed the procedure in less time than inexperienced residents. Survey results revealed that most residents agreed that practice on the simulator would help with future ventriculostomies.
CONCLUSION:
This mixed reality simulator provides a real-life experience, and will be an instrumental tool in training the next generation of neurosurgeons. We have now implemented a standard where incoming residents must prove efficiency and skill on the simulator before their first interaction with a patient.
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Affiliation(s)
| | - J. Richard Lister
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Gwen Lombard
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - David E. Lizdas
- Department of Anesthesiology, Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, Florida
| | - Samsun Lampotang
- Department of Anesthesiology, Center for Safety, Simulation & Advanced Learning Technologies, University of Florida, Gainesville, Florida
| | - Didier A. Rajon
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Frank Bova
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
| | - Gregory J.A. Murad
- Department of Neurological Surgery, University of Florida, Gainesville, Florida
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