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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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Hong JK, Bae IS, Kang HI, Kim JH, Jwa C. Development of a Pedicle Screw Fixation Simulation Model for Surgical Training Using a 3-Dimensional Printer. World Neurosurg 2023; 171:e554-e559. [PMID: 36563851 DOI: 10.1016/j.wneu.2022.12.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Training surgeons in pedicle screw fixation (PSF) techniques during actual surgery is limited because of patient safety, complications, and surgical efficiency issues. Recent technical developments are leading the world to an era of personalized three-dimensional (3D) printing. This study aimed to evaluate the educational effect of using a 3D-printed spine model to train beginners in PSF techniques to improve screw accuracy and procedure time. METHODS Computed tomography (CT) scan data were used in a 3D printer to produce a life-size lumbar spine replica of L1-3 vertebrae. Four residents performed PSF thrice. Each resident performed 18 screw fixations on both sides (6 screws per trial). The time to complete the procedure and pedicle violation was recorded. RESULTS The average time for the 3 procedures was 42.1±2.9 minutes, 38.8±3.3 minutes, and 32.1±2.5 minutes, respectively. Furthermore, the average pedicle screw score for the 3 procedures was 13.0±0.8, 14.5±0.6, and 16.0±0.8, respectively. As the trial was repeated, the procedure time decreased and the accuracy of screw fixation tended to be more accurate. CONCLUSIONS It was possible to decrease the procedure time and increase accuracy through repeated training using the 3D-printed spine model. By implementing a 3Dprinted spine model based on the patient's actual CT data, surgeons can perform simulation surgery before the actual surgery. Therefore, this technology can be useful in educating residents to improve their surgical skills.
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Affiliation(s)
- Joon-Ki Hong
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - In-Suk Bae
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea.
| | - Hee In Kang
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jae Hoon Kim
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Cheolsu Jwa
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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Simulation Training in Spine Surgery. J Am Acad Orthop Surg 2022; 30:400-408. [PMID: 35446299 DOI: 10.5435/jaaos-d-21-00756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/19/2022] [Indexed: 02/01/2023] Open
Abstract
Simulated surgery is part of a growing paradigm shift in surgical education as a whole. Various modalities from cadaver models to virtual reality have been developed and studied within the context of surgical education. Simulation training in spine surgery has an immense potential to improve education and ultimately improve patient safety. This is due to the inherent risk of operating the spine and the technical difficulty of modern techniques. Common procedures in the modern orthopaedic armamentarium, such as pedicle screw placement, can be simulated, and proficiency is rapidly achieved before application in patients. Furthermore, complications such as dural tears can be simulated and effectively managed in a safe environment with simulation. New techniques with steeper learning curves, such as minimally invasive techniques, can now be safely simulated. Hence, augmenting surgical education through simulation has great potential to benefit trainees and practicing orthopaedic surgeons in modern spine surgery techniques. Additional work will aim to improve access to such technologies and integrate them into the current orthopaedic training curriculum.
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Kelly PD, Yengo-Kahn AM, Roth SG, Zuckerman SL, Chitale RV, Wellons JC, Chambless LB. Data-Driven Residency Training: A Scoping Review of Educational Interventions for Neurosurgery Residency Programs. Neurosurgery 2021; 89:750-759. [PMID: 34423828 DOI: 10.1093/neuros/nyab322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurosurgery residency programs are tasked with imparting large volumes of both clinical knowledge and technical skill to trainees in limited time. Many investigators have described local practices, which may offer evidence-based interventions in neurosurgical residency education, but this literature has not been systematically reviewed. OBJECTIVE To perform a scoping review of educational practices in neurosurgery, which are supported by quantitative, peer-reviewed research. METHODS A scoping review of the literature was performed. PubMed, Embase, and Web of Science databases were queried for articles describing educational interventions for neurosurgery residents, which included a quantitative assessment of the effect on resident performance. RESULTS From an initial set of 1785 unique articles, 29 studies were ultimately screened and included. Studies were into the following 6 topics: (1) didactics and curricula (n = 13), (2) nontechnical skills (n = 6), (3) wellness and burnout (n = 4), (4) assessment and feedback (n = 2), (5) mentorship and career development (n = 2), and (6) research (n = 2). Individual study results were described. CONCLUSION Several educational interventions in neurosurgical training are supported by quantitative evidence. Methodological shortcomings are prevalent among studies of education, particularly in the selection of meaningful outcome measures. A summary of evidence-based considerations is provided for current and future program directors.
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Affiliation(s)
- Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohan V Chitale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Wellons
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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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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Mao JZ, Mullin JP, Pollina J. Commentary: Integration of Technology Within the Spine Neurosurgical Training Paradigm. Oper Neurosurg (Hagerstown) 2020; 19:E538-E542. [DOI: 10.1093/ons/opaa248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
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Gardeck AM, Pu X, Yang Q, Polly DW, Jones KE. The effect of simulation training on resident proficiency in thoracolumbar pedicle screw placement using computer-assisted navigation. J Neurosurg Spine 2020; 34:127-134. [PMID: 32886919 DOI: 10.3171/2020.5.spine2067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Residency work-hour restrictions necessitate efficient, reproducible training. Simulation training for spinal instrumentation placement shows significant benefit to learners' subjective and objective proficiency. Cadaveric laboratories are most effective but have high cost and low availability. The authors' goal was to create a low-cost, efficient, reproducible spinal instrumentation placement simulation curriculum for neurosurgery and orthopedic surgery residents using synthetic models and 3D computer-assisted navigation, assessing subjective and objective proficiency with placement of thoracolumbar pedicle screws. METHODS Fifteen neurosurgery and orthopedic surgery residents participated in a standardized curriculum with lecture followed by two separate sessions of thoracolumbar pedicle screw placement in a synthetic spine model utilizing 3D computer-assisted navigation. Data were collected on premodule experience, time and accuracy of screw placement, and both subjective and objective ratings of proficiency. RESULTS Fifteen of 15 residents demonstrated improvement in subjective (Physician Performance Diagnostic Inventory Scale [PPDIS]) and 14 in objective (Objective Structured Assessment of Technical Skills [OSATS]) measures of proficiency in navigated screw placement with utilization of this curriculum (p < 0.001 for both), regardless of the number of cases of previous experience using thoracolumbar spinal instrumentation. Fourteen of 15 residents demonstrated decreased time per screw placement from session 1 to session 2 (p = 0.006). There was no significant difference in pedicle screw accuracy between session 1 and session 2. CONCLUSIONS A standardized curriculum using synthetic simulation training for navigated thoracolumbar pedicle screw placement results in significantly improved resident subjective and objective proficiency. Development of a nationwide competency curriculum using simulation training for spinal instrumentation placement should be considered for safe, efficient resident training.
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Affiliation(s)
| | - Xuan Pu
- 2Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Qiuyu Yang
- 2Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - David W Polly
- 3Orthopedic Surgery, University of Minnesota, Minneapolis; and
| | - Kristen E Jones
- 1Departments of Neurosurgery and
- 2Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
- 3Orthopedic Surgery, University of Minnesota, Minneapolis; and
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Pedicle Screw Instrumentation in Scoliosis Surgery: On Site Simulation Data on Accuracy and Efficiency With Different Techniques. Spine (Phila Pa 1976) 2020; 45:E670-E676. [PMID: 31809473 DOI: 10.1097/brs.0000000000003358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective experimental study with on-site simulation. OBJECTIVE To compare the accuracy and efficiency of different techniques for pedicle screw instrumentation (PSI). SUMMARY OF BACKGROUND DATA Improving the safety and efficiency of PSI is a critical step to reduce the complication rates and the cost of scoliosis surgery. Innovative operative techniques for PSI have shown to safely improve efficiency, thereby reducing cost. Surgical simulation is a valuable tool to study different operative techniques. METHODS Five spine fellows instrumented 20 simulation models of a scoliotic spine with 10 pedicle screws per model. Four techniques were studied, including the conventional pedicle probe and the innovative sequential drilling technique, with or without computed tomography (CT)-based navigation. Our primary outcome measures were efficiency and accuracy of PSI. We analyzed the data with bivariate analyses using the Chi-square test for categorical variables and the Student t test or ANalysis Of VAriance with Bonferroni post-hoc tests for continuous variables. RESULTS The drilling techniques (free hand and navigated) were more efficient as compared with the pedicle probe techniques (P < 0.01). The navigated techniques resulted in better accuracy as compared with the free hand techniques (P = 0.036). Most pedicle breaches were medial (n = 32/52). The concave apical pedicle (T4 right side) had the highest incidence of breaches. There was no significant difference in efficiency comparing the free hand and the navigated pedicle probe techniques (P = 0.261) or comparing the free hand drilling and the navigated drilling techniques (P = 1.00). CONCLUSION On site surgical simulation is a promising concept for teaching advanced procedural skills. Our findings suggest that navigation improves the accuracy of PSI while sequential drilling safely improves efficiency. Combining navigation with sequential drilling can significantly improve the accuracy and the efficiency of PSI in scoliosis surgery, as previously suggested with our published clinical data. LEVEL OF EVIDENCE 4.
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Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A Systematic Review of Simulation-Based Training in Neurosurgery, Part 2: Spinal and Pediatric Surgery, Neurointerventional Radiology, and Nontechnical Skills. World Neurosurg 2020; 133:e874-e892. [DOI: 10.1016/j.wneu.2019.08.263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
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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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Robot-Assisted Pedicle Screw Placement: Learning Curve Experience. World Neurosurg 2019; 130:e417-e422. [DOI: 10.1016/j.wneu.2019.06.107] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 12/16/2022]
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James HK, Chapman AW, Pattison GTR, Griffin DR, Fisher JD. Systematic review of the current status of cadaveric simulation for surgical training. Br J Surg 2019; 106:1726-1734. [PMID: 31573088 PMCID: PMC6900127 DOI: 10.1002/bjs.11325] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/09/2019] [Accepted: 07/04/2019] [Indexed: 12/18/2022]
Abstract
Background There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training. Methods A PRISMA‐compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool. Results A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7). Conclusion There is an abundance of relatively low‐quality evidence showing that cadaveric simulation induces short‐term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre.
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Affiliation(s)
- H K James
- Clinical Trials Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire, Coventry, UK.,Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - A W Chapman
- Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - G T R Pattison
- Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D R Griffin
- Clinical Trials Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire, Coventry, UK.,Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - J D Fisher
- Clinical Trials Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire, Coventry, UK
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Clifton W, Nottmeier E, Edwards S, Damon A, Dove C, Refaey K, Pichelmann M. Development of a Novel 3D Printed Phantom for Teaching Neurosurgical Trainees the Freehand Technique of C2 Laminar Screw Placement. World Neurosurg 2019; 129:e812-e820. [DOI: 10.1016/j.wneu.2019.06.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
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Utilization of Spinal Intra-operative Three-dimensional Navigation by Canadian Surgeons and Trainees: A Population-based Time Trend Study. Can J Neurol Sci 2019; 46:87-95. [DOI: 10.1017/cjn.2018.376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackgroundComputer-assisted navigation (CAN) improves the accuracy of spinal instrumentation in vertebral fractures and degenerative spine disease; however, it is not widely adopted because of lack of training, high capital costs, workflow hindrances, and accuracy concerns. We characterize shifts in the use of spinal CAN over time and across disciplines in a single-payer health system, and assess the impact of intra-operative CAN on trainee proficiency across Canada.MethodsA prospectively maintained Ontario database of patients undergoing spinal instrumentation from 2005 to 2014 was reviewed retrospectively. Data were collected on treated pathology, spine region, surgical approach, institution type, and surgeon specialty. Trainee proficiency with CAN was assessed using an electronic questionnaire distributed across 15 Canadian orthopedic surgical and neurosurgical programs.ResultsIn our provincial cohort, 16.8% of instrumented fusions were CAN-guided. Navigation was used more frequently in academic institutions (15.9% vs. 12.3%, p<0.001) and by neurosurgeons than orthopedic surgeons (21.0% vs. 12.4%, p<0.001). Of residents and fellows 34.1% were fully comfortable using spinal CAN, greater for neurosurgical than orthopedic surgical trainees (48.1% vs. 11.8%, p=0.008). The use of CAN increased self-reported proficiency in thoracic instrumentation for all trainees by 11.0% (p=0.036), and in atlantoaxial instrumentation for orthopedic trainees by 18.0% (p=0.014).ConclusionsSpinal CAN is used most frequently by neurosurgeons and in academic centers. Most spine surgical trainees are not fully comfortable with the use of CAN, but report an increase in technical comfort with CAN guidance particularly for thoracic instrumentation. Increased education in spinal CAN for trainees, particularly at the fellowship stage and, specifically, for orthopedic surgery, may improve adoption.
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Selzer DJ. Overview of Simulation in Surgery. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Impact of resident participation on outcomes following lumbar fusion: An analysis of 5655 patients from the ACS-NSQIP database. J Clin Neurosci 2018; 56:131-136. [DOI: 10.1016/j.jocn.2018.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 01/21/2023]
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Effectiveness of Cadaveric Simulation in Neurosurgical Training: A Review of the Literature. World Neurosurg 2018; 118:88-96. [DOI: 10.1016/j.wneu.2018.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
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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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Zada G, Bakhsheshian J, Pham M, Minneti M, Christian E, Winer J, Robison A, Wrobel B, Russin J, Mack WJ, Giannotta S. Development of a Perfusion-Based Cadaveric Simulation Model Integrated into Neurosurgical Training: Feasibility Based On Reconstitution of Vascular and Cerebrospinal Fluid Systems. Oper Neurosurg (Hagerstown) 2018; 14:72-80. [DOI: 10.1093/ons/opx074] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Jensen RL, Alzhrani G, Kestle JRW, Brockmeyer DL, Lamb SM, Couldwell WT. Neurosurgeon as educator: a review of principles of adult education and assessment applied to neurosurgery. J Neurosurg 2017; 127:949-957. [DOI: 10.3171/2017.3.jns17242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Randy L. Jensen
- Department of Neurosurgery, Clinical Neurosciences Center, and
| | - Gmaan Alzhrani
- Department of Neurosurgery, Clinical Neurosciences Center, and
| | | | | | - Sara M. Lamb
- Departments of Internal Medicine and
- Pediatrics, University of Utah School of Medicine, University of Utah, Salt Lake City, Utah
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