Neurosurgery simulation in residency training: feasibility, cost, and educational benefit

• Published in: Neurosurgery Vol. 73 Suppl 1; p. 39
• Main Authors: Gasco, Jaime, Holbrook, Thomas J, Patel, Achal, Smith, Adrian, Paulson, David, Muns, Alan, Desai, Sohum, Moisi, Marc, Kuo, Yong-Fan, Macdonald, Bart, Ortega-Barnett, Juan, Patterson, Joel T
• Format: Journal Article
• Language: English
• Published: United States 01.10.2013
• Subjects: Cadaver; Clinical Competence; Computer Simulation; Cost-Benefit Analysis; Costs and Cost Analysis; Curriculum; Education, Medical, Graduate; Educational Measurement; History, 20th Century; History, 21st Century; Humans; Internship and Residency - economics; Internship and Residency - history; Models, Anatomic; Neurosurgery - economics; Neurosurgery - education; Neurosurgery - history
• ISSN: 1524-4040; 1524-4040
• DOI: 10.1093/neurosurgery/73.suppl_1.S39

The effort required to introduce simulation in neurosurgery academic programs and the benefits perceived by residents have not been systematically assessed. To create a neurosurgery simulation curriculum encompassing basic and advanced skills, cadaveric dissection, cranial and spine surgery simulation, and endovascular and computerized haptic training. A curriculum with 68 core exercises per academic year was distributed in individualized sets of 30 simulations to 6 neurosurgery residents. The total number of procedures completed during the academic year was set to 180. The curriculum includes 79 simulations with physical models, 57 cadaver dissections, and 44 haptic/computerized sessions. Likert-type evaluations regarding self-perceived performance were completed after each exercise. Subject identification was blinded to junior (postgraduate years 1-3) or senior resident (postgraduate years 4-6). Wilcoxon rank testing was used to detect differences within and between groups. One hundred eighty procedures and surveys were analyzed. Junior residents reported proficiency improvements in 82% of simulations performed (P < .001). Senior residents reported improvement in 42.5% of simulations (P < .001). Cadaver simulations accrued the highest reported benefit (71.5%; P < .001), followed by physical simulators (63.8%; P < .001) and haptic/computerized (59.1; P < .001). Initial cost is $341,978.00, with $27,876.36 for annual operational expenses. The systematic implementation of a simulation curriculum in a neurosurgery training program is feasible, is favorably regarded, and has a positive impact on trainees of all levels, particularly in junior years. All simulation forms, cadaver, physical, and haptic/computerized, have a role in different stages of learning and should be considered in the development of an educational simulation program.