Department of Neurosurgery, University of Florida, Gainesville, Florida 32610, USA.
J Neurointerv Surg. 2012 Nov;4(6):438-41. doi: 10.1136/neurintsurg-2011-010128. Epub 2011 Oct 20.
The use of simulators in medical training has been on the rise over the past decade as a means to teach procedural skills to trainees in a risk free environment. The goal of this study was to pilot a simulator based skills course for inexperienced neurosurgical residents to teach the fundamentals of cervicocerebral catheterization and angiography, with the ultimate goal of defining a universal simulator based curriculum that could be incorporated into neurosurgical resident training in the future.
Seven neurosurgery residents with no prior angiographic experience served as the pilot participants for this 2 day course. Four neurointerventional trained neurosurgeons served as faculty for instruction and evaluation. The majority of the course focused on hands-on simulator practice with close mentoring by faculty. Participants were evaluated with pre-course and post-course assessments.
Post-course written test scores were significantly higher than pre-course scores (p<0.001). Faculty assessments of participants' technical skills with angiography (graded 0-10, with 10 being best) also improved significantly from pre-course to post-course (pre 2.1; post 5.9; p<0.001). Objective simulator recorded assessments demonstrated a significant decrease in the time needed to complete a four vessel angiogram (p<0.001) and total fluoroscopic time (p<0.001).
Participant angiography skills, based on both faculty and simulator assessments, as well as participant knowledge, improved after this didactic, hands-on simulator course. Neuroendovascular simulator training appears to be a viable means of training inexperienced neurosurgery residents in the early learning stages of basic endovascular neurosurgery. Further studies evaluating the translation of procedural skills learned on the simulator to actual clinical skills in the angiography suite is necessary.
在过去十年中，模拟设备在医学培训中的使用呈上升趋势，成为在无风险环境中向受训者传授程序技能的一种手段。本研究的目的是为经验不足的神经外科住院医师试点一门基于模拟器的技能课程，教授颈椎脑血管造影和血管造影的基础知识，最终目标是定义一种通用的基于模拟器的课程，将来可以纳入神经外科住院医师培训。
7 名没有先前血管造影经验的神经外科住院医师作为本 2 天课程的试点参与者。4 名神经介入培训的神经外科医生担任教学和评估的教师。课程的大部分重点是在教师的密切指导下进行实际的模拟器练习。参与者通过课前和课后评估进行评估。
课后书面考试成绩明显高于课前成绩（p<0.001）。教师对参与者血管造影技术技能的评估（评分 0-10，10 分为最佳）也从课前到课后显著提高（课前 2.1；课后 5.9；p<0.001）。客观模拟器记录的评估显示，完成四血管血管造影的时间（p<0.001）和总透视时间（p<0.001）显著减少。
根据教师和模拟器评估以及参与者知识，在这门理论与实践相结合的模拟器课程之后，参与者的血管造影技能得到了提高。神经介入模拟器培训似乎是在基本神经介入血管内手术的早期学习阶段培训经验不足的神经外科住院医师的可行方法。需要进一步研究评估在血管造影室实际临床技能中模拟技能的应用。
