Kirkman Matthew A, Ahmed Maria, Albert Angelique F, Wilson Mark H, Nandi Dipankar, Sevdalis Nick
Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square;
J Neurosurg. 2014 Aug;121(2):228-46. doi: 10.3171/2014.5.JNS131766. Epub 2014 Jun 20.
There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty. To their knowledge this is the first systematic review published on this topic to date.
The authors searched the Ovid MEDLINE, Embase, and PsycINFO databases and identified 4101 articles; 195 abstracts were screened by 2 authors for inclusion. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations.
Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon's disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures. Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The mean Medical Education Research Study Quality Instrument score of included studies was 9.21 ± 1.95 (± SD) out of a possible score of 18.
The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design. Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes.
越来越多的证据表明，在住院医师值班时间受限的时代，模拟训练能提供高质量、高效的培训。模拟训练还可使学员在安全的环境中掌握关键技能，这在神经外科等专业中至关重要，因为技术失误可能导致灾难性后果。作者系统回顾了模拟训练在神经外科培训中的应用，并探讨了该专业模拟训练的现状。据他们所知，这是迄今为止发表的关于该主题的第一篇系统综述。
作者检索了Ovid MEDLINE、Embase和PsycINFO数据库，共识别出4101篇文章；由2位作者筛选195篇摘要以确定是否纳入。作者回顾了关于研究人群、研究设计与设置、结果指标、主要发现和局限性的数据。
28篇文章构成了本系统综述的基础。神经外科医生可使用多种不同的模拟器，包括用于脑室造瘘术、神经内镜手术和脊柱手术的模拟器，有证据表明在一系列手术中其性能有所提高。参与者的反馈总体良好。然而，研究质量总体较差，许多研究受到非随机设计、展示正常而非异常解剖结构、缺乏对照组和长期随访、研究报告不佳、缺乏模拟器性能改善转化为临床益处的证据以及可靠性和有效性证据不足的阻碍。纳入研究的医学教育研究质量工具平均得分在可能的18分中为9.21±1.95（±标准差）。
作者证明了一系列神经外科模拟器在质量和数量上的益处，但发现方法和设计存在重大不足。未来的研究应设法改进研究设计和报告，并提供关于模拟结果以及理想情况下患者结果的长期随访数据。
