Ciechanski Patrick, Cheng Adam, Lopushinsky Steven, Hecker Kent, Gan Liu Shi, Lang Stefan, Zareinia Kourosh, Kirton Adam
Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada.
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
World Neurosurg. 2017 Dec;108:876-884.e4. doi: 10.1016/j.wneu.2017.08.123. Epub 2017 Aug 31.
Recent changes in surgical training environments may have limited opportunities for trainees to gain proficiency in skill. Complex skills such as neurosurgery require extended periods of training. Methods to enhance surgical training are required to overcome duty-hour restrictions, to ensure the acquisition of skill proficiency. Transcranial direct-current stimulation (tDCS) can enhance motor skill learning, but is untested in surgical procedural training. We aimed to determine the effects of tDCS on simulation-based neurosurgical skill acquisition.
Medical students were trained to acquire tumor resection skills using a virtual reality neurosurgical simulator. The primary outcome of change in tumor resection was scored at baseline, over 8 repetitions, post-training, and again at 6 weeks. Participants received anodal tDCS or sham over the primary motor cortex. Secondary outcomes included changes in brain resected, resection effectiveness, duration of excessive forces (EF) applied, and resection efficiency. Additional outcomes included tDCS tolerability.
Twenty-two students consented to participate, with no dropouts over the course of the trial. Participants receiving tDCS intervention increased the amount of tumor resected, increased the effectiveness of resection, reduced the duration of EF applied, and improved resection efficiency. Little or no decay was observed at 6 weeks in both groups. No adverse events were documented, and sensation severity did not differ between stimulation groups.
The addition of tDCS to neurosurgical training may enhance skill acquisition in a simulation-based environment. Trials of additional skills in high-skill residents, and translation to nonsimulated performance are needed to determine the potential utility of tDCS in surgical training.
外科培训环境的近期变化可能使学员获得技能熟练程度的机会有限。诸如神经外科等复杂技能需要长时间的培训。需要增强外科培训的方法来克服值班时间限制，以确保获得技能熟练程度。经颅直流电刺激（tDCS）可增强运动技能学习，但在外科手术程序培训中尚未经过测试。我们旨在确定tDCS对基于模拟的神经外科技能习得的影响。
医学生使用虚拟现实神经外科模拟器接受肿瘤切除技能培训。在基线、8次重复训练期间、训练后以及6周时对肿瘤切除变化的主要结果进行评分。参与者在初级运动皮层接受阳极tDCS或假刺激。次要结果包括切除的脑量变化、切除效果、施加的过度力量（EF）持续时间以及切除效率。其他结果包括tDCS耐受性。
22名学生同意参与，在试验过程中无退出者。接受tDCS干预的参与者切除的肿瘤量增加，切除效果提高，施加的EF持续时间缩短，切除效率提高。两组在6周时均未观察到明显衰退。未记录到不良事件，刺激组之间感觉严重程度无差异。
在神经外科培训中添加tDCS可能会增强基于模拟环境中的技能习得。需要对高技能住院医师进行额外技能的试验，并将其转化为非模拟表现，以确定tDCS在外科培训中的潜在效用。
