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.
Neurosurg Rev. 2021 Aug;44(4):1853-1867. doi: 10.1007/s10143-020-01378-0. Epub 2020 Sep 18.
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.
在全球动荡不安和不确定的时期，围绕着未来几年临床培训的开展方式，我们对全球研究进行了系统回顾、荟萃分析和文献计量分析，这些研究表明模拟在培训中的重要作用。我们的目的是确定使用的模拟器类型，它们在提高临床技能方面的有效性，以及我们是否已经达到全球接受的程度。我们进行了一项基于 PRISMA 的全球神经外科模拟器可用性系统回顾，对其有效性进行了荟萃分析，并对符合我们纳入标准的神经外科教育模拟研究的渐进式学术接受情况进行了扩展分析。评估了程序知识和技术技能的提高。在确定的 7405 项研究中，有 56 项符合纳入标准，这些研究共报告了 50 种模拟器类型，从尸体、低保真度和部分任务到虚拟现实（VR）模拟器。共有 32 项研究被纳入荟萃分析，其中包括 7 项随机对照试验。随机效应，均值效应量的比率定量地量化了程序知识的统计学显著提高，提高了 50.2%（ES 0.502；CI 0.355；0.649，p <0.001），技术技能包括准确性提高了 32.5%（ES 0.325；CI -0.482；-0.167，p <0.001），速度提高了 25%（ES -0.25，CI -0.399；-0.107，p <0.001）。最初的 VR 研究数量（n = 91）大约是改进研究数量（n = 45）的两倍，这表明它尚未达到渐进式学术接受程度。有强有力的证据表明，在提高程序知识和技术技能方面，采用模拟具有有益的影响。我们展示了神经外科模拟器采用的增长趋势，尽管我们尚未完全在神经外科教育中获得基于 VR 的模拟技术的渐进式学术接受。
