Harvard Medical School, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
World Neurosurg. 2022 Oct;166:e551-e560. doi: 10.1016/j.wneu.2022.07.065. Epub 2022 Jul 20.
The neurosurgical sub-internship is a crucial step for prospective neurosurgeons. However, the expectations for sub-interns, particularly the technical skills required by residents and attendings, often are unclear. We present survey data on what medical students, residents, and attendings believe are important procedural proficiencies for neurosurgical sub-internships. We incorporated these tasks into a pilot skills-based craniotomy workshop, and here we report on the impact of the session on the neurosurgical training of medical students.
A 1-day craniotomy lab using cadaveric cranial specimens was conducted for medical students. Surveys querying important competencies for sub-internships were answered by residents and attendings at affiliated hospitals. Pre- and postlab surveys querying interest in and perceptions of neurosurgery, self-assessment of skills, and important competencies for sub-internship preparation were answered by attendees.
Medical students, residents, and attendings agreed that burr-hole placement, bone replating, and galea and skin closure were of high importance for sub-interns. There was significant disagreement on the importance of dural opening and closure, establishing a craniotomy, and neuronavigation. The workshop altered perceptions of neurosurgery, with significant changes in recognizing the value of peer mentorship. Students also expressed increased confidence in technical skills, with significant improvements shown in understanding of neurosurgical high-speed drill use (P < 0.001).
Although the expectations for sub-interns may be heterogeneous, there is general agreement that proficiency in the initial and final steps of craniotomies, as well as minor procedures, is recommended. Cadaveric labs can improve student engagement in neurosurgery, facilitate interactions with neurosurgical departments, and enhance technical skills.
神经外科实习医师是未来神经外科医师的关键步骤。然而，对于实习医师的期望，特别是住院医师和主治医生所需的技术技能，往往不清楚。我们提供了关于医学生、住院医师和主治医生认为神经外科实习医师重要程序能力的调查数据。我们将这些任务纳入了一个试点技能为基础的开颅术工作坊，并在此报告该会议对医学生神经外科培训的影响。
为医学生举办了为期 1 天的使用尸体颅骨标本的开颅术实验室。附属医院的住院医师和主治医生回答了询问实习医师重要能力的调查。参加者回答了开课前和课后的调查，询问他们对神经外科的兴趣和看法、对技能的自我评估以及实习医师准备的重要能力。
医学生、住院医师和主治医生一致认为颅骨钻孔、骨板重铺、颅骨和头皮缝合对实习医师很重要。对于硬脑膜切开和缝合、建立开颅术和神经导航的重要性存在很大分歧。该工作坊改变了对神经外科的看法，认识到同伴指导的价值有了显著变化。学生还对自己的技术技能更有信心，对神经外科高速钻头使用的理解有了显著提高（P<0.001）。
尽管对实习医师的期望可能存在差异，但普遍认为熟练掌握开颅术的初始和最终步骤以及一些小手术是推荐的。尸体实验室可以提高学生对神经外科的参与度，促进与神经外科部门的互动，并提高技术技能。
