1Division of Neurosurgery, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
2Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
Neurosurg Focus. 2022 Aug;53(2):E3. doi: 10.3171/2022.5.FOCUS22188.
Simulation is increasingly recognized as an important supplement to operative training. The live rat femoral artery model is a well-established model for microsurgical skills simulation. In this study, the authors present an 11-year experience incorporating a comprehensive, longitudinal microsurgical training curriculum into a Canadian neurosurgery program. The first goal was to evaluate training effectiveness, using a well-studied rating scale with strong validity. The second goal was to assess the impact of the curriculum on objective measures of subsequent operating room performance during postgraduate year (PGY)-5 and PGY-6 training.
PGY-2 neurosurgery residents completed a 1-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat vessel training models were used. Three modules comprised live microvascular anastomosis. Trainee performance was video recorded and blindly graded using the Objective Structured Assessment of Technical Skills Global Rating Scale. Eleven participants who completed the training curriculum and 3 subjects who had not participated had their subsequent operative performances evaluated when they were at the PGY-5 and PGY-6 levels.
Eighteen participants completed 106 microvascular anastomoses during the study. There was significant improvement in 6 measurable skills during the curriculum. The mean overall score was significantly higher on the fifth attempt compared with the first attempt for all 3 live anastomotic modules (p < 0.001). Each module had a different improvement profile across the skills assessed. Those who completed the microvascular skills curriculum demonstrated a greater number of independent evaluations during superficial surgical exposure, deep exposure, and primary maneuvers at the PGY-5 and PGY-6 levels.
High-fidelity microsurgical simulation training leads to significant improvement in microneurosurgical skills. Transfer of acquired skills to the operative environment and durability for at least 3 to 4 years show encouraging preliminary results and are subject to ongoing investigation.
模拟正越来越被认为是手术培训的重要补充。活体大鼠股动脉模型是一种成熟的显微技能模拟模型。在这项研究中，作者介绍了一项为期 11 年的经验，即将全面的、纵向的显微外科培训课程纳入加拿大神经外科项目中。第一个目标是使用经过充分研究的、具有较强有效性的评分量表来评估培训效果。第二个目标是评估课程对住院医师培训第 5 年和第 6 年手术室表现的客观测量指标的影响。
神经外科住院医师在第 2 年完成为期 1 年的课程，涵盖 17 次培训课程，分为 5 个模块，每个模块的保真度逐渐增加。都使用了灌注鸭翅和活体大鼠血管训练模型。有 3 个模块包含活体微血管吻合术。使用客观结构化评估技术技能全球评分量表对学员的表现进行视频记录和盲评。11 名完成培训课程的参与者和 3 名未参加过的参与者在第 5 年和第 6 年住院医师培训阶段时对他们的手术表现进行了评估。
18 名参与者在研究期间完成了 106 次微血管吻合术。在课程期间，有 6 项可衡量的技能显著提高。所有 3 个活体吻合模块的第 5 次尝试的总体得分明显高于第 1 次尝试（p < 0.001）。每个模块在评估的技能方面都有不同的改进情况。那些完成微血管技能课程的人在第 5 年和第 6 年的浅表手术暴露、深部暴露和主要操作中，有更多的独立评估。
高保真度的显微外科模拟培训可显著提高显微神经外科技能。所获得的技能转移到手术环境中并至少持续 3 到 4 年的效果显示出令人鼓舞的初步结果，并且正在进行进一步的研究。
