Neurosurg Focus. 2022 Aug;53(2):E2. doi: 10.3171/2022.6.FOCUS22199.
The longer learning curve and smaller margin of error make nontraditional, or "out of operating room" simulation training, essential in neurosurgery. In this study, the authors propose an evaluation system for residents combining both task-based and procedure-based exercises and also present the perception of residents regarding its utility.
Residents were evaluated using a combination of task-based and virtual reality (VR)-based exercises. The results were analyzed in terms of the seniority of the residents as well as their laboratory credits. Questionnaire-based feedback was sought from the residents regarding the utility of this evaluation system incorporating the VR-based exercises.
A total of 35 residents were included in this study and were divided into 3 groups according to seniority. There were 11 residents in groups 1 and 3 and 13 residents in group 2. On the overall assessment of microsuturing skills including both 4-0 and 10-0 microsuturing, the suturing skills of groups 2 and 3 were observed to be better than those of group 1 (p = 0.0014). Additionally, it was found that microsuturing scores improved significantly with the increasing laboratory credits (R2 = 0.72, p < 0.001), and this was found to be the most significant for group 1 residents (R2 = 0.85, p < 0.001). Group 3 residents performed significantly better than the other two groups in both straight (p = 0.02) and diagonal (p = 0.042) ring transfer tasks, but there was no significant difference between group 1 and group 2 residents (p = 0.35). Endoscopic evaluation points were also found to be positively correlated with previous laboratory training (p = 0.002); however, for the individual seniority groups, the correlation failed to reach statistical significance. The 3 seniority groups performed similarly in the cranial and spinal VR modules. Group 3 residents showed significant disagreement with the utility of the VR platform for improving surgical dexterity (p = 0.027) and improving the understanding of surgical procedures (p = 0.034). Similarly, there was greater disagreement for VR-based evaluation to identify target areas of improvement among the senior residents (groups 2 and 3), but it did not reach statistical significance (p = 0.194).
The combination of task- and procedure-based assessment of trainees using physical and VR simulation models can supplement the existing neurosurgery curriculum. The currently available VR-based simulations are useful in the early years of training, but they need significant improvement to offer beneficial learning opportunities to senior trainees.
非传统的“手术室外”模拟训练，由于其学习曲线较长且容错空间较小，对神经外科来说至关重要。在这项研究中，作者提出了一种结合任务和程序的住院医师评估系统，并展示了住院医师对其效用的看法。
通过任务和虚拟现实（VR）结合的练习来评估住院医师。根据住院医师的资历和实验室学分分析结果。通过问卷调查的方式征求住院医师对纳入 VR 练习的这种评估系统的反馈意见。
本研究共纳入 35 名住院医师，根据资历分为 3 组。第 1 组和第 3 组各有 11 名住院医师，第 2 组有 13 名住院医师。在包括 4-0 和 10-0 缝合的显微缝合技能的总体评估中，第 2 组和第 3 组的缝合技能明显优于第 1 组（p = 0.0014）。此外，研究发现，随着实验室学分的增加，显微缝合评分显著提高（R2 = 0.72，p < 0.001），第 1 组的提高最为显著（R2 = 0.85，p < 0.001）。第 3 组在直（p = 0.02）和对角（p = 0.042）环转移任务中的表现明显优于其他两组，但第 1 组和第 2 组之间没有显著差异（p = 0.35）。内镜评估点也与之前的实验室训练呈正相关（p = 0.002）；然而，对于各个资历组，相关性并未达到统计学意义。3 个资历组在颅神经外科和脊柱 VR 模块中的表现相似。第 3 组住院医师对 VR 平台提高手术灵巧性（p = 0.027）和提高手术程序理解（p = 0.034）的效用表示明显不同意。同样，资深住院医师对 VR 评估识别目标改进领域的意见存在较大分歧（第 2 组和第 3 组），但没有达到统计学意义（p = 0.194）。
使用物理和 VR 模拟模型对受训者进行基于任务和程序的评估，可以补充现有的神经外科学课程。目前可用的基于 VR 的模拟在培训的早期阶段很有用，但它们需要显著改进，以便为高级受训者提供有益的学习机会。
