Neurosurgery simulation in residency training: feasibility, cost, and educational benefit.
BACKGROUND
The effort required to introduce simulation in neurosurgery academic programs and the benefits perceived by residents have not been systematically assessed.


OBJECTIVE
To create a neurosurgery simulation curriculum encompassing basic and advanced skills, cadaveric dissection, cranial and spine surgery simulation, and endovascular and computerized haptic training.


METHODS
A curriculum with 68 core exercises per academic year was distributed in individualized sets of 30 simulations to 6 neurosurgery residents. The total number of procedures completed during the academic year was set to 180. The curriculum includes 79 simulations with physical models, 57 cadaver dissections, and 44 haptic/computerized sessions. Likert-type evaluations regarding self-perceived performance were completed after each exercise. Subject identification was blinded to junior (postgraduate years 1-3) or senior resident (postgraduate years 4-6). Wilcoxon rank testing was used to detect differences within and between groups.


RESULTS
One hundred eighty procedures and surveys were analyzed. Junior residents reported proficiency improvements in 82% of simulations performed (P < .001). Senior residents reported improvement in 42.5% of simulations (P < .001). Cadaver simulations accrued the highest reported benefit (71.5%; P < .001), followed by physical simulators (63.8%; P < .001) and haptic/computerized (59.1; P < .001). Initial cost is $341,978.00, with $27,876.36 for annual operational expenses.


CONCLUSIONS
The systematic implementation of a simulation curriculum in a neurosurgery training program is feasible, is favorably regarded, and has a positive impact on trainees of all levels, particularly in junior years. All simulation forms, cadaver, physical, and haptic/computerized, have a role in different stages of learning and should be considered in the development of an educational simulation program.
*Division of Neurosurgery; and ‡Division of Epidemiology & Biostatistics, Preventive Medicine Department, University of Texas Medical Branch, Galveston, Texas.
Jaime
J
Gasco
Thomas J
TJ
Holbrook
Achal
A
Patel
Adrian
A
Smith
David
D
Paulson
Alan
A
Muns
Sohum
S
Desai
Marc
M
Moisi
Yong-Fan
YF
Kuo
Bart
B
Macdonald
Juan
J
Ortega-Barnett
Joel T
JT
Patterson
D002102:Cadaver; D002983:Clinical Competence; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003479:Curriculum; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007396:Internship and Residency / Q000191:economics / Q000266:history*; D008953:Models, Anatomic; D009493:Neurosurgery / Q000191:economics / Q000193:education* / Q000266:history*