title: Simulation Training Curricula for Neurosurgical Residents: Cervical Foraminotomy and Durotomy Repair Modules.
abstract: BACKGROUND
  Since 2010, the Congress of Neurological Surgeons (CNS) has offered a neurosurgical skills simulation course for residents and medical students. The authors describe their experience with incorporation of two neurosurgical skills simulation modules into the dedicated resident training curriculum of a single ACGME-accredited training program, using lumbar dural repair (5) and posterior cervical laminoforaminotomy modules from the CNS simulation initiative (6).
  
  
  METHODS
  Each of the available 22 neurosurgery residents at a single residency program was given two 20-question pretests for a cervical laminoforaminotomy and durotomy repair module as a basic test of regional anatomy, general disease knowledge, surgical decision making, and recently published literature. This was followed by a faculty-directed skills simulation course and concluded with a final 20 question post-test.
  
  
  RESULTS
  Posterior cervical laminoforaminotomy was performed once by each resident, and grading was conducted using the predetermined OSATs. The overall score was 56.1 (70%, range 26-76, maximum 80 points) with a trend towards higher scores with advanced levels of training. All residents completed the durotomy repair OSATs for a total of three trials. Of a maximum composite score of 60, a mean 37.2 (62%, range 15-58) was scored by the residents (Table 3). The mean OSAT scores for each durotomy trial was 2.66, 3.15, and 3.48 on each success test. A trend towards higher scores in advanced years of training was observed, but did not reach statistical significance (Figure 3).
  
  
  CONCLUSIONS
  Duty hour limitations and regulatory pressure for enhanced quality and outcomes may limit access of neurosurgical residents to fundamental skills training. Fundamental skills training as part of a validated simulation curriculum can mitigate this challenge to residency education. National development of effective technical simulation modules for use in individual residency training programs is a promising strategy to achieve these goals.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: Georgeghobrial@gmail.com.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Balsara
authors.affiliation: Department of Neurological Surgery, Tulane University, New Orleans, Louisiana, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Maulucci
authors.affiliation: Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Resnick
authors.affiliation: Campagna Professor of Pediatric Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Selden
authors.affiliation: Professor of Neurological Surgery, Thomas Jefferson University Hospital, Department of Neurological Surgery, Philadlephia, Pennsylvania, USA.
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.affiliation: Professor of Neurological Surgery, Thomas Jefferson University Hospital, Department of Neurological Surgery, Philadlephia, Pennsylvania, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery; D002983:Clinical Competence; D003479:Curriculum; D004388:Dura Mater / Q000601:surgery*; D004503:Education, Medical, Graduate; D005539:Foramen Magnum / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D008953:Models, Anatomic; D009493:Neurosurgery / Q000193:education*
keywords: Cervical foraminotomy; Durotomy repair; Resident education; Simulation