title: Bimanual Psychomotor Performance in Neurosurgical Resident Applicants Assessed Using NeuroTouch, a Virtual Reality Simulator.
abstract: OBJECTIVE
  Current selection methods for neurosurgical residents fail to include objective measurements of bimanual psychomotor performance. Advancements in computer-based simulation provide opportunities to assess cognitive and psychomotor skills in surgically naive populations during complex simulated neurosurgical tasks in risk-free environments. This pilot study was designed to answer 3 questions: (1) What are the differences in bimanual psychomotor performance among neurosurgical residency applicants using NeuroTouch? (2) Are there exceptionally skilled medical students in the applicant cohort? and (3) Is there an influence of previous surgical exposure on surgical performance?
  
  
  METHODS
  Participants were instructed to remove 3 simulated brain tumors with identical visual appearance, stiffness, and random bleeding points. Validated tier 1, tier 2, and advanced tier 2 metrics were used to assess bimanual psychomotor performance. Demographic data included weeks of neurosurgical elective and prior operative exposure.
  
  
  METHODS
  This pilot study was carried out at the McGill Neurosurgical Simulation Research and Training Center immediately following neurosurgical residency interviews at McGill University, Montreal, Canada.
  
  
  METHODS
  All 17 medical students interviewed were asked to participate, of which 16 agreed.
  
  
  RESULTS
  Performances were clustered in definable top, middle, and bottom groups with significant differences for all metrics. Increased time spent playing music, increased applicant self-evaluated technical skills, high self-ratings of confidence, and increased skin closures statistically influenced performance on univariate analysis. A trend for both self-rated increased operating room confidence and increased weeks of neurosurgical exposure to increased blood loss was seen in multivariate analysis.
  
  
  CONCLUSIONS
  Simulation technology identifies neurosurgical residency applicants with differing levels of technical ability. These results provide information for studies being developed for longitudinal studies on the acquisition, development, and maintenance of psychomotor skills. Technical abilities customized training programs that maximize individual resident bimanual psychomotor training dependant on continuously updated and validated metrics from virtual reality simulation studies should be explored.
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: alexander.winkler-schwartz@mail.mcgill.ca.
authors.forename: Alexander
authors.initials: A
authors.lastname: Winkler-Schwartz
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Division of Neurosurgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
authors.forename: Khalid
authors.initials: K
authors.lastname: Bajunaid
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.
authors.forename: Muhammad A S
authors.initials: MAS
authors.lastname: Mullah
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Marwa
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute (NNI), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.
authors.forename: Fahad E
authors.initials: FE
authors.lastname: Alotaibi
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Jawad
authors.initials: J
authors.lastname: Fares
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Marta
authors.initials: M
authors.lastname: Baggiani
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Azarnoush
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, National Neuroscience Institute (NNI), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.
authors.forename: Gmaan Al
authors.initials: GA
authors.lastname: Zharni
authors.affiliation: Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Sommer
authors.initials: S
authors.lastname: Christie
authors.affiliation: Section of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital & Research Center (Gen. Org) - Jeddah Branch, Jeddah, Saudi Arabia.
authors.forename: Abdulrahman J
authors.initials: AJ
authors.lastname: Sabbagh
authors.affiliation: Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Penny
authors.initials: P
authors.lastname: Werthner
authors.affiliation: Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Rolando F
authors.initials: RF
authors.lastname: Del Maestro
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D008297:Male; D009493:Neurosurgery / Q000193:education*; D010560:Personnel Selection / Q000379:methods; D011597:Psychomotor Performance; D011792:Quebec; D012577:Schools, Medical; D000066908:Simulation Training / Q000379:methods*; D013337:Students, Medical / Q000706:statistics & numerical data; D014584:User-Computer Interface
keywords: Medical Knowledge; NeuroTouch/NeuroVR; Patient Care; Practice-Based Learning and Improvement; bimanual psychomotor performance; interview; medical student neurosurgical applicants; technical abilities customized training (TACT); virtual reality simulator