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Strategies to improve surgical technical competency: a systematic review

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Abstract

Background

A cornerstone of surgical residency training is an educational program that produces highly skilled and effective surgeons. Training structures are constantly being revised due to evolving program structures, shifting workforces, and variability in the clinical environment. This has resulted in significant heterogeneity in all surgical resident education, training tools utilized, and measures of training efficacy.

Methods

We systematically reviewed educational interventions for technical skills in neurosurgery published across PubMed, Embase, and Web of Science over four decades. We extracted general characteristics of each surgical training tool while categorizing educational interventions by modality and neurosurgical application.

Results

We identified 626 studies which developed surgical training tools across eight different training modalities: textbooks and literature (11), online resources (53), didactic teaching and one-on-one instruction (7), laboratory courses (50), cadaveric models (63), animal models (47), mixed reality (166), and physical models (229). While publication volume has grown exponentially, a majority of studies were cited with relatively low frequency. Most training programs were published in the development and validation phase with only 2.1% of tools implemented long-term. Each training modality expressed unique strengths and limitations, with limited data reported on the educational impact connected to each training tool.

Conclusions

Numerous surgical training tools have been developed and implemented across residency training programs. Though many creative and cutting-edge tools have been devised, evidence supporting educational efficacy and long-term application is lacking. Increased utilization of novel surgical training tools will require validation of metrics used to assess the training outcomes and optimized integration with clinical practice.

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Data Availability

In cases where specific datasets or materials are referenced in this paper, we have provided appropriate citations and references to the original sources and included papers.

References

  1. Aboud E, Aboud G, Al-Mefty O et al (2015) New laboratory model for neurosurgical training that simulates live surgery. J Neurosurg 123(5):1339–1346. https://doi.org/10.3171/2014.12.JNS141551

    Article  PubMed  Google Scholar 

  2. Alotaibi FE, AlZhrani GA, Mullah MAS et al (2015) Assessing Bimanual Performance in Brain Tumor Resection With NeuroTouch, a Virtual Reality Simulator. Operative Neurosurg 11(1):89–98. https://doi.org/10.1227/NEU.0000000000000631

    Article  Google Scholar 

  3. Ament JD, Kim T, Gold-Markel J et al (2017) Planning and Executing the Neurosurgery Boot Camp: The Bolivia Experience. World Neurosurg 104:407–410. https://doi.org/10.1016/j.wneu.2017.05.046

    Article  PubMed  Google Scholar 

  4. Breese R, Piazza M, Quinsey C, Blatt J (2020) Tactile Skill-Based Neurosurgical Simulators Are Effective and Inexpensive. World Neurosurg 137:319–326. https://doi.org/10.1016/j.wneu.2020.02.017

    Article  PubMed  Google Scholar 

  5. Clark AD, Guilfoyle MR, Candy NG et al (2017) Stereoscopic Three-Dimensional Neuroanatomy Lectures Enhance Neurosurgical Training: Prospective Comparison with Traditional Teaching. World Neurosurg 108:917–923. https://doi.org/10.1016/j.wneu.2017.09.019

    Article  PubMed  Google Scholar 

  6. Clifton W, Nottmeier E, Edwards S et al (2019) Development of a Novel 3D Printed Phantom for Teaching Neurosurgical Trainees the Freehand Technique of C2 Laminar Screw Placement. World Neurosurg 129:e812–e820. https://doi.org/10.1016/j.wneu.2019.06.038

    Article  PubMed  Google Scholar 

  7. Derossis AM, Bothwell J, Signman HH et al (1998) Th effect of practice on performance in a laparoscopic simulator. Surg Endosc 12(9):1117–1120. https://doi.org/10.1007/s004649900796

    Article  CAS  PubMed  Google Scholar 

  8. Fernandez G, Page DW, Coe NP et al (2012) Boot cAMP: educational outcomes after 4 successive years of preparatory simulation-based training at onset of internship. J Surg Educ 69(2):242–248. https://doi.org/10.1016/j.jsurg.2011.08.007

    Article  PubMed  Google Scholar 

  9. Franasiak JM, Craven R, Gehrig PA (2013) Feasibility and effectiveness of an ergonomics training program to address high rates of strain among robotic surgeons. J Minim Invasive Gynecol 20(6):S80. https://doi.org/10.1016/j.jmig.2013.08.260

    Article  Google Scholar 

  10. Grantcharov TP (2008) Is virtual reality simulation an effective training method in surgery? Nat Clin Pract Gastroenterol Hepatol 5(5):232–233. https://doi.org/10.1038/ncpgasthep1101

    Article  PubMed  Google Scholar 

  11. Gurusamy Aggarwal R, Palanivelu L et al (2008) Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg 95(9):1088–1097. https://doi.org/10.1002/bjs.6344

    Article  PubMed  Google Scholar 

  12. Han E, Yeo S, Kim M et al (2019) Medical education trends for future physicians in the era of advanced technology and artificial intelligence: an integrative review. BMC Med Educ 19(1):460. https://doi.org/10.1186/s12909-019-1891-5

    Article  PubMed  PubMed Central  Google Scholar 

  13. Indo M, Tsutsumi K, Shin M (2011) The practice of knots untying technique using a 10-0 nylon suture and gauze to cope with technical difficulties of microvascular anastomosis. World Neurosurg 75(1):87–89. https://doi.org/10.1016/j.wneu.2010.07.030

    Article  PubMed  Google Scholar 

  14. Koivula A, Räsänen P, Sarpila O (2019) Examining Social Desirability Bias in Online and Offline Surveys. Int Conf Human-Computer Inter 11566. https://doi.org/10.1007/978-3-030-22646-6_11

  15. Moiraghi A, Perin A, Sicky N et al (2020) EANS Basic Brain Course (ABC): combining simulation to cadaver lab for a new concept of neurosurgical training. Acta Neurochir 162(3):453–460. https://doi.org/10.1007/s00701-020-04216-w

    Article  PubMed  Google Scholar 

  16. Olabe J, Olabe J, Sancho V (2009) Human cadaver brain infusion model for neurosurgical training. Surg Neurol 72(6):700–702. https://doi.org/10.1016/j.surneu.2009.02.028

    Article  PubMed  Google Scholar 

  17. Ortiz-Garcia J, Doerrler M, Douglas P et al (2016) Simulation-based training in brain death determination incorporating family discussion: A pilot project. Neurology 86(16). https://doi.org/10.4300/JGME-D-18-00185.1

  18. Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med 18(3):e1003583. https://doi.org/10.1371/journal.pmed.1003583

    Article  PubMed  PubMed Central  Google Scholar 

  19. Park JJ, Tiefenbach J, Demetriades AK (2022) The role of artificial intelligence in surgical simulation. Front Med Technol 4:1076755. https://doi.org/10.3389/fmedt.2022.1076755

    Article  PubMed  PubMed Central  Google Scholar 

  20. Reddy PP, Reddy TP, Jennifer RF et al (2011) The impact of the alexander technique on improving posture and surgical ergonomics during minimally invasive surgery: pilot study. J Urol 186(4S):1658–1662. https://doi.org/10.1016/j.juro.2011.04.013

    Article  PubMed  Google Scholar 

  21. Saltarelli AJ, Roseth CJ, Saltarelli W (2014) Human cadavers Vs. multimedia simulation: A study of student learning in anatomy. Anat Sci Educ 7(5). https://doi.org/10.1002/ase.1429

  22. Samuel N, Alotaibi NM, Lozano AM (2017) YouTube as a Source of Information on Neurosurgery. World Neurosurg 105:394–398. https://doi.org/10.1016/j.wneu.2017.05.111

    Article  PubMed  Google Scholar 

  23. Selden NR, Barbaro N, Origitano TC et al (2011) Fundamental skills for entering neurosurgery residents: report of a Pacific region "boot camp" pilot course, 2009. Neurosurgery 68:759–764. https://doi.org/10.1227/NEU.0b013e3182077969

    Article  PubMed  Google Scholar 

  24. Stienen MN, Bartek J Jr, Czabanka MA et al (2019) Neurosurgical procedures performed during residency in Europe-preliminary numbers and time trends. Acta Neurochir 161(5):843–853. https://doi.org/10.1007/s00701-019-03888-3

    Article  PubMed  Google Scholar 

  25. Stienen MN, Netuka D, Demetriades AK et al (2016) Neurosurgical resident education in Europe—results of a multinational survey. Acta Neurochir 158:3–15. https://doi.org/10.1007/s00701-015-2632-0

    Article  PubMed  Google Scholar 

  26. Stienen MN, Netuka D, Demetriades AK et al (2016) Working time of neurosurgical residents in Europe—results of a multinational survey. Acta Neurochir 158:17–25. https://doi.org/10.1007/s00701-015-2633-z

    Article  PubMed  Google Scholar 

  27. Takahashi M, Okudera H (2014) Neuroresuscitation simulation training courses in Japan. Neuroepidemiology 43(2):104. https://doi.org/10.1159/000369115

    Article  Google Scholar 

  28. Thawani JP, Ramayya AG, Abdullah KG et al (2016) Resident simulation training in endoscopic endonasal surgery utilizing haptic feedback technology. J Clin Neurosci 34:112–116. https://doi.org/10.1016/j.jocn.2016.05.036

    Article  PubMed  Google Scholar 

  29. Ward M, Ward B, Abraham M et al (2019) The Educational Quality of Neurosurgical Resources on YouTube. World Neurosurg 130:e660–e665. https://doi.org/10.1016/j.wneu.2019.06.184

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Emma Schmidt for the artistic illustration in this paper.

Code availability

The code utilized for data visualization is available upon request.

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Authors and Affiliations

  1. Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Lauren Banko, Ruchit V. Patel, Noah Nawabi, Marcelle Altshuler, Lila Medeiros, G. Rees Cosgrove & Wenya Linda Bi

  2. University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Lauren Banko

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  1. Lauren Banko
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Contributions

Study conception, design, and search strategy: L.B., W.L.B. Literature search, screening, and data extraction: L.B., R.P., N.N., M.A., L.M. Study screening conflict resolution: W.L.B. Data analysis, interpretation, manuscript production: L.B., R.P., W.L.B. All authors had full access to data included in this manuscript.

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Correspondence to Wenya Linda Bi.

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Banko, L., Patel, R.V., Nawabi, N. et al. Strategies to improve surgical technical competency: a systematic review. Acta Neurochir 165, 3565–3572 (2023). https://doi.org/10.1007/s00701-023-05868-0

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