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High fidelity craniotomy simulation improves neurosurgical operative performance
EANS Academy. Kumaria A. 09/25/19; 275366; EP10004
Mr. Ashwin Kumaria
Mr. Ashwin Kumaria

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Abstract
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Objectives: High fidelity simulation is increasingly indicated in contemporary neurosurgical training. Simulation offers a safe learning experience, with no risk to patient safety and circumvents trainee surgeons' working time restrictions.
We asked if ab initio neurosurgical trainees benefit from the intensive two day 'QMC Craniotomy Simulator Course' using the Realistic Operative Workstation for Educating Neurosurgical Apprentices (ROWENA™). Skills taught include 3-pin head fixation, burr holes, cannulating ventricles, intracranial pressure bolt placement, turning a craniotomy flap, bone flap fixation and basics of image-guided stereotactic and neuroendoscopic surgery.
Methods: Twenty seven course participants, over four courses, with minimal prior neurosurgical operating experience were assessed by two independent assessors (Consultant and Registrar level). Participants' ability to perform a basic neurosurgical procedure was compared at the beginning and end of the course.
Assessments were performed using the Modified Objective Structured Assessment of Technical Skills (MOSATS) - a validated and well-utilised test of operative skill. MOSATS subdivide surgical performance by domain and their inherent objectivity is evidenced by minimal variability between assessors.
Results: All participants' operative ability was demonstrably improved. There were significant improvements in participants' knowledge of instruments and procedure (by 48% and 45% respectively on MOSATS). Most importantly, significantly improved time and motion (42%), instrument handling (45%), respect for tissue (37%) and flow of operation (48%) were shown. The course was very well received and participants provided encouraging feedback regarding the usefulness and realism of craniotomy simulation.
Conclusion: These results, which build on our previous paper, suggest a promising role for intensive craniotomy simulation in neurosurgical training because it appears to improve trainees' neurosurgical operative ability. Twelve such courses have been carried out over six years and we intend to continue to assess improvement in trainees' neurosurgical abilities through simulation under the auspices of the Nottingham Neurosimulation Group.
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