Current status of simulation-based training in neurosurgery: a systematic review
EANS Academy. Patel E. 09/25/19; 275769; EP10011
Ebrahim Adnan Patel
Ebrahim Adnan Patel

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The recent emphasis on simulation-based training in neurosurgery has led to the development of many simulation models and training courses. We aim to identify the currently available simulators and training courses for neurosurgery, assess their validation and determine their effectiveness.
Both Medline and EMBASE were searched for English language articles which validate simulation models for neurosurgery. Each study was screened according to Messick's validity framework, and rated in each domain. McGaghie's model of translational outcomes was then used to assign a level of effectiveness (LoE) for each simulator or training course.
A total of 97 simulation-based training models or courses have been validated or demonstrated translational outcomes. These encompass; General Neurosurgery (26), Neuro-oncology (10), Neurovascular (19), Paediatric (9), Spine (26), Skull-base (13), and Non-Technical Skills (3). Six models and training courses achieved the highest rating for content validity, 19 for response processes, 5 for internal structure, 12 for relations to other variables and only 2 for consequences. For translational outcomes, 45 simulators or training courses were given a LoE of 1, 34 a LoE of 2, 1 a LoE of 3 and 1 a LoE of 4. Three models and one training course achieved the highest LoE
of 5.
With increasing neurosurgery simulators and training tools, there is a need for more validity studies. Such studies must utilise modern validity definitions to allow for a more informative appraisal of such simulators. Greater attempts to investigate translational outcomes to the operating room is particularly warranted. Finally, more training tools incorporating full immersion simulation and Non-Technical skills training is recommended.

Parameter Content Response Processes Internal Structure Relations to other variables Consequences
Criteria Test items are relevant and representative of the intended construct Thought processes and actions of subjects and observers are made in accordance with the intended construct Test scores across tasks can be reliably reproduced Test scores correlate with external, independent measures which share a theoretical relationship The impact of using the assessment
[Messick's Modern Concept of Validity]

Parameter 1) Internal acceptability 2) Contained effects 3) Downstream effects 4) Target effects 5) Collateral effects
Definition The trainee's satisfaction with using the simulator Changes in performance in the simulation context Behavioural changes in the clinical context Direct changes to patient outcomes Changes on a wider, systemic level
[Translational Outcomes of Simulation-based Mastery Learning]

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