Fundamentals of Neurosurgery : virtual reality tasks for training and evaluation of technical skills

摘要

Background: Technical skills training in neurosurgery is mostly done in the operating room. New educational paradigms are encouraging the development of novel training methods for surgical skills. Simulation could answer some of these needs. This paper presents the development of a conceptual training framework for use on a virtual reality (VR) neurosurgical simulator. Methods: Appropriate tasks were identified by reviewing neurosurgical oncology curricula requirements and performing cognitive task analyses of basic techniques and representative surgeries. The tasks were then elaborated into training modules by including learning objectives, instructions, levels of difficulty and performance metrics. Surveys and interviews were iteratively conducted with subject matter experts (SMEs) to delimitate, review, discuss and approve each of the development stages. Results: Five tasks were selected as representative of basic and advanced neurosurgical skill. These tasks were: 1) ventriculostomy, 2) endoscopic nasal navigation, 3) tumour debulking, 4) hemostasis and 5) microdissection. The complete training modules were structured into easy, intermediate and advanced settings. Performance metrics were also integrated to provide feedback on outcome, efficiency and errors. The SMEs deemed the proposed modules as pertinent and useful for neurosurgical skills training. Conclusion: The conceptual framework presented here, the Fundamentals of Neurosurgery (FNS), represents a first attempt to develop standardized training modules for technical skills acquisition in neurosurgical oncology. The National Research Council Canada is currently developing NeuroTouch, a VR simulator for cranial microneurosurgery. The simulator presently includes the five FNS modules at varying stages of completion. A first pilot study has shown that neurosurgical residents obtained higher performance scores on the simulator than medical students. Further work will validate its components and use in a training curriculum.