High-Fidelity Microsurgical Simulation: The Thiel Cadaveric Nerve Model and Evaluation Instrument (original) (raw)
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High Fidelity Microsurgical Simulation: The Thiel Model and Evaluation Instrument
Plastic Surgery, 2018
Background: The Thiel embalmment method has recently been used in a number of medical simulation fields. The authors investigate the use of Thiel vessels as a high fidelity model for microvascular simulation and propose a new checklist-based evaluation instrument for microsurgical training. Methods: Thirteen residents and 2 attending microsurgeons performed video recorded microvascular anastomoses on Thiel embalmed arteries that were evaluated using a new evaluation instrument (Microvascular Evaluation Scale) by 4 fellowship trained microsurgeons. The internal validity was assessed using the Cronbach coefficient. The external validity was verified using regression models. Results: The reliability assessment revealed an excellent intra-class correlation of 0.89. When comparing scores obtained by participants from different levels of training, attending surgeons and senior residents (Post Graduate Year [PGY] 4-5) scored significantly better than junior residents (PGY 1-3). The differe...
Silicone-based simulation models for peripheral nerve microsurgery
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2018
There is a need for a peripheral nerve model on which surgeons-in-training can simulate the repair of nerve injuries at their own pace. Although practicing on animal models/cadavers is considered the "gold standard" of microsurgical training, the proposed model aims to provide a platform for improving the technical skills of surgical trainees prior to their practice on cadaver/animal models. In addition, this model has the potential to serve as a standardized test medium for assessing the skill sets of surgeons.
High-fidelity, simulation-based microsurgical training for neurosurgical residents
Neurosurgical Focus
OBJECTIVE Simulation is increasingly recognized as an important supplement to operative training. The live rat femoral artery model is a well-established model for microsurgical skills simulation. In this study, the authors present an 11-year experience incorporating a comprehensive, longitudinal microsurgical training curriculum into a Canadian neurosurgery program. The first goal was to evaluate training effectiveness, using a well-studied rating scale with strong validity. The second goal was to assess the impact of the curriculum on objective measures of subsequent operating room performance during postgraduate year (PGY)–5 and PGY-6 training. METHODS PGY-2 neurosurgery residents completed a 1-year curriculum spanning 17 training sessions divided into 5 modules of increasing fidelity. Both perfused duck wing and live rat vessel training models were used. Three modules comprised live microvascular anastomosis. Trainee performance was video recorded and blindly graded using the Ob...
Operative Neurosurgery, 2016
BACKGROUND: The potential for simulation-based learning in neurosurgical training has led the Congress of Neurosurgical Surgeons to develop a series of simulation modules. The Northwestern Objective Microanastomosis Assessment Tool (NOMAT) was created as the corresponding assessment tool for the Congress of Neurosurgical Surgeons Microanastomosis Module. The face and construct validity of the NOMAT have been previously established. OBJECTIVE: To further validate the NOMAT by determining its interrater reliability (IRR) between raters of varying levels of microsurgical expertise. METHODS: The NOMAT was used to assess residents’ performance in a microanastomosis simulation module in 2 settings: Northwestern University and the Society of Neurological Surgeons 2014 Boot Camp at the University of Indiana. At Northwestern University, participants were scored by 2 experienced microsurgeons. At the University of Indiana, participants were scored by 2 postdoctoral fellows and an experienced ...
Specialized microsurgery simulation training models for the neurosurgery residents
Issues of Reconstructive and Plastic Surgery, 2022
Introduction. Microvascular training constitutes a foundational element of many highly specialized surgical fields. This manuscript describes my experience (D.A. Devia) as a neurosurgical resident during the advanced microsurgical course guided by the senior author (Ye. Akelina) at the Microsurgery Training and Research laboratory, Dept of Orthopedic Surgery, Columbia University Irving Medical Center.Methods. The technical aspects of advanced vascular exercises performed in the microsurgery laboratory are reviewed and presented, accompanied by figures of each exercise accomplished.Conclusions. Microsurgery vascular training is an important tool in every cerebrovascular surgeon, or any other specialty interested microvascular procedures. The experience and exercises demonstrated in this paper are extremely useful for microvascular practice and should be included in any advanced course around the world for every surgeon interested in this field.
The role of simulation in neurosurgery
Child's Nervous System, 2014
It is increasingly apparent that the standards for surgical training are shifting from time-based to criterion-based parameters that emphasize obtaining and maintaining competencies . The formation of a surgeon demands significant dedication and effort, in addition to time . Current, wellestablished methods of surgical training are being challenged as the environment becomes increasingly competitive and litigious with greater scrutiny of patient outcomes . In order to increase patient safety and improve treatment outcomes, several strategies such as problem-based learning and objective structured clinical examinations have promoted the development of new curricula in surgical education .
Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 2017
Microsurgical techniques are essential in plastic surgery; however, inconsistent training practices, acquiring these skills can be difficult. To address this, we designed a standardised laboratory-based microsurgical training programme, which allows trainees to develop their dexterity, visuospatial ability, operative flow and judgement as separate components. Thirty trainees completed an initial microsurgical anastomosis on a chicken femoral artery, assessed using the structured assessment of microsurgical skills (SAMS) method. The study group (n = 18) then completed a 3-month training programme, while the control group (n = 19) did not. A final anastomosis was completed by all trainees (n = 30). The study group had a significant improvement in the microsurgical technique, assessed using the SAMS score, when the initial and final scores were compared (Mean: 24 SAMS initial versus 49 SAMS final) (p < 0.05, Wilcoxon's rank test). The control group had a significantly lower rate...
Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models
Plastic and reconstructive surgery, 2016
Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model. Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant. Learning curves were achieved. Ten residents improved their median gl...
Acta Neurochirurgica
Background Neurosurgical training has been traditionally based on an apprenticeship model. However, restrictions on clinical exposure reduce trainees' operative experience. Simulation models may allow for a more efficient, feasible, and time-effective acquisition of skills. Our objectives were to use face, content, and construct validity to review the use of simulation models in neurosurgical education. Methods PubMed, Web of Science, and Scopus were queried for eligible studies. After excluding duplicates, 1204 studies were screened. Eighteen studies were included in the final review. Results Neurosurgical skills assessed included aneurysm clipping (n = 6), craniotomy and burr hole drilling (n = 2), tumour resection (n = 4), and vessel suturing (n = 3). All studies assessed face validity, 11 assessed content, and 6 assessed construct validity. Animal models (n = 5), synthetic models (n = 7), and VR models (n = 6) were assessed. In face validation, all studies rated visual realism favourably, but haptic realism was key limitation. The synthetic models ranked a high median tactile realism (4 out of 5) compared to other models. Assessment of content validity showed positive findings for anatomical and procedural education, but the models provided more benefit to the novice than the experienced group. The cadaver models were perceived to be the most anatomically realistic by study participants. Construct validity showed a statistically significant proficiency increase among the junior group compared to the senior group across all modalities. Conclusion Our review highlights evidence on the feasibility of implementing simulation models in neurosurgical training. Studies should include predictive validity to assess future skill on an individual on whom the same procedure will be administered. This study shows that future neurosurgical training systems call for surgical simulation and objectively validated models.