Introduction: Surgical simulators have been widely utilized in general surgery and urology as effective tools in resident education, but are far less available in neurosurgery. There is a need for an inexpensive, portable, and easily reproducible method for teaching and practicing neurosurgical techniques safely. We developed a high-fidelity lumbar spine simulator for teaching neurosurgical residents to perform minimally invasive microdiscectomies. Feedback from the first prototype guided refinements of the second prototype. We evaluated both prototypes for content validity.
Methods: Four neurosurgery residents and one attending neurosurgeon (n=5) evaluated the first prototype. Modifications were then made to the simulator based on the results of the first evaluations. Eight residents and five attendings (n=13) evaluated the second prototype. Evaluators incised, dissected, placed tubular retractors, and reviewed fluoroscopic images of the model. For each evaluation, participants completed a four-point rating scale, ranging from “Not at all realistic” [1] to “Highly realistic” [4], in domains including physical attributes (PA), realism of experience (RE) and ability to perform tasks (A). Participants also rated the simulator’s value (V) and relevance (R) on a five-point scale.
Results: The observed averages for the first and second prototypes, respectively, were 3.2 and 3.4 (PA), 3.1 and 3.6 (R), 3.1 and 3.8 (A), 4.6 and 4.9 (V) and 4.8 and 4.7 (R). Significant differences were identified for realism of experience (p = 0.047) and value (p = 0.005). The global ratings of 2.6 and 3.2 indicated that the simulator “can be used as is for training, but could be improved slightly”. Final inter-rater reliability was high, ICC(2,13) = 0.81, 95% CI [0.61, 0.93], suggesting high participant rating agreement.
Conclusions: There was improvement in the content validity of the simulator between the first and second prototypes. Faculty and resident evaluation of the simulator indicate that it is a valuable training device, with minor improvements.
Patient Care: This research will improve patient care by improving neurosurgery education. Residents and practicing clinicians will be able to practice lumbar microdiscectomies and other lumbar spine procedures in a high-fidelity, simulated fashion, allowing improvement in surgical technique and learning of new techniques as they become available.
Learning Objectives: By the conclusion of this session, participants should recognize the value of simulators in neurosurgical training and the current lack of low-cost, high-fidelity simulators and should be introduced to the simulator currently in production and the progressive improvements that have been made.