Introduction: Simulation-based teaching of surgical procedures is an increasingly important adjunct in residency training in surgical specialties. The Congress of Neurological Surgeons (CNS) Simulation Committee offers a neurosurgery simulation course to residents at the CNS annual meeting. This course includes a virtual reality, haptics-based ventriculostomy simulator (ImmersiveTouch, Inc., Chicago, IL) to train residents in skills relevant to one of the most commonly encountered procedures during residency. We hypothesized that simulator-based instruction in ventriculostomy placement may enhance current training methods and reduce procedure related complications.
Methods: The ventriculostomy simulator was evaluated as one component of the trauma module of the simulation course, which incorporated a pre-test, didactic session, simulator performance before and after faculty instruction, a post-test and a post-course questionnaire. Test scores, simulator scores and questionnaire results were used to evaluate face, content and construct validity. Performance measures included time to complete the simulator, bur hole location, catheter length, catheter trajectory and distance of catheter tip from foramen of Monro. Residents were categorized by post-graduate year into junior (PGY 1-3) or senior (PGY 4-7) residents for data analysis.
Results: 15 residents completed the written tests and 7 completed the ventriculostomy simulator. Correct responses rose significantly from pre-test (75%) to post-test (87%) (p<0.05). All simulator scores improved with repeat testing, with bur hole placement (p<0.03), catheter location (p<0.05) and time (p<0.004) achieving statistical significance. Catheter trajectory was significantly better among senior residents, supporting construct validity. Post-course questionnaires supported the simulator as an accurate and useful representation of the clinical task of ventriculostomy placement, confirming face and content validity.
Conclusions: The ventriculostomy simulator in the CNS Resident Simulation Course is a valid and efficacious training tool. Incorporation of this simulator into residency training may enhance teaching and improve patient safety by moving the learning curve for ventriculostomy out of the hospital and into the simulation laboratory.
Patient Care: Simulation-based training has the potential to move the learning curve for surgical procedures from clinical settings to the simulator laboratory, thereby improving patient safety.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) understand the basis for judging efficacy of a virtual reality ventriculostomy simulator, 2) appreciate the potential impact of the ventriculostomy simulator on residency training, and 3) be able to discuss concepts in simulator validation