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  • Assessing Neurosurgical Technical Skills in Medical Students using a Virtual Reality Simulator

    Final Number:

    Alexander Winkler-Schwartz; Hamed Azarnoush PhD; Gmaan Alzhrani; Fahad E Alotaibi MD; Rolando Del Maestro

    Study Design:
    Laboratory Investigation

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Neurosurgical virtual-reality simulation systems like NeuroTouch have been developed to improve neurosurgical patient safety by enhancing the acquisition and assessment of neurosurgical skills. Advancements in medical computer-based simulation have created opportunities to safely study cognitive and psychomotor skills in a surgically naïve population during complex simulated neurosurgical tasks. The purpose of this study was to determine if medical student characteristics influence performance in simulated tumor removal tasks using NeuroTouch.

    Methods: Seventy-nine medical students were recruited to participate in the resection of nine different simulated brain tumors using the NeuroTouch simulator. Performance metrics including percentage of tumor removed, percentage of normal tissue removed, amount of force applied during tumor resection, total path length of the instrument tip and pedal activation were recorded. Demographic data, surgery interest, musical instrument and video game exposure were obtained. Participants rated the trial according to difficulty, realism and overall satisfaction.

    Results: Medical students interested in surgery removed less normal tissue, used less force and spent less time performing the task. Within those interested in surgery, those who had indicated a particular surgical specialty of interest removed significantly less normal tissue, used greater maximum force, and had increased pedal utilization during the task compared to those unsure of surgical specialty choice. As participants rated the task more difficult, the total path length for the instrument tip increased and less normal tissue was removed.

    Conclusions: In a surgically untrained medical student population, level of surgical interest and subjective rating of difficulty influences surgical performance. These findings have implications for residency candidate selection, as level of interest may signal to prospective surgical programs a candidate’s intrinsic surgical skill. Findings also have implications for surgical education, as surgically naïve trainees may approach more difficult tasks more cautiously and make fewer errors as compared to more experienced peers.

    Patient Care: A better understanding of the factors that influence surgical performance in a surgically naïve population allows for recruitment of a higher yield of intrinsically surgically skilled residents. This group may make fewer surgical errors during the course of their training, and attain a higher level of expertise at the end of their training programs, thus allowing for higher quality care delivered to patients.

    Learning Objectives: Simulated virtual reality systems capable of assessing neurosurgical performance may be useful in the screening of medical students interested in surgical specialities.


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