Introduction: Increasing evidence suggests that simulation can enhance surgical performance and improve outcomes. While validation studies have been done in other specialties, validated assessment tools and curricula have yet to be established in the field of neurosurgery. To this end, we developed a microsurgical simulation laboratory and an assessment scale. We then assessed residents’ microsurgical skills in a blinded fashion.
Methods: Fifteen Neurosurgery residents, two research fellows and four medical students performed end-to-end anastomosis on one 3mm and one 1mm silicon vessel using 8-O and 10-O nylon sutures, respectively. Video footage of the procedure and of candidates’ posture were de-identified then rated by an experienced vascular neurosurgeon. For this purpose, we developed the NOMAT, a 14-item evaluation tool devised to address the various technical aspects of the procedure. The NOMAT evaluation tool was used to obtain objective scores of the performance. Simultaneously, the expert surgeon also gave a subjective score for each anastomosis.
Results: We analyzed the performance of participating candidates in function of their Post Graduate Year (PGY). We found a positive linear correlation between NOMAT score and PGY level and between subjective grade and PGY level. The correlation was r=0.72 for 1mm vessels and r=0.51 for 3mm vessels. We also analyzed the correlation between NOMAT score and subjective grade, which were significantly correlated (p<0.01). Finally, we compared the performance of trained pre-residency postdoctoral fellows to the performance of neurosurgical residents. Postdoctoral fellows preformed significantly better (NOMAT scores of 60.5 and 38.16 respectively).
Conclusions: We present “NOMAT”, the first validated tool for assessment of microanastomosis in neurosurgery. Assessment of inter-observer reliability and assessment of a larger number of residents may further validate this scale. This scale has the potential to help assess resident skills over time and to better understand the value of various educational interventions and deliberate practice.
Patient Care: The research presented in this abstract help improve residents' performance via simulation. Thus it affect patient outcomes by avoiding unnecessary risks.
Learning Objectives: we present NOMAT a validated tool for assessment of microanasotmosis
NOMAT scale can differentiate resident according to their skill level