CNS Simulation-Based Neurosurgical Training: Innovating, Evolving, Growing

James S. Harrop, MD, FACS

The Congress of Neurological Surgeons’ (CNS) mission is to enhance health and improve lives worldwide through the advancement of neurological education and scientific exchange. We use several resources to accomplish this mission: the Annual Meeting, numerous CNS publications (Neurosurgery, Clinical Neurosurgery, Congress Quarterly), CNS online learning, SANS, webinar series, and most recently, the introduction of the CNS SIMTM curriculum and training program.

In 2003, medical resident education in the United States underwent a paradigm shift when the ACGME initiated an 80-hour work-week restriction for resident training. Nevertheless, neurosurgery is a task-based residency program, and the ACGME restriction resulted in a significant reduction of time that residents spent in the operating room. Consequently, educators throughout North America have focused on ways to accelerate resident education to make their training more efficient. The result has been an advancement in simulation-based education.

The CNS initiated its simulation educational program with a resident simulation course in 2010. The course proved extremely successful, based on subjective and objective metrics.

Our simulation program is unique in that its framework is an educational curriculum with both objective didactic and technical measures. It also blends live and online learning activities that measure cognitive and practical improvement.

We continue to invest in the evolution and growth of the curriculum, most recently with the development of a CNS simulation interactive computer platform. This electronic platform gives residents the opportunity to perform a module pre-test, view a didactic program, and complete a post-test. Currently, two modules are available online: the posterior cervical and CSF repair modules. Evaluators are also able to assess and score objective measures for selective modules.

The spine/peripheral nerve curriculum consists of five modules: CSF repair, ACDF, posterior cervical laminectomy, MIS lumbar fusion, and a new cubital tunnel release. In the cranial simulation curriculum, there are both virtual reality and physical modules for craniotomy and decompression of the posterior fossa, as well as a traumatic skull fracture and a ventriculostomy module.

Another major component of the curriculum consists of vascular simulation with angiography and endovascular aneurysm coiling, aneurysm clipping, and vascular bypass modules. In addition, we are fortunate to have several virtual reality and haptic devices such as a thoracic pedicle screw insertion by Immersive Touch, and a glioma resection by NeuroTouch.

We are excited about further expanding the modules, and we continue to explore opportunities to provide courses at residents’ home institutions. We have also expanded the training geographically, with international simulation courses in Prague and Barcelona (with the EANS); in Mumbai, India (with the NSI); and in Brazil. All of the courses have been well received and have allowed us to consider expanding our global education efforts. Future courses are planned in Turkey, India, and Sweden.

In summary, since its initial launch the CNS simulation-based neurological training continues to innovate and evolve, successfully serving the advancement of neurosurgical education. We remain excited about future growth opportunities for the program.

We encourage your input and comments at info@cns.org.