Developing microsurgical milestones for psychomotor skills in neurological surgery residents as an adjunct to operative training: the home microsurgery laboratory

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  • Department of Neurological Surgery, University of Washington, Seattle, Washington
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OBJECTIVE

A variety of factors contribute to an increasingly challenging environment for neurological surgery residents to develop psychomotor skills in microsurgical technique solely from operative training. While adjunct training modalities such as cadaver dissection and surgical simulation are embraced and practiced at our institution, there are no formal educational milestones defined to help residents develop, measure, and advance their microsurgical psychomotor skills in a stepwise fashion when outside the hospital environment. The objective of this report is to describe an efficient and convenient “home microsurgery lab” (HML) assembled and tested by the authors with the goal of supporting a personalized stepwise advancement of microsurgical psychomotor skills.

METHODS

The authors reviewed the literature on previously published simulation practice models and designed adjunct learning modules utilizing the HML. Five milestones were developed for achieving proficiency with each graduated exercise, referencing the Accreditation Council for Graduate Medical Education (ACGME) guidelines. The HML setup was then piloted with 2 neurosurgical trainees.

RESULTS

The total cost for assembling the HML was approximately $850. Techniques for which training was provided included microinstrument handling, tissue dissection, suturing, and microanastomoses. Five designated competency levels were developed, and training exercises were proposed for each competency level.

CONCLUSIONS

The HML offers a unique, entirely home-based, affordable adjunct to the operative neurosurgical education mandated by the ACGME operative case logs, while respecting resident hospital-based education hours. The HML provides surgical simulation with specific milestones, which may improve confidence and the microsurgical psychomotor skills required to perform microsurgery, regardless of case type.

ABBREVIATIONS ABNS = American Board of Neurological Surgery; ACGME = Accreditation Council for Graduate Medical Education; AVM = arteriovenous malformation; bAVM = brain AVM; HML = home microsurgery lab; MCA = middle cerebral artery; NOMAT = Northwestern Objective Microanastomosis Assessment Tool; PGY = postgraduate year; PVA = polyvinyl alcohol; STA = superficial temporal artery.

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Contributor Notes

Correspondence Laligam N. Sekhar: University of Washington, Seattle, WA. respub3@uw.edu.

INCLUDE WHEN CITING Published online September 4, 2020; DOI: 10.3171/2020.5.JNS201590.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Lai L, Morgan MK. The impact of changing intracranial aneurysm practice on the education of cerebrovascular neurosurgeons. J Clin Neurosci. 2012;19(1):8184.

    • Search Google Scholar
    • Export Citation
  • 2

    Abecassis IJ, Zeeshan Q, Ghodke BV, Surgical versus endovascular management of ruptured and unruptured intracranial aneurysms: emergent issues and future directions. World Neurosurg. 2020;136:1727.

    • Search Google Scholar
    • Export Citation
  • 3

    Chowdhry SA, Spetzler RF. Genealogy of training in vascular neurosurgery. Neurosurgery. 2014;74(suppl 1):S198S203.

  • 4

    Lawton MT, Lang MJ. The future of open vascular neurosurgery: perspectives on cavernous malformations, AVMs, and bypasses for complex aneurysms. J Neurosurg. 2019;130(5):14091425.

    • Search Google Scholar
    • Export Citation
  • 5

    Accreditation Council for Graduate Medical Education. Neurological Surgery Milestones. ACGME. Accessed June 24, 2020. https://www.acgme.org/Portals/0/PDFs/Milestones/NeurologicalSurgeryMilestones.pdf

    • Export Citation
  • 6

    Inoue T, Tsutsumi K, Adachi S, Effectiveness of suturing training with 10-0 nylon under fixed and maximum magnification (x 20) using desk type microscope. Surg Neurol. 2006;66(2):183187.

    • Search Google Scholar
    • Export Citation
  • 7

    Indo M, Tsutsumi K, Shin M. The practice of knots untying technique using a 10-0 nylon suture and gauze to cope with technical difficulties of microvascular anastomosis. World Neurosurg. 2011;75(1):8789.

    • Search Google Scholar
    • Export Citation
  • 8

    Lahiri A, Lim AY, Qifen Z, Lim BH. Microsurgical skills training: a new concept for simulation of vessel-wall suturing. Microsurgery. 2005;25(1):2124.

    • Search Google Scholar
    • Export Citation
  • 9

    Atlan M, Lellouch AG, Legagneux J, A new synthetic model for microvascular anastomosis training? A randomized comparative study between silicone and polyvinyl alcohol gelatin tubes. J Surg Educ. 2018;75(1):182187.

    • Search Google Scholar
    • Export Citation
  • 10

    Mokhtari P, Tayebi Meybodi A, Lawton MT, Transfer of learning from practicing microvascular anastomosis on silastic tubes to rat abdominal aorta. World Neurosurg. 2017;108:230235.

    • Search Google Scholar
    • Export Citation
  • 11

    Abla AA, Uschold T, Preul MC, Zabramski JM. Comparative use of turkey and chicken wing brachial artery models for microvascular anastomosis training. J Neurosurg. 2011;115(6):12311235.

    • Search Google Scholar
    • Export Citation
  • 12

    Muhammad S, Lehecka M, Huhtakangas J, Meditation music improved the quality of suturing in an experimental bypass procedure. Acta Neurochir (Wien). 2019;161(8):15151521.

    • Search Google Scholar
    • Export Citation
  • 13

    El Ahmadieh TY, Aoun SG, El Tecle NE, A didactic and hands-on module enhances resident microsurgical knowledge and technical skill. Neurosurgery. 2013;73(suppl 1):5156.

    • Search Google Scholar
    • Export Citation
  • 14

    American Board of Neurological Surgery. Mission, Vision, Values & Finances. ABNS. Accessed August 13, 2020. https://www.abns.org/mission-vision-values-2/

    • Export Citation
  • 15

    Accreditation Council for Graduate Medical Education. About Us. ACGME. Accessed June 24, 2020. https://www.acgme.org/About-Us/Overview

    • Export Citation
  • 16

    Sharma M, Ugiliweneza B, Fortuny EM, National trends in cerebral bypass for unruptured intracranial aneurysms: a National (Nationwide) Inpatient Sample analysis of 1998–2015. Neurosurg Focus. 2019;46(2):E15.

    • Search Google Scholar
    • Export Citation
  • 17

    Piazza M, Nayak N, Ali Z, Trends in resident operative teaching opportunities for treatment of intracranial aneurysms. World Neurosurg. 2017;103:194200.

    • Search Google Scholar
    • Export Citation
  • 18

    Patel EA, Aydin A, Cearns M, A systematic review of simulation-based training in neurosurgery, part 1: cranial neurosurgery. World Neurosurg. 2020;133:e850e873.

    • Search Google Scholar
    • Export Citation
  • 19

    Gnanakumar S, Kostusiak M, Budohoski KP, Effectiveness of cadaveric simulation in neurosurgical training: a review of the literature. World Neurosurg. 2018;118:8896.

    • Search Google Scholar
    • Export Citation
  • 20

    Dumestre D, Yeung JK, Temple-Oberle C. Evidence-based microsurgical skill-acquisition series part 1: validated microsurgical models—a systematic review. J Surg Educ. 2014;71(3):329338.

    • Search Google Scholar
    • Export Citation
  • 21

    Malik MM, Hachach-Haram N, Tahir M, Acquisition of basic microsurgery skills using home-based simulation training: a randomised control study. J Plast Reconstr Aesthet Surg. 2017;70(4):478486.

    • Search Google Scholar
    • Export Citation
  • 22

    Chung SB, Ryu J, Chung Y, An affordable microsurgical training system for a beginning neurosurgeon: how to realize the self-training laboratory. World Neurosurg. 2017;105:369374.

    • Search Google Scholar
    • Export Citation
  • 23

    Hafez A, Raj R, Lawton MT, Niemelä M. Simple training tricks for mastering and taming bypass procedures in neurosurgery. Surg Neurol Int. 2017;8:295.

    • Search Google Scholar
    • Export Citation
  • 24

    Dumestre D, Yeung JK, Temple-Oberle C. Evidence-based microsurgical skills acquisition series part 2: validated assessment instruments—a systematic review. J Surg Educ. 2015;72(1):8089.

    • Search Google Scholar
    • Export Citation
  • 25

    Steiger HJ. Training of cerebrovascular specialists: the surgeon’s view. Acta Neurochir Suppl (Wien). 2018;129:129134.

  • 26

    Gélinas-Phaneuf N, Del Maestro RF. Surgical expertise in neurosurgery: integrating theory into practice. Neurosurgery. 2013;73(suppl 1):3038.

    • Search Google Scholar
    • Export Citation
  • 27

    Ericsson KA. An expert-performance perspective of research on medical expertise: the study of clinical performance. Med Educ. 2007;41(12):11241130.

    • Search Google Scholar
    • Export Citation
  • 28

    Fitts PM, Posner MI. Human Performance. Brooks/Cole Publishing Company; 1967.

  • 29

    Vygotsky LS. Mind in Society: The Development of Higher Psychological Processes. Harvard University Press; 1978.

  • 30

    Dunphy BC, Williamson SL. In pursuit of expertise. Toward an educational model for expertise development. Adv Health Sci Educ Theory Pract. 2004;9(2):107127.

    • Search Google Scholar
    • Export Citation
  • 31

    Rhoton AL. Rhoton Cranial Anatomy and Surgical Approaches. Lippincott Williams & Wilkins; 2003.

  • 32

    Fessler RG, Sekhar LN, eds. Atlas of Neurosurgical Techniques. Thieme; 2006.

  • 33

    Fredrickson VL, Strickland BA, Ravina K, State of the union in open neurovascular training. World Neurosurg. 2019;122:e553e560.

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