Needs assessment for simulation training in neuroendoscopy: a Canadian national survey

Clinical article

Restricted access


In recent years, dramatic changes in surgical education have increased interest in simulation-based training for complex surgical skills. This is particularly true for endoscopic third ventriculostomy (ETV), given the potential for serious intraoperative errors arising from surgical inexperience. However, prior to simulator development, a thorough assessment of training needs is essential to ensure development of educationally relevant platforms. The purpose of this study was to conduct a national needs assessment addressing specific goals of instruction, to guide development of simulation platforms, training curricula, and assessment metrics for ETV.


Canadian neurosurgeons performing ETV were invited to participate in a structured online questionnaire regarding the procedural steps for ETV, the frequency and significance of intraoperative errors committed while learning the technique, and simulation training modules of greatest potential educational benefit. Descriptive data analysis was completed for both quantitative and qualitative responses.


Thirty-two (55.2%) of 58 surgeons completed the survey. All believed that virtual reality simulation training for ETV would be a valuable addition to clinical training. Selection of ventriculostomy site, navigation within the ventricles, and performance of the ventriculostomy ranked as the most important steps to simulate. Technically inadequate ventriculostomy and inappropriate fenestration site selection were ranked as the most frequent/significant errors. A standard ETV module was thought to be most beneficial for resident training.


To inform the development of a simulation-based training program for ETV, the authors have conducted a national needs assessment. The results provide valuable insight to inform key design elements necessary to construct an educationally relevant device and educational program.

Abbreviations used in this paper:ETV = endoscopic third ventriculostomy; FLS = Fundamentals of Laparoscopic Surgery; OR = operating room; SBME = simulation-based medical education; VR = virtual reality.

Article Information

Address correspondence to: Faizal Aminmohamed Haji, M.D., 43 Corvette Court, Brampton, Ontario, Canada, L7A 2H8. email:

Please include this information when citing this paper: published online December 7, 2012; DOI: 10.3171/2012.10.JNS12767.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Bar graph showing utility of VR simulation training for ETV.


  • 1

    Ahlberg GEnochsson LGallagher AGHedman LHogman CMcClusky DA III: Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 193:7978042007

  • 2

    Alaraj ALemole MGFinkle JHYudkowsky RWallace ALuciano C: Virtual reality training in neurosurgery: review of current status and future applications. Surg Neurol Int 2:522011

  • 3

    Bernstein MHamstra SJWoodrow SGoldsman SReznick RKFairholm D: Needs assessment of neurosurgery trainees: a survey study of two large training programs in the developing and developed worlds. Surg Neurol 66:1171262006

  • 4

    Boszczyk BMMooij JJSchmitt NDi Rocco CFakouri BBLindsay KW: Spine surgery training and competence of European neurosurgical trainees. Acta Neurochir (Wien) 151:6196282009

  • 5

    Bouras TSgouros S: Complications of endoscopic third ventriculostomy. A review. J Neurosurg Pediatr 7:6436492011

  • 6

    Bouras TSgouros S: Complications of endoscopic third ventriculostomy: a systematic review. Acta Neurochir Suppl 113:1491532012

  • 7

    Cusimano MD: Virtual reality surgery: neurosurgery and the contemporary landscape a three-dimensional interactive virtual dissection model to simulate transpetrous surgical avenues. Neurosurgery 53:101010122003. (Letter)

  • 8

    de Boer PGBuckley RSchmidt PFox RJupiter J: Learning assessment toolkit. J Bone Joint Surg Am 92:132513292010

  • 9

    de Ribaupierre SRilliet BVernet ORegli LVillemure JG: Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst 23:5275332007

  • 10

    Drake JM: Endoscopic third ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery 60:8818862007

  • 11

    Drake JM: The surgical management of pediatric hydrocephalus. Neurosurgery 62:Suppl 26336422008

  • 12

    Dvorak MFCollins BJMurnaghan LHurlbert RJFehlings MFox R: Confidence in spine training among senior neurosurgical and orthopedic residents. Spine (Phila Pa 1976) 31:8318372006

  • 13

    Erşahin YArslan D: Complications of endoscopic third ventriculostomy. Childs Nerv Syst 24:9439482008

  • 14

    Fried GMFeldman LSVassiliou MCFraser SAStanbridge DGhitulescu G: Proving the value of simulation in laparoscopic surgery. Ann Surg 240:5185282004

  • 15

    Fried MPSatava RWeghorst SGallagher AGSasaki CRoss D: Identifying and reducing errors with surgical simulation. Qual Saf Health Care 13:Suppl 1i19i262004

  • 16

    Gallagher AGCates CU: Approval of virtual reality training for carotid stenting: what this means for procedural-based medicine. JAMA 292:302430262004

  • 17

    Grantcharov TPKristiansen VBBendix JBardram LRosenberg JFunch-Jensen P: Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 91:1461502004

  • 18

    Haase JBoisen E: Neurosurgical training: more hours needed or a new learning culture?. Surg Neurol 72:89972009

  • 19

    Hailong FGuangfu HHaibin THong PYong CWeidong L: Endoscopic third ventriculostomy in the management of communicating hydrocephalus: a preliminary study. Clinical article. J Neurosurg 109:9239302008

  • 20

    Jones RFStening WABrydon M: Endoscopic third ventriculostomy. Neurosurgery 26:86921990

  • 21

    Kohn LTCorrigan JMDonaldson MS: Errors in health care: a leading cause of death and injury. To Err Is Human: Building a Safer Health System Washington, DCNational Academy Press2000. 2648

  • 22

    Kolozsvari NOFeldman LSVassiliou MCDemyttenaere SHoover ML: Sim one, do one, teach one: considerations in designing training curricula for surgical simulation. J Surg Educ 68:4214272011

  • 23

    Lockyer J: Getting started with needs assessment: Part 1—the questionnaire. J Contin Educ Health Prof 18:58611998

  • 24

    Long DM: Neurosurgical training at present and in the next century. Acta Neurochir Suppl 69:58641997

  • 25

    Malone HRSyed ONDownes MSD'Ambrosio ALQuest DOKaiser MG: Simulation in neurosurgery: a review of computer-based simulation environments and their surgical applications. Neurosurgery 67:110511162010

  • 26

    Mazzola CALobel DAKrishnamurthy SBloomgarden GMBenzil DL: Efficacy of neurosurgery resident education in the new millennium: the 2008 Council of State Neurosurgical Societies post-residency survey results. Neurosurgery 67:2252332010

  • 27

    McGaghie WCIssenberg SBCohen ERBarsuk JHWayne DB: Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Acad Med 86:7067112011

  • 28

    McGaghie WCIssenberg SBPetrusa ERScalese RJ: A critical review of simulation-based medical education research: 2003–2009. Med Educ 44:50632010

  • 29

    Moorthy KMunz YSarker SKDarzi A: Objective assessment of technical skills in surgery. BMJ 327:103210372003

  • 30

    Navarro RGil-Parra RReitman AJOlavarria GGrant JATomita T: Endoscopic third ventriculostomy in children: early and late complications and their avoidance. Childs Nerv Syst 22:5065132006

  • 31

    Paas FG: Training strategies for attaining transfer of problem-solving skill in statistics: a cognitive-load approach. J Educ Psychol 84:4294341992

  • 32

    Paas FGVan Merriënboer JJAdam JJ: Measurement of cognitive load in instructional research. Percept Mot Skills 79:4194301994

  • 33

    Popp AJ: Navigating the Strait of Magellan: mapping a new paradigm for neurosurgical residency training. Presidential Address to the Society of Neurological Surgeons, May 7, 2007. J Neurosurg 109:5765822008

  • 34

    Ratnapalan SHilliard RI: Needs assessment in postgraduate medical education: a review. Med Educ Online 7:182002

  • 35

    Reznick RKMacRae H: Teaching surgical skills—changes in the wind. N Engl J Med 355:266426692006

  • 36

    Sandelowski M: Whatever happened to qualitative description?. Res Nurs Health 23:3343402000

  • 37

    Schroeder HWSNiendorf WRGaab MR: Complications of endoscopic third ventriculostomy. J Neurosurg 96:103210402002

  • 38

    Scott DJBergen PCRege RVLaycock RTesfay STValentine RJ: Laparoscopic training on bench models: better and more cost effective than operating room experience?. J Am Coll Surg 191:2722832000

  • 39

    Seymour NE: VR to OR: a review of the evidence that virtual reality simulation improves operating room performance. World J Surg 32:1821882008

  • 40

    Seymour NEGallagher AGRoman SAO'Brien MKAndersen DKSatava RM: Analysis of errors in laparoscopic surgical procedures. Surg Endosc 18:5925952004

  • 41

    Seymour NEGallagher AGRoman SAO'Brien MKBansal VKAndersen DK: Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg 236:4584642002

  • 42

    Spicer MAApuzzo MLJ: Virtual reality surgery: neurosurgery and the contemporary landscape. Neurosurgery 52:4894972003

  • 43

    Sroka GFeldman LSVassiliou MCKaneva PAFayez RFried GM: Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial. Am J Surg 199:1151202010

  • 44

    Stefanidis D: Optimal acquisition and assessment of proficiency on simulators in surgery. Surg Clin North Am 90:4754892010




All Time Past Year Past 30 Days
Abstract Views 499 497 151
Full Text Views 233 233 0
PDF Downloads 134 134 0
EPUB Downloads 0 0 0


Google Scholar