Neurosurgeon as educator: a review of principles of adult education and assessment applied to neurosurgery

Randy L. Jensen Department of Neurosurgery, Clinical Neurosciences Center, and

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Gmaan Alzhrani Department of Neurosurgery, Clinical Neurosciences Center, and

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John R. W. Kestle Department of Neurosurgery, Clinical Neurosciences Center, and

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Douglas L. Brockmeyer Department of Neurosurgery, Clinical Neurosciences Center, and

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Sara M. Lamb Departments of Internal Medicine and
Pediatrics, University of Utah School of Medicine, University of Utah, Salt Lake City, Utah

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William T. Couldwell Department of Neurosurgery, Clinical Neurosciences Center, and

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  • 1

    Ahmed K, Miskovic D, Darzi A, Athanasiou T, Hanna GB: Observational tools for assessment of procedural skills: a systematic review. Am J Surg 202:469480, 480.e1–480.e6, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Alaraj A, Charbel FT, Birk D, Tobin M, Luciano C, Banerjee PP, et al.: Role of cranial and spinal virtual and augmented reality simulation using immersive touch modules in neurosurgical training. Neurosurgery 72 (Suppl 1):115123, 2013 (Erratum in Neurosurgery 73:E913, 2013)

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Alman BA, Ferguson P, Kraemer W, Nousiainen MT, Reznick RK: Competency-based education: a new model for teaching orthopaedics. Instr Course Lect 62:565569, 2013

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    AlZhrani G, Alotaibi F, Azarnoush H, Winkler-Schwartz A, Sabbagh A, Bajunaid K, et al.: Proficiency performance benchmarks for removal of simulated brain tumors using a virtual reality simulator NeuroTouch. J Surg Educ 72:685696, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Azarnoush H, Alzhrani G, Winkler-Schwartz A, Alotaibi F, Gelinas-Phaneuf N, Pazos V, et al.: Neurosurgical virtual reality simulation metrics to assess psychomotor skills during brain tumor resection. Int J CARS 10:603618, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Bhatti NI, Cummings CW: Competency in surgical residency training: defining and raising the bar. Acad Med 82:569573, 2007

  • 7

    Bova FJ, Rajon DA, Friedman WA, Murad GJ, Hoh DJ, Jacob RP, et al.: Mixed-reality simulation for neurosurgical procedures. Neurosurgery 73 (Suppl 1):138145, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Bridges M, Diamond DL: The financial impact of teaching surgical residents in the operating room. Am J Surg 177:2832, 1999

  • 9

    Brightwell A, Grant J: Competency-based training: who benefits? Postgrad Med J 89:107110, 2013

  • 10

    Brown JS, Collins A, Duguid P: Situated cognition and the culture of learning. Educ Res 18:3242, 1989

  • 11

    Buckley S, Zamora J: Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors’ skills and attitudes towards teachers and teaching. BMC Med Educ 7:20, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Burchiel KJ: Neurosurgical education: a new paradigm for curriculum, core, and subspecialty training. Neurosurgery 63 (Suppl 1):8890, 2016

  • 13

    Carraccio C, Burke AE: Beyond competencies and milestones: adding meaning through context. J Grad Med Educ 2:419422, 2010

  • 14

    Carter FJ, Schijven MP, Aggarwal R, Grantcharov T, Francis NK, Hanna GB, et al.: Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc 19:15231532, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Chitale R, Ghobrial GM, Lobel D, Harrop J: Simulated lumbar minimally invasive surgery educational model with didactic and technical components. Neurosurgery 73 (Suppl 1):107110, 2013

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Chugh AJ, Pace JR, Singer J, Tatsuoka C, Hoffer A, Selman WR, et al.: Use of a surgical rehearsal platform and improvement in aneurysm clipping measures: results of a prospective, randomized trial. J Neurosurg 126:838844, 2017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Clarke DB, Kureshi N, Hong M, Sadeghi M, D’Arcy RC: Simulation-based training for burr hole surgery instrument recognition. BMC Med Educ 16:153, 2016

  • 18

    Cobb MI, Taekman JM, Zomorodi AR, Gonzalez LF, Turner DA: Simulation in neurosurgery—a brief review and commentary. World Neurosurg 89:583586, 2016

  • 19

    Collins A, Brown JS, Newman S: Cognitive apprenticeship: teaching the craft of reading, writing and mathematics, in Resnick LB (ed): Knowing, Learning, and Instruction: Essays in Honor of Robert Glaser. Hillsdale, NJ: Erlbaum, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Darzi A, Smith S, Taffinder N: Assessing operative skill. Needs to become more objective. BMJ 318:887888, 1999

  • 21

    Donnon T, Al Ansari A, Al Alawi S, Violato C: The reliability, validity, and feasibility of multisource feedback physician assessment: a systematic review. Acad Med 89:511516, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Downing SM, Haladyna TM: Validity and its threats, in Downing SM, Yudkowsky R (eds): Assessment in Health Professions Education. New York: Routledge, 2009, pp 2156

  • 23

    Doyle JD, Webber EM, Sidhu RS: A universal global rating scale for the evaluation of technical skills in the operating room. Am J Surg 193:551555, 2007

  • 24

    Faulkner H, Regehr G, Martin J, Reznick R: Validation of an objective structured assessment of technical skill for surgical residents. Acad Med 71:13631365, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Ferguson PC, Kraemer W, Nousiainen M, Safir O, Sonnadara R, Alman B, et al.: Three-year experience with an innovative, modular competency-based curriculum for orthopaedic training. J Bone Joint Surg Am 95:e166, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Fontes RB, Selden NR, Byrne RW: Fostering and assessing professionalism and communication skills in neurosurgical education. J Surg Educ 71:e83e89, 2014

  • 27

    Frank JR, Snell LS, Cate OT, Holmboe ES, Carraccio C, Swing SR, et al.: Competency-based medical education: theory to practice. Med Teach 32:638645, 2010

  • 28

    Gallagher AG, Ritter EM, Satava RM: Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc 17:15251529, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Ganju A, Aoun SG, Daou MR, El Ahmadieh TY, Chang A, Wang L, et al.: The role of simulation in neurosurgical education: a survey of 99 United States neurosurgery program directors. World Neurosurg 80:e1e8, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Gasco J, Holbrook TJ, Patel A, Smith A, Paulson D, Muns A, et al.: Neurosurgery simulation in residency training: feasibility, cost, and educational benefit. Neurosurgery 73 (Suppl 1):3945, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Gasco J, Patel A, Ortega-Barnett J, Branch D, Desai S, Kuo YF, et al.: Virtual reality spine surgery simulation: an empirical study of its usefulness. Neurol Res 36:968973, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

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

  • 33

    Glarner CE, McDonald RJ, Smith AB, Leverson GE, Peyre S, Pugh CM, et al.: Utilizing a novel tool for the comprehensive assessment of resident operative performance. J Surg Educ 70:813820, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Gofton WT, Dudek NL, Wood TJ, Balaa F, Hamstra SJ: The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE): a tool to assess surgical competence. Acad Med 87:14011407, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Grantcharov TP, Rosenberg J, Pahle E, Funch-Jensen P: Virtual reality computer simulation. Surg Endosc 15:242244, 2001

  • 36

    Gray JD: Global rating scales in residency education. Acad Med 71 (1 Suppl):S55S63, 1996

  • 37

    Hadley C, Lam SK, Briceño V, Luerssen TG, Jea A: Use of a formal assessment instrument for evaluation of resident operative skills in pediatric neurosurgery. J Neurosurg Pediatr 16:497504, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Harrop J, Lobel DA, Bendok B, Sharan A, Rezai AR: Developing a neurosurgical simulation-based educational curriculum: an overview. Neurosurgery 73 (Suppl 1):2529, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Harrop J, Rezai AR, Hoh DJ, Ghobrial GM, Sharan A: Neurosurgical training with a novel cervical spine simulator: posterior foraminotomy and laminectomy. Neurosurgery 73 (Suppl 1):9499, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Heiland DH, Petridis AK, Maslehaty H, Thissen J, Kinzel A, Scholz M, et al.: Efficacy of a new video-based training model in spinal surgery. Surg Neurol Int 5:1, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Hoh BL, Neal DW, Kleinhenz DT, Hoh DJ, Mocco J, Barker FG II: Higher complications and no improvement in mortality in the ACGME resident duty-hour restriction era: an analysis of more than 107,000 neurosurgical trauma patients in the Nationwide Inpatient Sample database. Neurosurgery 70:13691382, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Hooten KG, Lister JR, Lombard G, Lizdas DE, Lampotang S, Rajon DA, et al.: Mixed reality ventriculostomy simulation: experience in neurosurgical residency. Neurosurgery 10 (Suppl 4):576581, 2014

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Hwang CS, Pagano CR, Wichterman KA, Dunnington GL, Alfrey EJ: Resident versus no resident: a single institutional study on operative complications, mortality, and cost. Surgery 144:339344, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Jagannathan J, Vates GE, Pouratian N, Sheehan JP, Patrie J, Grady MS, et al.: Impact of the Accreditation Council for Graduate Medical Education work-hour regulations on neurosurgical resident education and productivity. J Neurosurg 110:820827, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Jordan JA, Gallagher AG, McGuigan J, McGlade K, McClure N: A comparison between randomly alternating imaging, normal laparoscopic imaging, and virtual reality training in laparoscopic psychomotor skill acquisition. Am J Surg 180:208211, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46

    Kane M, Crooks T, Cohen A: Validating measures of performance. Educ Meas 18:517, 1999

  • 47

    Kerfoot BP, Kissane N: The use of gamification to boost residents’ engagement in simulation training. JAMA Surg 149:12081209, 2014

  • 48

    Kestle JR: Editorial: Measuring resident operative skills. J Neurosurg Pediatr 16:495496, 2015

  • 49

    Kim MJ, Williams RG, Boehler ML, Ketchum JK, Dunnington GL: Refining the evaluation of operating room performance. J Surg Educ 66:352356, 2009

  • 50

    Kirkman MA, Ahmed M, Albert AF, Wilson MH, Nandi D, Sevdalis N: The use of simulation in neurosurgical education and training. A systematic review. J Neurosurg 121:228246, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 51

    Kolb DA: Experiential Learning. Englewood Cliffs, NJ: Prentice-Hall, 1984

  • 52

    Larson JL, Williams RG, Ketchum J, Boehler ML, Dunnington GL: Feasibility, reliability and validity of an operative performance rating system for evaluating surgery residents. Surgery 138:640649, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53

    Long DM: Competency-based residency training: the next advance in graduate medical education. Acad Med 75:11781183, 2000

  • 54

    Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al.: Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 84:273278, 1997

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 55

    Messick S: Standards of validity and the validity of standards in performance assessment. Educ Meas 14:58, 1995

  • 56

    Miller GE: The assessment of clinical skills/competence/performance. Acad Med 65 (9 Suppl):S63S67, 1990

  • 57

    Niitsu H, Hirabayashi N, Yoshimitsu M, Mimura T, Taomoto J, Sugiyama Y, et al.: Using the Objective Structured Assessment of Technical Skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today 43:271275, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 58

    Norby K, Siddiq F, Adil MM, Haines SJ: The effect of duty hour regulations on outcomes of neurological surgery in training hospitals in the United States: duty hour regulations and patient outcomes. J Neurosurg 121:247261, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 59

    Norcini JJ, Blank LL, Duffy FD, Fortna GS: The mini-CEX: a method for assessing clinical skills. Ann Intern Med 138:476481

  • 60

    Nousiainen MT, McQueen SA, Ferguson P, Alman B, Kraemer W, Safir O, et al.: Simulation for teaching orthopaedic residents in a competency-based curriculum: do the benefits justify the increased costs? Clin Orthop Relat Res 474:935944, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 61

    Nousiainen MT, McQueen SA, Hall J, Kraemer W, Ferguson P, Marsh JL, et al.: Resident education in orthopaedic trauma: the future role of competency-based medical education. Bone Joint J 98-B:13201325, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 62

    Park YS, Zar FA, Norcini JJ, Tekian A: Competency evaluations in the next accreditation system: contributing to guidelines and implications. Teach Learn Med 28:135145, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 63

    Parker SL, McGirt MJ, Asher AL, Selden NR: Quality improvement in neurological surgery graduate medical education. Neurosurg Clin N Am 26:231238, ix, 2015

  • 64

    Phan PN, Patel K, Bhavsar A, Acharya V: Do we need to overcome barriers to learning in the workplace for foundation trainees rotating in neurosurgery in order to improve training satisfaction? Adv Med Educ Pract 7:211217, 2016

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 65

    Pitt MB, Borman-Shoap EC, Eppich WJ: Twelve tips for maximizing the effectiveness of game-based learning. Med Teach 37:10131017, 2015

  • 66

    Prystowsky JB, Regehr G, Rogers DA, Loan JP, Hiemenz LL, Smith KM: A virtual reality module for intravenous catheter placement. Am J Surg 177:171175, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 67

    Qureshi NS, Swamy NN: Postgraduate trainees’ assessment of the educational value of ward rounds in obstetrics and gynaecology. J Obstet Gynaecol 28:671675, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 68

    Reddy ST, Endo J, Gupta S, Tekian A, Park YS: A case for caution: chart-stimulated recall. J Grad Med Educ 7:531535, 2015

  • 69

    Regehr G, MacRae H, Reznick RK, Szalay D: Comparing the psychometric properties of checklists and global rating scales for assessing performance on an OSCE-format examination. Acad Med 73:993997, 1998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 70

    Reznick R, Regehr G, MacRae H, Martin J, McCulloch W: Testing technical skill via an innovative “bench station” examination. Am J Surg 173:226230, 1997

  • 71

    Reznick RK, MacRae H: Teaching surgical skills—changes in the wind. N Engl J Med 355:26642669, 2006

  • 72

    Riffaud L, Neumuth T, Morandi X, Trantakis C, Meixensberger J, Burgert O, et al.: Recording of surgical processes: a study comparing senior and junior neurosurgeons during lumbar disc herniation surgery. Neurosurgery 67 (2 Suppl Operative):325332, 2010

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 73

    Rosseau G, Bailes J, del Maestro R, Cabral A, Choudhury N, Comas O, et al.: The development of a virtual simulator for training neurosurgeons to perform and perfect endoscopic endonasal transsphenoidal surgery. Neurosurgery 73 (Suppl 1):8593, 2013

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 74

    Sarkiss CA, Philemond S, Lee J, Sobotka S, Holloway TD, Moore MM, et al.: Neurosurgical skills assessment: measuring technical proficiency in neurosurgery residents through intraoperative video evaluations. World Neurosurg 89:18, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 75

    Schirmer CM, Elder JB, Roitberg B, Lobel DA: Virtual reality-based simulation training for ventriculostomy: an evidence-based approach. Neurosurgery 73 (Suppl 1):6673, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 76

    Schirmer CM, Mocco J, Elder JB: Evolving virtual reality simulation in neurosurgery. Neurosurgery 73 (Suppl 1):127137, 2013

  • 77

    Selden NR, Abosch A, Byrne RW, Harbaugh RE, Krauss WE, Mapstone TB, et al.: Neurological surgery milestones. J Grad Med Educ 5 (1 Suppl 1):2435, 2013

  • 78

    Selden NR, Anderson VC, McCartney S, Origitano TC, Burchiel KJ, Barbaro NM: Society of Neurological Surgeons boot camp courses: knowledge retention and relevance of hands-on learning after 6 months of postgraduate year 1 training. J Neurosurg 119:796802, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 79

    Selden NR, Barbaro N, Origitano TC, Burchiel KJ: Fundamental skills for entering neurosurgery residents: report of a Pacific region “boot camp” pilot course, 2009. Neurosurgery 68:759764, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 80

    Selden NR, Origitano TC, Burchiel KJ, Getch CC, Anderson VC, McCartney S, et al.: A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery 70:971981, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 81

    Sonnadara RR, Mui C, McQueen S, Mironova P, Nousiainen M, Safir O, et al.: Reflections on competency-based education and training for surgical residents. J Surg Educ 71:151158, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 82

    Stanley P: Structuring ward rounds for learning: can opportunities be created? Med Educ 32:239243, 1998

  • 83

    Stredney D, Rezai AR, Prevedello DM, Elder JB, Kerwin T, Hittle B, et al.: Translating the simulation of procedural drilling techniques for interactive neurosurgical training. Neurosurgery 73 (Suppl 1):7480, 2013

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 84

    Sundar SJ, Healy AT, Kshettry VR, Mroz TE, Schlenk R, Benzel EC: A pilot study of the utility of a laboratory-based spinal fixation training program for neurosurgical residents. J Neurosurg Spine 24:850856, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 85

    Taylor DC, Hamdy H: Adult learning theories: implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach 35:e1561e1572, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 86

    Van Der Vleuten CP: The assessment of professional competence: developments, research and practical implications. Adv Health Sci Educ Theory Pract 1:4167, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 87

    van Hove PD, Tuijthof GJ, Verdaasdonk EG, Stassen LP, Dankelman J: Objective assessment of technical surgical skills. Br J Surg 97:972987, 2010

  • 88

    Vygotsky LS: Interaction between learning and development, in Gauvin M, Cole M (eds): Mind and Society. Readings on the Development of Children. Cambridge, MA: Harvard University Press, 1978, pp 7991

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 89

    Walton JM, Steinert Y: Patterns of interaction during rounds: implications for work-based learning. Med Educ 44:550558, 2010

  • 90

    Winckel CP, Reznick RK, Cohen R, Taylor B: Reliability and construct validity of a structured technical skills assessment form. Am J Surg 167:423427, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 91

    Zevin B, Bonrath EM, Aggarwal R, Dedy NJ, Ahmed N, Grantcharov TP, et al.: Development, feasibility, validity, and reliability of a scale for objective assessment of operative performance in laparoscopic gastric bypass surgery. J Am Coll Surg 216:955965, 965.e1–965.e8, 1029–1031, 1033, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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