Practice Makes Perfect? The Role of Simulation-Based Deliberate Practice and Script-Based Mental Rehearsal in the Acquisition and Maintenance of Operative Neurosurgical Skills

Neurosurgery (Impact Factor: 3.62). 01/2013; 72:A124-A130. DOI: 10.1227/NEU.0b013e318270d010


Despite significant advances in technology and intraoperative techniques over the last century, operations on the brain and spinal cord continue to carry a significant risk of serious morbidity or mortality. Potentially avoidable technical errors are well recognized as contributing to poor surgical outcome. Surgical education is undergoing overwhelming change, in part as a result of changes in the economic, political, social, cultural, and technological climates in which it operates. Shortened training, reductions in the working week, economic difficulties, and increasing emphasis on patient safety have required educators to radically rethink the way in which surgical education is delivered. This has resulted in the development of simulation technology, mental script-based rehearsal, and simulation-based deliberate practice. Although these tools and techniques are garnering increasing evidence for their efficacy, the evidence for their use in neurosurgery is somewhat more limited. Here, we review the theory behind these tools and techniques and their application to neurosurgery. We conclude that further research into the utility of these tools and techniques is essential for determining their widespread adoption. If they ultimately prove to be successful, they may have a central role in neurosurgical training in the 21st century, improving the acquisition of technical skills in a specialty in which a technical error can result in grave consequences. ABBREVIATION: LC, laparoscopic cholecystectomy

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    • "Without exception , these studies demonstrate consistent and robust improvements in clinical performance based on deliberate practice principles. Simulation-based deliberate practice studies in medicine versus nursing are also more likely to use research designs that include preintervention baseline measurement and comparison groups (Kessler, Auerbach, Pusic, Tunik, & Foltin, 2011; Marcus, Vakharia, Kirkman, Murphy, & Nandi, 2013; McGaghie et al., 2011). "
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    ABSTRACT: The purpose of this study was to establish the efficacy of a deliberate practice intervention designed to enhance levels of clinical performance in senior baccalaureate nursing students.MethodA randomized control design was used. Forty participants were randomly assigned to control and intervention groups.ResultsThe deliberate practice-based intervention resulted in statistically significant improvements to key aspects of participants' efforts in each of the four scenarios.Conclusions The deliberate practice protocol prompted participants to reconsider and act on salient stimuli present in the simulated task environment, resulting in substantive performance improvement.
    Clinical Simulation in Nursing 11/2014; DOI:10.1016/j.ecns.2014.10.005
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    ABSTRACT: The past decade has seen significant changes to the face of neurosurgical training in the United Kingdom, driven in part by an increasing focus on patient safety and the introduction of Modernising Medical Careers and the European Working Time Directive (EWTD). Recent reforms to neurosurgical training over the past few years have resulted in creation of an 8-year 'run-through' training programme. In this programme, early years (ST1 and ST2) trainees often lack dedicated time for elective theatre lists and outpatient clinics. Further, any time spent in theatre and clinics is often with different teams. Here we describe a training model for early years trainees at the National Hospital for Neurology and Neurosurgery, who are given the responsibilities traditionally associated with a more senior trainee including dedicated weekly theatre and clinic time under the supervision of a single consultant, in addition to out of hours experience. The advantages and considerations for implementing this model are discussed, including the benefit of guidance under a single consultant in the early stages of training, along with key educational concepts necessary for understanding its utility. We feel that this is an effective model for junior neurosurgical training in the EWTD era, expediting the trainee's development of key technical and non-technical skills, with potentially significant rewards for patient, trainee and trainer. National implementation of this model should be considered.
    British Journal of Neurosurgery 05/2013; 27(5). DOI:10.3109/02688697.2013.793290 · 0.96 Impact Factor
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    ABSTRACT: Purpose: NeuroTouch is a virtual reality (VR) simulator developed for neurosurgical skill training. Validation demonstrating that the system is useful and reliable is required for formal adoption into training curriculums. Face and content validity have been demonstrated for some neurosurgical simulators, but construct validity remains difficult to establish. A pilot validation study was conducted for a NeuroTouch training exercise. Methods: Participants completed the internal resection of a simulated convexity meningioma and filled out questionnaires to provide feedback on the experience. Performance metrics included volume of tissues removed, tool path lengths, duration of excessive forces applied and efficient use of the aspirator. Results were analyzed according to participants' level of training, gender, handedness, surgical experience in meningioma removal and hours/week playing musical instruments or video games. Results: Seventy-two participants (10 medical students, 18 junior residents and 44 senior residents) were enrolled. Analyses demonstrated statistically significant increase in tumor removed and efficiency of ultrasonic aspirator use between medical students and residents, but not between junior and senior residents. After covariate adjustment for the number of meningioma cases operated on, multivariate analysis of the level of training became nonsignificant. Participants judged the exercise appropriate and realistic, desiring use of the system in current training programs. Conclusion: We have conducted a pilot validation study for the NeuroTouch tumor resection scenario and demonstrated for the first time, face, content and construct validity of a VR neurosurgical simulation exercise. Future full-scale studies will be conducted in noncompetitive settings and incorporate expert participants.
    International Journal of Computer Assisted Radiology and Surgery 06/2013; 9(1). DOI:10.1007/s11548-013-0905-8 · 1.71 Impact Factor
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