Cent Eur Neurosurg 2011; 72(4): 192-195
DOI: 10.1055/s-0030-1261906
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Training Microneurosurgery – Four Years Experiences with an in vivo Model

J. Regelsberger1 , O. Heese1 , P. Horn2 , M. Kirsch3 , S. Eicker4 , M. Sabel4 , M. Westphal1
  • 1Department of Neurosurgery, University Medical center Hamburg Eppendorf, Germany
  • 2Charite University Medicine, Neurosurgery, Berlin, Germany
  • 3Department of Neurosurgery, Faculty of Medicine, Carl Gustav Carus, Dresden, Germany
  • 4Heinrich-Heine University, Neurosurgery, Düsseldorf, Germany
Further Information

Publication History

Publication Date:
15 July 2010 (online)

Abstract

Objective: Enquiries among surgical trainees revealed an increasing discontent regarding their quality of training. 40 % of young surgical trainees judge their training as inadequate and 70% are offered no structured training programme. Working time restrictions and economic pressure may be strong factors hindering residents from becoming skillful surgeons. Therefore, additional forms of training seem to be needed.

Method: An in vivo swine model was evaluated for its practical use in training neurosurgical residents. Surgical procedures included craniotomy, dural opening, brain surgery and excision of an artificial tumour created by injection of coloured fibrin glue. Microscopy and bleeding management with bipolar cautery and haemostyptics were an integrated part of training. Supervision by experienced neurosurgeons with up to 3 trainees in a 2-day course was warranted. Standardised questionnairies before and after training were used to assess the quality and utility of the programme.

Results: 24 residents have participated in the course (1st–5th year of training). Minor experience with less than 100 conducting surgeries was seen in 59% of trainees. 14 residents had participated in more than 100 surgeries as first assistant. Spinal surgery was the predominant common experience. All participants judged their surgical training as insufficient. 77% had no microsurgical lab at their clinics. Expectations for the course were met for all trainees and the tutorials judged as excellent (65%) or good (35%). Positive evaluations of the in vivo model (97%), a realistic laboratory setup (94%), the working environment (94%) and close supervision (94%) showed that these were the most favourable aspects of the course.

Conclusion: Educational training in surgical specialities is becoming a major problem in our daily practice and requires additional training facilities. In this context, in vivo models are an ideal opportunity for young neurosurgeons to train bleeding management and surgical complications in particular. This educational form is thought to be a unique training model which is now added by spinal and neurovascular courses.

References

  • 1 Aboud E, Al-Mefty O, Yasargil MG. New laboratory model for neurosurgical training that simulates live surgery.  J Neurosurg. 2002;  97 1367-1372
  • 2 Bastani PP, Osada N, Schwering I. et al . Development of an instructional and learning system for neurosurgery.  Stud Health Technol Inform. 2000;  77 490-493
  • 3 Brennum J. European neurosurgical education – the next generation.  Acta Neurochir (Wien). 2000;  142 1081-1087
  • 4 Brennum J, Gjerris F. Morbidity & mortality conferences – how can we do it?.  Acta Neurochir Suppl. 2004;  90 67-71
  • 5 Chikwe J, de Souza AC, Pepper JR. No time to train the surgeons.  BMJ. 2004;  328 418-419
  • 6 Curet MJ. Resident work hour restrictions: where are we now?.  J Am Coll Surg. 2008;  207 767-776
  • 7 Dimitris KD, Taylor BC, Fankhauser RA. Resident work-week regulations: historical review and modern perspectives.  J Surg Educ. 2008;  65 290-296
  • 8 Eroes CA, Barth C, Tonn JC. et al . The revised European neurosurgical electronic logbook of operations.  Acta Neurochir (Wien). 2008;  150 195-198
  • 9 Grady MS, Batjer HH, Dacey RG. Resident duty hour regulation and patient safety: establishing a balance between concerns about resident fatigue and adequate training in neurosurgery.  J Neurosurg. 2009;  110 828-836
  • 10 Gruber A, Bavinszki G, Killer M. et al . In vitro training model for endovascular embolization of cerebral aneurysms.  Minim Invasive Neurosurg. 1997;  40 121-123
  • 11 Hansen KV, Brix L, Pedersen CF. et al . Modelling of interaction between a spatula and a human brain.  Med Image Anal. 2004;  8 23-33
  • 12 Jagannathan J, Vates GE, Pouratian N. et al . Impact of the accreditation council for graduate medical education work-hour regulations on neurosurgical resident education and productivity.  J Neurosurg. 2009;  110 820-827
  • 13 Mazotti LA, Vidyarthi AR, Wachter RM. et al . Impact of duty-hour restriction on resident inpatient teaching.  J Hosp Med. 2009;  4 476-480
  • 14 Miller K, Chinzei K, Orssengo G. et al . Mechanical properties of brain tissue in-vivo: experiment and computer simulation.  J Biomech. 2000;  33 1369-1376
  • 15 Mooij JJ. Introduction of ISO 9000 and other quality concepts applied to neurosurgery.  Acta Neurochir Suppl. 2001;  78 201-202
  • 16 Moreau JJ, Caire F, Kalamarides M. et al . Changing the teaching of neurosurgery with information technology.  Presse Med. 2009;  38 1425-1433
  • 17 Olabe J. Microsurgical training on an in vitro chicken wing infusion model.  Surg Neurol. 2009;  72 (6) 695-699
  • 18 Olabe J, Sancho V. Human cadaver brain infusion model for neurosurgical training.  Surg Neurol. 2009;  72 (6) 70-702
  • 19 Ovens L. No time to train the surgeons: learning from the New Zealand experience.  BMJ. 2004;  328 1134 discussion 1134–1135
  • 20 Pickard JD, Richards HK. Principles of quality management in medicine: the British concept.  Acta Neurochir Suppl. 2001;  78 45-52
  • 21 Ponnusamy K, Chewning S, Mohr C. Robotic approaches to the posterior spine.  Spine (Phila Pa 1976). 2009;  34 2104-2109
  • 22 Reulen HJ. The semi-annual residency rotation summary: a means to assess the quality of neurosurgical training.  Acta Neurochir Suppl. 2001;  78 159-164
  • 23 Reulen HJ. Harmonisation of neurosurgical training in the European countries – a personal view.  Acta Neurochir (Wien). 2003;  145 523-525
  • 24 Seiler RW. Principles of the morbidity and mortality conference.  Acta Neurochir Suppl. 2001;  78 125-126
  • 25 Sure U, Miller D, Bozinov O. Neurosurgical training in Europe, problems and possible solutions.  Surg Neurol. 2007;  67 626-628 discussion 628–633
  • 26 Swide CE, Kirsch JR. Duty hours restriction and their effect on resident education and academic departments: the American perspective.  Curr Opin Anaesthesiol. 2007;  20 580-584
  • 27 Thomson S, Phillips N. Internet resources for neurosurgeons and neuropathologists.  J Neurol Neurosurg Psychiatry. 2003;  74 154-157
  • 28 Trojanowski T. Report of the JRAAC on the situation of the accreditation training programmes in Europe.  Acta Neurochir (Wien). 2008;  150 515-517
  • 29 Vloeberghs M, Glover A, Benford S. et al . Virtual neurosurgery, training for the future.  Br J Neurosurg. 2007;  21 262-267

Correspondence

Dr. J. Regelsberger

Universitätsklinik Eppendorf Hamburg

Neurochirurgische Klinik

Martinistraße 52

20249 Hamburg

Germany

Phone: +49/4042/803 3751

Fax: +49/4042/803 7406

Email: j.regelsberger@uke.uni-hamburg.de

    >