RSS-Feed abonnieren

DOI: 10.4103/ajns.AJNS_463_20
Simulation training for neurosurgical residents: Need versus reality in Indian Scenario

Sir,
Neurosurgical training is provided at 156 training centers across India[[1]],[[2]] and most of the neurosurgical training programs are based on the traditional apprenticeship model. Changing health-care scenarios, for example, high patient satisfaction demands, cost constraints, ethical issues of practicing on patients, and intolerant and hostile attitude of our society toward surgical mis-happenings in the past two decades have reduced learning opportunities of neurosurgical residents.[[3]],[[4]] Some centers have started to follow outcome-based reimbursements and reporting surgeon specific outcome data. In many instances, these factors practically lead to qualified faculty members performing the larger part of procedures themselves and thus reducing the required hands-on experience for resident trainees. To add to this list, there has been a disproportionate increase in the number of neurosurgical seats, without regard to actual training opportunities.[[5]] As most of the neurosurgery training programs in India follow the traditional apprenticeship model only, an unplanned increase in the number of residents is decreasing their surgical exposure. Thus, the need of better training is obvious for producing competent neurosurgeons. Laboratory training/simulation is an avenue that can augment the training prospects of neurosurgical trainees and has the capability to shorten the arduous learning curve of neurosurgery. It can provide uniformity in neurosurgical education and is a good tool of assessment also.[[6]],[[7]],[[8]] We made telephonic inquiries to faculty members/alumni of major neurosurgical training centers across various Indian states about the availability of simulation facilities and whether they are being utilized for resident training or not. Institute websites were also searched for these details. We have discussed the present status of simulation facilities for neurosurgical postgraduate students in India and shared our views on the challenges as well as possible solutions for the inclusion of laboratory training into the training curriculum. We have also mentioned our experience of starting simulation training in the form of cadaver dissection.
Current Situation in India
In India, there are two types of programs for a medicine graduate who aspires to be a neurosurgeon, namely Magister Chirurgiae/Master of Chirurgiae (Mch) and Diplomate of National Board (DNB). The course duration is 3 years for a candidate who joins the program after completing general surgery residency and 6 years for those who join directly after finishing graduation (MBBS). Currently, there are about 156 centers in India where there is a neurosurgical residency program (88 providing Mch training + 68 providing DNB training).[[1]],[[2]] Mch training centers are largely in government-funded medical colleges, while most of the DNB programs are run by private hospitals. As compared to a large number of training centers, only a few utilize simulation regularly for their neurosurgical trainees. [[Table 1]] mentions a list of neurosurgical training centers with availability of simulation facilities in India. {Table 1}


The Neurosurgery Education and Training School (NETS) at All India Institute of Medical Sciences (AIIMS), New Delhi, is a nonprofit-based education and skills training platform established with Indo-German and medico-technological collaboration with the Indian Institute of Technology, Delhi, India. This is probably the only one of a kind facility dedicated to neurosurgery in India, which offers well-structured modules for both trainee as well as practicing neurosurgeons through its multiple cadaveric as well as computer and noncomputer based simulation programs.[[9]]
Neta Ji Subhash Chander Bose (NSCB) Medical College, Jabalpur, utilizes an anatomy dissection hall for their neuroendoscopy-training program organized twice a year and they have a small departmental laboratory also. Himalayan Institute, Dehradun, Ramaiah Institute, Bengaluru, and DY Patil Institute, Kolhapur, have good simulation (cadaveric dissection) labs. Although these laboratories use well-structured dissection programs as a part of training workshops, most of the participants are practicing neurosurgeons and information about regular use of dedicated resident training modules for their own postgraduates of neurosurgery is lacking.
[[Table 2]] provides a list of simulation workshops organized on a regular basis. Although these meetings are open to residents and offer discounted course fees for them, the majority of participants are qualified neurosurgeons in their early career.{Table 2}


The 1st day of annual conferences of two professional neurosurgical societies of India, namely neurological Society of India (NSI) in collaboration with Congress of Neurological Surgeons, USA, and Neurological Surgeons Society of India (NSSI), is dedicated to various simulation workshops for residents as a fixed event. However, these two events are usually held only once a year and the number of residents that can take part is limited. CEMAST, Mumbai, is a nonprofit organization run by surgeons with grants from Karl Stroz, Germany, which caters to minimal access surgical training of 17 specialties including neurosurgery and skull base surgery. It also runs multiple workshops over year.[[10]]
Hence, it is obvious that simulation facilities that are dedicated for residents during their training period and available round the year at their disposal are very few as compared to large number of neurosurgical trainees trained every year.
#
Financial support and sponsorship
Prof Radhey Shyam Mittal is currently serving as president of Neurological Surgeons Society of India.
Dr Chandershker E. Deopujari is co- chairman WFNS neuroendoscopy committee, memeber educational committee, Neurological Society of India and is associated with CEMAST.
However, there are no financial disclosures to be made.
Publikationsverlauf
Eingereicht: 09. Oktober 2020
Angenommen: 17. Dezember 2020
Artikel online veröffentlicht:
16. August 2022
© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Available from: https://www.mciindia.org/CMS/information-desk/college-and-course-search. [Last accessed on 2020 Jun 10].
- 2 Available from: https://accr.natboard.edu.in/online_user/frontpage.php?v=4. [Last accessed on 2020 Jun 10].
- 3 Suri A, Roy TS, Lalwani S, Deo RC, Tripathi M, Dhingra R, et al. Practical guidelines for setting up neurosurgery skills training cadaver laboratory in India. Neurol India 2014;62:249-56.
- 4 Bajaj J, Yadav YR, Pateriya A, Parihar V, Ratre S, Dubey A. Indigenous inexpensive practice models for skill development in neuroendoscopy. J Neurosci Rural Pract 2017;8:170-3.
- 5 Ramesh VG. Neurosurgical teaching in the present context. Neurol India 2015;63:1003-4.
- 6 Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC. The role of laboratory dissection training in neurosurgical residency: Results of a national survey. World Neurosurg 2014;82:554-9.
- 7 Liu JK, Kshettry VR, Recinos PF, Kamian K, Schlenk RP, Benzel EC. Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training. J Neurosurg 2015;123:1331-8.
- 8 Harrop J, Lobel DA, Bendok B, Sharan A, Rezai AR. Developing a neurosurgical simulation-based educational curriculum: An overview. Neurosurgery 2013;73 Suppl 1:25-9.
- 9 Suri A. Simulation in neurosurgery in India-NETS. CNSq 2014;15:23-6.
- 10 Available from: https://www.cemast.org. [Last accessed on 2020 Jul 20].
- 11 Dardick J, Allen S, Scoco A, Zampolin RL, Altschul DJ. Virtual reality simulation of neuroendovascular intervention improves procedure speed in a cohort of trainees. Surg Neurol Int 2019;10:184.
- 12 Sharma G, Aycart MA, Najjar PA, van Houten T, Smink DS, Askari R, et al. A cadaveric procedural anatomy course enhances operative competence. J Surg Res 2016;201:22-8.
- 13 Belykh E, Miller EJ, Lei T, Chapple K, Byvaltsev VA, Spetzler RF, et al. Face, content, and construct validity of an aneurysm clipping model using human placenta. World Neurosurg 2017;105:952-6000.
- 14 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 2014;121:228-46.
- 15 Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A Systematic review of simulation-based training in neurosurgery, Part 1. Cranial Neurosurg World Neurosurg 2020;133:e850-73.
- 16 Patel EA, Aydin A, Cearns M, Dasgupta P, Ahmed K. A Systematic review of simulation-based training in neurosurgery part 2. Spinal Pediat Surg 2020;133:e874-92.
- 17 Gnanakumar S, Kostusiak M, Budohoski KP, Barone D, Pizzuti V, Kirollos R, et al. Effectiveness of cadaveric simulation in neurosurgical training: A review of the literature. World Neurosurg 2018;118:88-96.
- 18 Byvaltsev VA, Akshulakov SK, Polkin RA, Ochkal SV, Stepanov IA, Makhambetov YT, et al. Microvascular anastomosis training in neurosurgery: A review. Minim Invasive Surg 2018;2018:6130286. doi: 10.1155/2018/6130286.
- 19 Suri A, Patra DP, Meena RK. Simulation in neurosurgery: Past, present, and future. Neurol India 2016;64:387-95.
- 20 Gmeiner M, Dirnberger J, Fenz W, Gollwitxer M, Wurm G, Trenkler J, et al. Virtual cerebral aneurysm clipping with real-time haptic force feedback in neurosurgical education. World Neurosurg 2018;112:e313-23.
- 21 Oliveira Magaldi M, Nicolato A, Godinho JV, Santos M, Prosdocimi A, Malheiros JA, et al. Human placenta aneurysm model for training neurosurgeons in vascular microsurgery. Operat Neurosurg 2014;10:592-601.
- 22 Russin JJ, Mack WJ, Carey JN, Minneti M, Giannotta S. Simulation of a high-flow extracranial-intracranial bypass using a radial artery graft in a novel fresh tissue model. Operat Neurosurg 2012;71:315-20.
- 23 Pereia EA, Aziz TZ. Simulation in spinal surgery and the transition from novice to expert. World Neurosurg 2015;84:1511-2.
- 24 Trojanowski T. Certification of competence in neurosurgery-the European perspective. World Neurosurg 2010;74:432-3.
- 25 Kim BJ, Kim ST, Jeong YG, lee WH, Lee KS, Paeng SH. An efficient microvascular anastomosis training model based on chicken wings and simple instruments. J Cerebrovasc Endovasc Neurosurg 2013;15:20-5.
- 26 Rashim K, Verma Pawan K, Sinha VD. Increasing the safety of surgical treatment for complex Cranio-vertebral anomalies using customized 3D printed models. J Clin Neurosci 2018;48:203-8.
- 27 Deopujari CE, Karmarkar VS, Shaikh ST, Gadgil US. Developing a dynamic simulator for endoscopic intraventricular surgeries. Childs Nerv Syst. 2019 35:621-27. doi: 10.1007/s00381-019-04087-2. Epub 2019 Feb 20. PMID: 30788583.
- 28 Teegala R; 2014. Available from: https://www.quickcompany.in/patents/a-medical-training-device-for endoscopic- third-ventriculostomy-procedure-and-a-methodthereof#specification. [Last retrieved on 2019 Jan 12].
- 29 Bernardo A. Virtual reality and simulation in neurosurgical training. World Neurosurg 2017;106:1015-29.
- 30 Oliveira LM, Figueiredo EG. Simulation training methods in neurological surgery. Asian J Neurosurg 2019;14:364-70.
- 31 Bohl MA, McBryan S, Spear C, Pais D, Preu MC, Wilhelmi B, et al. Evaluation of a novel surgical skills training course: Are cadavers still the gold standard for surgical skills training? World Neurosurg. 2019;127:63-71.
- 32 Shono N, Kin T, Nomura S, Miyawaki S, Saito T, Imai H, et al. Microsurgery simulator of cerebral aneurysm clipping with interactive cerebral deformation featuring a virtual arachnoid. Operat Neurosurg 2018;14:579-89.
- 33 Aboud E, Aboud G, Al-Mefty O, Aboud T, Rammos S, Abolfotoh M, et al. Live cadavers for training in the management of intraoperative aneurysmal rupture. J Neurosurg 2015;123:1339-46.
- 34 Zada G, Bakhsheshian J, Pham M, Minneti M, Christian E, Winer J, et al. Development of a perfusion-based cadaveric simulation model integrated into neurosurgical training: Feasibility based on reconstitution of vascular and cerebrospinal fluid systems. Oper Neurosurg (Hagerstown) 2018;14:72-80.
- 35 Henn JS, Lemole MG, Ferreira MA, Gonzalez LF, Schornak M, Preul MC, et al. Interactive stereoscopic virtual reality: A new tool for neurosurgical education. J Neurosurg 2002;96:144-9.
- 36 Memon I. Cadaver dissection is obsolete in medical training! A misinterpreted notion. Med Princ Pract 2018;27:201-10.