VISION: The Globalization of Safe Neurosurgery through Simulation.
MISSION: To Develop the World’s Most Advanced Neurosurgical Simulation Research and Training Centre at McGill University.
Surgical simulation with haptic feedback and visual and tactile reality is an emerging field that has the potential to revolutionize research and training in all surgical specialities because of its ability to develop metrics which can assess, quantify and train technical skills, lessen human error and therefore improve patient outcomes.
Assessment is an essential element in the evaluation of psychomotor skills during surgical training. Proficiency-based training and assessment implies that the trainee has to achieve a set of predefined criteria during their training to move to the next level in a safe and controlled learning environment. While proficiency-based training is practiced in many disciplines, for neurosurgery and other surgical specialties technical skills learning is linked to chronology; e.g. skills learned during the specific period of time spent in a residency program and in the operating room (6-7 years) in a novice/expert apprenticeship model. Proficiency-based training ensures that specific criteria have been met while chronological-based training does not guarantee that a resident has achieved a degree of skill commiserate with competency in the surgical care of patients.
Surgical competence is the ability of performing specific surgical skills successfully and encompasses knowledge, technical, and social skills to solve familiar and novel situations to provide adequate patient care. Interestingly, this definition focuses on “adequate” rather than “excellent” or “expert” patient care and what constitutes an expert in the field of neurosurgery has not been clearly defined. Cadavers, animal models, synthetic phantoms, manikin-based, and other mechanical simulators are all used for neurosurgical training purposes. These models have the disadvantages of lack of realism, absence of disease-related pathology and bleeding and no limits on surgical exposure. The utilization of virtual reality (VR) simulators and appropriate metric technologies could address some of these shortcomings in the assessment and teaching of bimanual psychomotor skills.
The ultimate goal of simulation-based training is to eliminate patient risks associated with technical skills learning. The learner achieves the desired learning outcome in a safe simulated environment where one can repeat the simulated procedure(s) with appropriate demonstrator and metric feedback. The Neurosurgical Simulation Research and Training Centre opened at the Montreal Neurological Institute and Hospital in 2010 and its vision statement reads: The Globalization of Safe Neurosurgery through Simulation.
The goal of Neurosurgical Simulation Research and Training is to simulate all neurosurgical procedures with appropriate tactile and visual reality. To begin to accomplish our vision and goal it was necessary to outline the promise of surgical simulation which included: critical assessment of neurosurgical expertise, the ability to assess how expert surgeons do surgical operations. How important are tactile, visual and cognitive components to surgical expertise and outcome? What is surgical expertise? Critical assessment of the reasons for neurosurgical errors: how and why do errors occur? Can they be prevented? How are is education theory applied to neurosurgery? What is the role of the teacher, repetition, rehearsal, and other factors to surgical skills acquisition? What is the role of proficiency-based training and use of benchmarks? What is the role of simulation in selection, teaching and retraining of surgeons?
We then took the necessary steps to fulfill our vision and goal which included:
- Developed an excellent collaborative and working relationship with Dr. Robert DiRaddo, Group Leader, Simulation, Life Sciences Division, National Research Council of Canada (NRC) at Boucherville and all his team utilizing their expertise in the development of simulation platforms. This collaboration resulted in the development of and publication of the NeuroTouch VR simulation platform (caeneurovr.com).
- Adapted the aviation industry model to develop a set of essential research requirements including
- Development of realistic scenarios developed with input from a consortium of neurosurgeons and experts in education
- Measurement of bimanual psychomotor performance utilizing virtual reality simulators (NeuroTouch/NeuroVR) with haptic feedback in appropriate learning environments
- Development novel metrics which emphasize patient safety
- Carrying out multiple levels of validation
- Development of proficiency performance benchmarks
- Development of the concept of individual Technical Ability Customized Training (TACT) to expand the potential of all surgical trainees. We have carried out research in each of these areas and published our results (see Publications).
- Included other surgical specialties in our program including Otolaryngology – Head and Neck Surgery (see Publications) and Orthopedics and Spine surgery with the AO Foundation, demonstrating that scenario development and our innovative metrics can be applied to other surgical specialities.
The Neurosurgical Simulation Research and Training Centre academic mission provides a model that allows one to develop and design the world’s most advanced Neurosurgical Simulation Research and Training Centre at McGill.