As background to this paper the authors mention some external pressures on surgical resident education due to changes in modern health care. On the one hand, health care is constantly striving for greater efficiency and accountability. On the other hand, mandated reductions in on-duty hours have curtailed residents' practical surgical experience. The authors state that these pressures have spurred surgical educational programs to respond with innovative ways to supplement and assess residents' surgical capabilities. The Department of Neurosurgery at the Cleveland Clinic chose to establish a surgical skills laboratory and corresponding curricula for junior- and senior-level resident training.
The authors describe their experience in creating the lab and corresponding coursework. Surgical skills labs are not new, but a formal curriculum of structured dissection and provision of all the materials for that purpose are relatively novel and have not been established in all neurosurgical programs. The authors list basics needed to establish such a program, specifically lab space, funding, and equipment. They offer a review of their experience to show how they were able to set up a fully equipped facility at the Cleveland Clinic while keeping costs down.
Space was allocated within the institution. Most of the equipment used to fill that space was donated by industry. The Department of Neurosurgery provided minimal start-up funds. The authors obtained funding through educational grants from the Cleveland Clinic as well as from industry for equipment that was not donated.
The authors describe in detail the equipment needed to simulate the surgical experience. A number of dissection stations were outfitted to resemble the setup in the operating room. Added to these was a master dissection station where demonstrations can be made. The master station includes a video monitor on which trainees can follow microscopic procedures and a video capture unit to retain videos and still pictures for educational archives. Each station has a variety of tools necessary to perform anatomical dissection: operating microscopes, high-speed drills, and portable electric aspirators, to name a few. The authors mention various ways of procuring new and refurbished equipment and supplies for little or no money. They even suggest the purchase of veterinary surgical equipment because it is often less expensive than items used in human operations.
Of course, you cannot have a surgical skills lab without anatomical specimens. The authors tell us that a minimum of two cadaveric specimens are sufficient for a year- long curriculum, although the availability of more specimens can enhance the surgical educational experience and allow residents the means for extra practice. The authors describe specimen preservation techniques that provide realistic experiences for the residents and prolong the use of each specimen. They also outline how curriculum topics can be arranged so that specimens last throughout the course of study.
Attending neurosurgeons and neurosurgical residents provided feedback on the new lab and curricula by responding to an internal survey. The attending surgeons all agreed that the lab and curricula were excellent additions to resident education, and almost all stated that the surgical skills of their trainees improved after the experience. All respondents also agreed that proficiency of certain skills and techniques in the lab should become a prerequisite to performing them in the operating room. Likewise, nearly all residents found that the lab and curricula improved their experience in understanding anatomical relationships and mastering surgical approaches. Full coverage of the results of this survey is provided in the paper as well.
A recent survey conducted by the Cleveland Clinic found that 94% of responding US neurosurgical programs provide residents with access to cadaver or animal dissection, but only 59% of the programs provide regularly scheduled dissection sessions and additional lab time for individual practice. Ninety-six percent (96%) of respondents stated that an anatomical dissection curriculum should be incorporated into all neurosurgical resident educational programs. The authors would like to see this occur.
When asked about the new program, Dr. Liu responded, "Our experience serves as a proof of concept that a surgical skills lab and dissection curricula can be achieved at any training program, and we have provided a blueprint to do so. The addition of this resource has resulted in a more comprehensive training environment, one that is likely to become the standard in the future of surgical training."
INFORMATION:
Liu JKC, Kshettry VR, Recinos PF, Kamian K, Schlenk RP, Benzel EC:
Establishing a surgical skills laboratory and dissection curriculum for neurosurgical residency training. Journal of Neurosurgery, published online, ahead of print, May 26, 2015; DOI: 10.3171/2014.11.JNS14902.
Disclosures: The Cleveland Clinic surgical skills lab is supported in part by an educational grant from Stryker. In addition, previous product donations and grants for the laboratory were obtained from Covidien, Medtronic, Synthes Anspach, and Aesculap.
For additional information, please contact:
Ms. Jo Ann M. Eliason, Communications Manager
Journal of Neurosurgery Publishing Group
One Morton Drive, Suite 200, Charlottesville, VA 22903
Email: jaeliason@thejns.org Phone 434-982-1209; Fax 434-924-2702
For 71 years, the Journal of Neurosurgery has been recognized by neurosurgeons and other medical specialists the world over for its authoritative clinical articles, cutting-edge laboratory research papers, renowned case reports, expert technical notes, and more. Each article is rigorously peer reviewed. The Journal of Neurosurgery is published monthly by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons. Other peer-reviewed journals published by the JNS Publishing Group each month include Neurosurgical Focus, the Journal of Neurosurgery: Spine, and the Journal of Neurosurgery: Pediatrics. All four journals can be accessed at http://www.thejns.org.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,300 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, and peripheral nerves. For more information, visit http://www.AANS.org.
