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Cadaver-less anatomy: New paradigms in Neurosurgical Simulation Training

Oral Presentation 8
Jamal Ross

Cadaver-less anatomy: New paradigms in Neurosurgical Simulation Training

Neurosurgery is one of the most unforgiving surgical specialties and thus junior doctors are rarely afforded opportunities to practice and gain new skills in the OR, in the interest of patient safety. In many instances, junior doctors become passive observers and are delegated very simple tasks that do not enrich their understanding or lead to skill acquisition. We set out to use the VARK model of learning which encompasses, visual,. Auditory, reading and kinaesthetic stimuli (Fleming., 1987) to create a cadaver-less Neuroanatomy simulation platform that improves accessibility, minimises cost and environmental damage, whilst ensuring that trainees get a more immersive and tailored surgical experience, without posing harm to patients.

Furthermore, there are often inequalities in surgical training across the UK which creates disparities in competencies amongst junior doctors, which needs to be addressed and mitigated. We believe that surgical simulation is therefore an underutilised tool in medical and surgical education and should be integrated very early into training to enable doctors to acquire the necessary tactile and cognitive skills required to excel within their chosen surgical discipline.

This study was conducted in two phases. In the first phase, we conducted a needs assessment survey among junior doctors to identify their knowledge and training needs related to neuroanatomy. In the second phase, we provided simulation training in neurovascular anatomy using augmented reality, 3D printing and a procedural exercise on Transnasal Transphenoidal approach to the pituitary. Data was gathered from interviews with 30 participants comprised of medical students, junior doctors and surgical trainees. Participants took our neurosurgery skull-base course where they were able to explore the skull base in a mixed reality setting whilst having tactile models with pathological findings. Real patient’s CT and CT-A scans were converted into digital assets that were 3D printed within hours and posted to the recipients around the world. We devised a kinaesthetic way for students to learn advanced skull-base surgical anatomy as well as procedural skills that are transferable to the operative realm.

Kinaesthetic learning was deemed more intuitive than textbook learning by 93% of participants. 80% of trainees felt like they understood a more critical part of surgical anatomy, namely spatial relationships. This mode of training was extremely cost-effective whilst reducing solid waste and energy consumption. Equivalent operative demonstration of these principles would have caused approximately 750-1250kg CO2e , with major procurement of anaesthetic agents. Moreover, we found that our simulation had more educational value than cadaver dissection as trainees performed better in retention of anatomical structures when compared with our cohort who partook in cadaver dissection alone.

There is a significant challenge ahead to ensure that surgical trainees acquire the necessary skills to progress in their careers. We find that surgical simulation is an underutilised method for training surgeons and can bring a more sustainable future to surgical training. We also found that simulation was far superior to cadaver dissections which, based on our findings, provided little educational value to trainees. From this study we have found repeatability and task decomposition to be particularly important for refining newly acquired psychomotor skills, both of which are not possible in the OR or in Cadaver labs. Surgical simulation is a powerful tool that can help to reduce inequalities and disparities in surgical education across the UK.