A Tablet-based Virtual Environment for Neurosurgery Training

Abstract

The requirement for training surgical procedures without exposing the patient to additional risk is well accepted and is part of a national drive in the UK and internationally. Computer-based simulations are important in this context, including neurosurgical resident training. The objective of this study is to evaluate the effectiveness of a custom built virtual environment in assisting training of a ventriculostomy procedure. The training tool (called VCath) has been developed as an app for a tablet platform to provide easy access and availability to trainees. The study was conducted at the first boot camp organized for all year one trainees in neurosurgery in the UK. The attendees were randomly distributed between the VCath training group and the Control group. Efficacy of performing ventriculostomy for both groups was assessed at the beginning and end of the study using a simulated insertion task. Statistically significant changes in performance of selecting the burr hole entry point, the trajectory length and duration metrics for the VCath group, together with a good indicator of improved normalized jerk (representing the speed and smoothness of arm motion), all suggest that there has been a higher level cognitive benefit to using VCath. The app is successful as it is focused on the cognitive task of ventriculostomy, encouraging the trainee to rehearse the entry point and use anatomical landmarks to create a trajectory to the target. In straight-line trajectory procedures such as ventriculostomy, cognitive task based education is a useful adjunct to traditional methods and may reduce the learning curve and ultimately improve patient safety.