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A Systematic Review of Simulation-based Training in Neurosurgery, Part 2: Spinal and Pediatric Surgery, Neurointerventional Radiology, and Nontechnical Skills

Research output: Contribution to journalArticle

Ebrahim Patel, Abdullatif Aydin, Michael Cearns, Prokar Dasgupta, Kamran Ahmed

Original languageEnglish
Pages (from-to)e874-e892
JournalWorld Neurosurgery
Early online date18 Sep 2019
Publication statusPublished - 1 Jan 2020

Bibliographical note

Copyright © 2019 Elsevier Inc. All rights reserved.

King's Authors


OBJECTIVE: The increasing challenges facing the training of future neurosurgeons has led to continued development of simulation-based training, particularly for neurosurgical subspecialties. The simulators must be scientifically validated to fully assess their benefit and their educational effects determined. In this second part, we aim to identify the currently available simulators for spine, paediatric neurosurgery, interventional neuroradiology (NIR) and non-technical skills (NTS), assess their validity and determine their effectiveness.

DESIGN: Both Medline and EMBASE were searched for English language articles which validate simulation models for neurosurgery. Each study was screened according to Messick's validity framework, and rated in each domain. McGaghie's model of translational outcomes was then used to determine a level of effectiveness (LoE) for each simulator or training course.

RESULTS: Overall, 114 articles for 108 simulation-based training models or courses were identified. These included 24 articles for 24 spine simulators, 3 for NTS, 10 articles for 9 paediatric neurosurgery simulators and 12 articles for 11 NIR simulators. Achieving the highest rating for each validity domain were: three models for content validity; 16 for response processes; 1 for internal structure; 2 for relations to other variables and only 1 for consequences. For translational outcomes, 2 training courses achieved an LoE of greater than 2 demonstrating skills transfer beyond the simulator environment.

CONCLUSIONS: With increasing simulators, there is a need for more validity studies and attempts to investigate translational outcomes to the operating theatre when using these simulators. Non-technical skills training is notably lacking, despite current demand within the field.

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