Efficacy of a new video-based training model in spinal surgery

Abstract

Background: An important part of neurosurgical training is the improvement of surgical skills. Acquiring microsurgical skills follows a learning curve, influenced by specific exercises, feedback, and training. Aim of training should be rapid learning success. The study shows the way in which video-based training can influence the learning curve.

Methods: Over a period of 18 months (2011-2012) 12 residents were evaluated in spinal surgery (12 cases per resident) by a skilled evaluator based on different criteria. The evaluation criteria (exposition of important anatomy, intraoperative bleeding, efficacy of using bipolar cauterization) were weighted and added to a single quality-score. The participating residents were divided into two groups. Only one group (n = 5) received video-based training.

Results: Residents showed an individually different but explicit increase in microsurgical skills. The quality-score during the first surgery compared with the end point of the study demonstrated a faster improvement of surgical skills in the group with video-based training than in the group without special training. Considering all residents together, the video-training group displayed a steeper gradient of microsurgical success. Comparison of the single resident's microsurgical skills showed individual disparities. Various biases that influence the learning success are under examination.

Conclusion: Video-based training can improve microsurgical skills, leading to an improved learning curve. An earlier entry of the learning curve plateau in the video-training group promotes a higher acquisition of surgical skills. Because of the positive effect, we plan to apply the video-based training model to other neurosurgical subspecialties, especially neurovascular and skull base surgery.

Keywords: Learning curve; microsurgery; surgical skills; video-based training.

Figure 1

An example of a score sheet, which was used to validate the surgical interventions. The supervisor completed this score sheet directly after the surgery

Figure 2

(a) A flowchart of the study design. (b) A diagram of the beginning point, which presents the average quality score depending in the year of neurosurgical residency. A significant difference in the skill level (P= 0.04) was detectable between the first and second and the following years. The values were connected by a logarithm function, which shows a typical learning curve. (c) A flowchart reveals the training session procedure. The video-based training focused on the resident, the supervisor, the surgery and the training. The main effect of the learn successes was presented by this double feedback. On one side the intraoperative feedback, on the other side feedback of the training session

Figure 3

(a) The learning curve of the video-based training group (VbG) and the control group (cG). The values shown were the mean quality score of all members in one surgical intervention of one group. The learning curve of the video-based group revealed a faster increase of the surgical skills after the sixth surgery and an earlier entry of the learning plateau. (b) The diagram presents the different mean gradients of the regression analysis. The video-based training group presents a significantly (P= 0.02) steeper gradient of their learning success between the beginning point and the seventh surgical interventions. (c) All linear regression curves are shown

Figure 4

Different pictures of typical situations, which were important to validate the surgery. (a) Different preparation techniques for entry into subcutis and muscles. (b) Effective use of the bipolar (c) Preparation of the dura. (d) Resection of the intervertebral disk tissue. (e) Wound closure with microscopic help. This trains the residents to handle the microscope in general. (f) An example for ineffective use of the microscope due to problems with correct focus