Transformation of neurosurgical training from "see one, do one, teach one" to AR/VR & simulation - A survey by the EANS Young Neurosurgeons

Abstract

Introduction: Modern technologies are increasingly applied in neurosurgical resident training. To date, no data are available regarding how frequently these are used in the training of neurosurgeons, and what the perceived value of this technology is.

Research question: The aim was to benchmark the objective as well as subjective experience with modern- and conventional training technologies.

Material and methods: The EANS Young Neurosurgeons Committee designed a 12-item survey. It was distributed to neurosurgical residents and board-certified neurosurgeons between 6th of February and April 13, 2022.

Results: We considered 543 survey responses for analysis. Most participants (67%) indicated not having gained any training experience with modern technology. Most (40.7%) indicated lack of any modern or conventional training technology. Cadaver training was available to 27.6% while all modern training technology to <10%. Participants from countries with high gross domestic product per capita had more access to modern training technologies (p ​< ​0.001). The perceived value of the different technologies was highest for hands-on OR training, followed by cadaver lab. The value of these was rated higher, compared to all modern technologies (p ​< ​0.001).

Discussion and conclusion: Our survey reveals that cadaver labs are used more frequently than modern technologies for today's neurosurgical training. Hands-on training in the operating room (OR) was rated significantly more valuable than any conventional and modern training technology. Our data hence suggest that while modern technologies are well perceived and can surely add to the training of neurosurgeons, it remains critical to ensure sufficient OR exposure.

Keywords: AR/VR; EANS; Neurosurgery; Simulation; Survey; Training.

Fig. 1

Shows a bar chart with the answers to the question whether the participants have already trained with modern technologies such as virtual reality, augmented reality or simulators. Of all respondents (n ​= ​543), 33% answered “yes” to this question, 67% answered “no”.

Fig. 2

Box plots represent the evaluation of the relationship between the availability of modern training technologies in each hospital and GDP per capita for each country. Paired t-test analysis revealed a highly significant (p ​< ​0.001) association of high GDP per capita as a positive predictor of the availability of advanced training modalities. The figures display the median with 25th and 75th percentile (box) of GDP per capita of countries, the upper and lower adjacent values (whiskers) and outliners (dots). T (538) ​= ​-5.40, p ​< ​0.001; n ​= ​540.

Fig. 3

A: Bar graphs, illustrating that 71% (n ​= ​384/543) of the survey respondents have participated in a training course using conventional training methods (such as cadaver training) within the last three years, either as participants or faculty. Fig. 2B: However, only the minority (n ​= ​204, 38%) participated in a training course that employed modern training methods (such as VR/AR-based or simulator-based models). There was one respondent with missing data for both questions. VR: virtual reality; AR: augmented reality.

Fig. 4

Box plots containing the subjective evaluation of the different training modalities (Augmented or Virtual Reality, VR Simulator, Spine Model Simulators, Cranial Model Simulators, Cadaver Training, Hands-on Training in OR). The rating is ordinally distributed (from 0 - not valuable at all, 1 - little valuable, 2 - somewhat valuable, 3 - valuable, 4 - very valuable, to 5 - extremely valuable). Respondents rated “hands-on” OR training highest compared to all other modalities (p ​< ​0.001), and cadaver training scored higher than all other modern training modalities (p ​< ​0.001; paired t-tests). The figures display the median with the 25th–75th percentile (box), the upper and lower adjacent values (whiskers) and outliers (dots).