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

Objective: The increasing challenges facing the training of future neurosurgeons have led to continued development of simulation-based training, particularly for neurosurgical subspecialties. The simulators must be scientifically validated to fully assess their benefit and determine their educational effects. In this second part, we aim to identify the available simulators for spine, pediatric neurosurgery, interventional neuroradiology, and nontechnical skills, assess their validity, and determine their effectiveness.

Methods: Both Medline and Embase were searched for English language articles that validate simulation models for neurosurgery. Each study was screened according to the Messick validity framework, and rated in each domain. The McGaghie model of translational outcomes was then used to determine a level of effectiveness for each simulator or training course.

Results: Overall, 114 articles for 108 simulation-based training models or courses were identified. These articles included 24 for spine simulators, 3 for nontechnical skills, 10 for 9 pediatric neurosurgery simulators, and 12 for 11 interventional neuroradiology simulators. Achieving the highest rating for each validity domain were 3 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 a level of effectiveness of >2, showing 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 theater when using these simulators. Nontechnical skills training is notably lacking, despite demand within the field.