1.1. Challenges in Neurosurgical Training
In the recent years, medical training has been challenged by the introduction and adoption of various sophisticared technologies including Virtual Reality, Robotics, Artificial Intelligence and others. The objective of this paper aims to assess the needs of neurosurgical training believe their physical health is affected by operating environment (Cavanagh et al., 2012). Adequate education on surgical ergonomics might lead to an improvement in the outcomes for both surgeon and patient.
Medical education is a key step in the acquisition of clinical skills and improvement in overall patient care. As the amount of medical information steadily increases, the complexity of treatment options also increases. Therefore, it is essential that medical practitioners and other health care professionals continuously improve their skills and stay informed with the innovations in their field. An important factor in the progress of surgical education and training is the technical solutions that determine the standards of competence in the performance of surgical procedures (Atesok et al., 2017). Therefore, systems that allow consistent evaluation of skills, in a risk-free, controlled manner, are of imperative importance. In this context, the simulation-based techniques are “go-to tools” for a variety of medical and surgical specializations. Medical education has increasingly begun to incorporate viritual reality (VR) as a key method in the training of students in the past decade. It has been observed that VR has taken on a basic role in medical and, more clearly, surgical training as a method that can be used both for its cognitive task analysis and training for technical skills (Konakondla et al., 2017).
Neurosurgical training programs share certain limitations with other surgical training programs, specifically when it comes to residency education. Most significantly, educators must balance the optimization of learner education against the objective of patient safety with properly graduated learner autonomy (Konakondla et al., 2017). To achieve improvements of a surgical resident abilities, surgical training, whether in the form of observation or as practice in and out of the operating room (OR), is crucial. By using repetition and objective observation, a virtual human body enhances learning. Thus, in simulation, computers are replacing patients in surgical preparation. Surgeons can learn and transfer their virtual abilities into the OR with virtual instruments and patients. In general, studies show that VR and other simulations decrease operative time and error by increasing the surgeon's confidence and minimizing wasted movements (Bernardo, 2017).
Neurosurgery is one of the most challenging medical professions that engages a high level of expertise. It is a very challenging surgical specialty where new techniques and technologies are continually emerging. A recent increase of interest in neurosurgical simulation has emerged. This is primarily due to the decreased exposure of trainees to surgical cases based on constraints on residency duty-hours, and technical developments in the area of simulation imaging, computing, virtual reality (VR), and 3D printing (Rehder et al., 2016).
In the field of neurosurgery, there has been an interest in exploring and using medical simulation and VR for preparation, maintenance of expertise, development, demonstration, and evaluation purposes (Konakondla et al., 2017). Nowadays, there are several commercial neurosurgical simulation technologies that aim to help trainees improve their skills. However, most of the available technologies are not fully validated and are underutilized by trainees (Atesok et al., 2017).
Several Neurosurgical simulators have been available in the market such as ImmersiveTouch (Lemole et al., 2007), NeuroTouch (NeuroVR ™) (Delorme et al., 2012), Dextroscope (Stadie et al., 2008), and Surgical theater (Zhalmukhamedov & Urakov, 2019) as well as others.. These simulators were made available in the past 2 decades but never gained enough widespread adoption in neurosurgical education. Some were not updated and others are no longer on the market. This may have been because most of the simulators available so far do not represent advanced micro-neurosurgical cases, hence recently a roadmap was proposed to developed and validate complex neurosurgical scenarios (Sabbagh et al., 2020).
Rather than only assessing surgical procedures, existing simulation models can be used to assess other aspects. The NeuroTouch (NeuroVR ™), a virtual reality neurosurgical simulator, was used by Bajunaid et al. (Bajunaid et al., 2017) to build and validate a set of methods for testing technical skills that can assess bimanual psychomotor performance skills and aimed to explore the effect of a simulated stressful virtual reality tumor resection scenario. They simulated acute stress and explored its effect on psychomotor performance in safe environments.