Training microneurosurgery - four years experiences with an in vivo model.

Objective: Enquiries among surgical trainees revealed an increasing discontent regarding their quality of training. 40 % of young surgical trainees judge their training as inadequate and 70% are offered no structured training programme. Working time restrictions and economic pressure may be strong factors hindering residents from becoming skillful surgeons. Therefore, additional forms of training seem to be needed.

Method: An in vivo swine model was evaluated for its practical use in training neurosurgical residents. Surgical procedures included craniotomy, dural opening, brain surgery and excision of an artificial tumour created by injection of coloured fibrin glue. Microscopy and bleeding management with bipolar cautery and haemostyptics were an integrated part of training. Supervision by experienced neurosurgeons with up to 3 trainees in a 2-day course was warranted. Standardised questionnairies before and after training were used to assess the quality and utility of the programme.

Results: 24 residents have participated in the course (1 (st)-5 (th) year of training). Minor experience with less than 100 conducting surgeries was seen in 59% of trainees. 14 residents had participated in more than 100 surgeries as first assistant. Spinal surgery was the predominant common experience. All participants judged their surgical training as insufficient. 77% had no microsurgical lab at their clinics. Expectations for the course were met for all trainees and the tutorials judged as excellent (65%) or good (35%). Positive evaluations of the in vivo model (97%), a realistic laboratory setup (94%), the working environment (94%) and close supervision (94%) showed that these were the most favourable aspects of the course.

Conclusion: Educational training in surgical specialities is becoming a major problem in our daily practice and requires additional training facilities. In this context, in vivo models are an ideal opportunity for young neurosurgeons to train bleeding management and surgical complications in particular. This educational form is thought to be a unique training model which is now added by spinal and neurovascular courses.