A Playbook for Neurosurgical Resident Training in Skull Base Surgery

Introduction: To be adequately prepared for the technical surgical demands and interprofessional teamwork required of the operating room, cadaveric laboratory training is essential.1 A recent survey of neurosurgical residency programs in the United States bore this out: 95.4% of respondents view laboratory dissection as an integral to training and an additional 89.2% would support a national “suggested” dissection curriculum and manual.2 To address this demand, the OHSU Neurosurgery residency program in partnership with OHSU Simulation, the OHSU Body Donation Program, and industry stakeholders have developed, over the past 6 years, an annual three-part cadaveric surgical simulation course series that has provided training in skull base procedures. Methods: Resident surgical education aims to (1) Develop decision-making, complication management and technical surgical abilities in a low-risk environment, (2) review anatomy, and (3) refine interprofessional teamwork typical to the operating room between otolaryngology (ENT) and neurosurgery disciplines. Successful resident education in simulation is dependent on collaboration between neurosurgical faculty, educational support staff, and industry experts. We describe a manuscript for successfully implementing a cadaveric surgical simulation course to meet the educational objectives above. This comprehensive overview details (1) equipment and instrumentation, (2) course maps and photos ([Figs. 1] and [2]), (3) curriculum development, (4) tissue procurement and preparation, (5) communications between major stakeholders, (6) scheduling and logistics, (7) evaluation of resident proficiency, and (8) COVID-19-specific modifications to course curriculum. Results: Course evaluations from 337 OHSU neurosurgery and otolaryngology residents over the past 6 years were collected and analyzed. Means and SDs of Likert's scale questions were calculated and indicated uniformly positive responses ([Table 1]). Free-text responses were analyzed via sentiment analysis. This resultant heat map ([Fig. 3]) indicated positive attitudes, with the lowest value being +0.41 (on a scale of -1.0 to 1.0). Conclusion: We hope this manuscript can serve as a guide for other institutes to develop their own residency educational curriculum in cadaveric skull base procedures. (Figure Presented).

Telemedicine visits in an established multidisciplinary central nervous system clinic for radiation oncology and neurosurgery (RADIANS) in a community hospital setting.

OBJECTIVE: To determine the impact of telemedicine visits, compared to in-person visits, on patient satisfaction in an established community hospital-based multidisciplinary central nervous system (CNS) clinic. METHODS: Telemedicine options - virtual visits and teleconferencing - were introduced in July 2020. Both radiation oncologist and neurosurgeon were simultaneously present for the telemedicine visit. Descriptive patient demographics, survey responses, and travel time and distance calculations were analyzed. Satisfaction score was compared to previously published data. RESULTS: A total of twenty-five telemedicine visits (n=22 video; n=3 phone) were completed since July 2020. Patient demographics are as follows: mean age was 59 years (range=22-81), women (9) and men (16), repeat telemedicine visits n=10, malignant CNS disease (17) and benign disease (5). Mean one-way distance traveled was 165.07 miles (median=114; range=0.8-358). Mean roundtrip travel time was estimated at 5h 5min. Mean telemedicine visit duration was 15.3 mins (range=4-46). Mean patient satisfaction score for telemedicine visits was 4.84. CONCLUSION: Patients who opted for the telemedicine visits found them just as effective as in-person visits, saving time and travel costs as well as ensuring patient safety during the current COVID-19 pandemic. The telemedicine visit platform facilitates the multidisciplinary clinic model and should be considered for more widespread utilization (Tab. 3, Fig. 1, Ref. 18).