The success of the biannual ‘QMC Craniotomy Simulator Course’  led to the development of the permanent Nottingham Neurosurgical Simulator and teaching programme, to provide regular in-house simulation opportunities for neurosurgical trainees and rotational junior doctors. The intention was to emulate training in the aviation industry by providing early exposure to basic neurosurgical procedures in a safe and controlled environment, in preparation for the transition to performing these on patients. The simulator comprises the ROWENA (Realistic Operative Workstation for Educating Neurosurgical Apprentices) simulation model  alongside surgical equipment identical to that used within the department. We have evaluated the impact of delivering monthly teaching sessions over the course of 3 years and will also present the anticipated future direction for this programme.
35 teaching sessions have been delivered since 2019, totalling 75 hours of teaching, and 260 training man-hours. 16 sessions have been attended by trainee or registrar grade doctors, and 24 by junior doctors. The simulator can also be used for independent practice, of which 5 hours have been formally logged. The most popular and commonly delivered teaching topics have been patient positioning and 3-point headrest use (n=9) and insertion of intracranial pressure monitors (n=12) in addition to creation of burr holes (n=15) and craniotomies (n=7) using a variety of different drills. A dedicated session on ward-based procedures for incoming junior doctors has recently been implemented as part of the mandatory induction training.
Feedback collected has consistently demonstrated an increase in self-reported confidence in performing a procedure following simulation teaching. 23 clinicians have achieved formal accreditation in safe use of the 3-point headrest as assessed by a senior consultant and accreditation in ultrasound-guided insertion of external ventricular drains will soon be offered. Assessment using the MOSATS (Modified Objective Structured Assessment of Technical Skills) tool  is currently being introduced to objectively track progress of attendees over time.
We have shown that regular neurosurgical simulation teaching improves the confidence of trainees and is suitable for accreditation of key procedural elements. We hope to further show that this is also reflected by objective improvement in skill as assessed using the MOSATS tool. We intend to develop the programme further by designing a prescribed curriculum and formative assessment process for both early years trainees and junior doctors.
Mr Ashpole is the inventor of the ROWENA simulation system.
1. Kumaria A, Chan H, Javed S, Dapaah A, Mitoko C, Glancz L, D’Aquino D, Ashpole R. Training on a craniotomy simulator improves neurosurgical operative performance. BMJ Simulation and Technology Enhanced Learning. 2019; 5 Supplement 2: A13.
2. Ashpole RD. Introducing ROWENA: a simulator for surgical training. Royal College of Surgeons Bulletin. 2015;97(7):299–301.
3. Gough M, Solomou G, Khan DZ, Kamel M, Fountain D, Kumaria A, Ashpole R, Sinha S, Mendoza N. The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data. Acta Neurochirurgica. 2020;162(10): 2323–2334.