Besta NeuroSim Center – PASSION

New training paradigms for young neurosurgeons: The PASSION Study at the Besta NeuroSim Center (Milano, Italy)

The Psychometric Assessment and Skills training by Simulation in Neurosurgery (PASSION) Study was designed to verify if intensive training with neurosurgical simulators improves the residents’ operative procedures skills. The aim of this randomized, prospective, and international study was to assess a new training method to be implemented in standard Neurosurgery training programs in order to provide a faster route to competency, without exposing patients to further risks. We focused on psychometric assessment to understand if some psychological traits were related to individual differences in surgical performance and learning pace.

The course was held at the Besta NeuroSim Center (Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Milan) from March to September 2019. The course was organized by Dr Francesco DiMeco and Dr Alessandro Perin the NeuroSim Center Scientific Director. The course was sponsored by Integra and Soring GmBh.

The study involved 77 residents (PGY 1-5) from several European Countries (Italy, France, Germany, UK, Spain, Belgium, Switzerland, Austria, Poland, Croatia, Ukraine, Bulgaria, Czech Republic, Lithuania, Albania, Serbia, Bosnia), from North Africa (Morocco, Egypt, Algeria), and from Asia (Turkey, Saudi Arabia, Bahrain, China).

The residents were randomized in two groups (simulation vs control) with a 1:1 ratio, on the basis of their current year of residency (PGY). The course included 5 days of activities. During the first day (pre-training) residents’ technical skills were assessed throughout physical models created to reproduce some basic neurosurgical procedures, such as (1) dural opening and closure with a microscope, (2) tumor removal on a physical model, (3) lumbar puncture on a mannequin, (4) burr hole selection and EVD positioning on experimental model, and (5) aneurysm clipping in virtual reality. We also assessed the residents’ psychometric profiles by analyzing their personality, spatial ability, logical reasoning, and bimanual dexterity.

On day 2, 3 and 4 (training) the simulation group attended an intensive training on simulators, practicing lumbar puncture, EVD placement, tumor removal and general bi-manual exercises. The control group performed their ordinary activities in a neurosurgical operating room (OR). On day 5 (post-training) both groups’ surgical skills were evaluated again with the same tasks performed during the first day. The object of this method was to assess an improvement in the simulation group between the pre-training (day 1) and post-training (day 5). In order to evaluate the impact of the intensive training with the simulators on their surgical abilities in the OR, all the residents had to send three CT scans of EVDs performed before and after the course.

The study results are going to be published soon.

May 2021