ABSTRACT
Aneurysm clipping requires the proficiency of several skills, yet the traditional way of practicing them has been recently challenged. The use of simulators could be an alternative educational tool. The aim of this data analysis is to provide further evaluation of a reusable low-cost 3D printed training model we developed for aneurysm clipping [1]. The simulator was designed to replicate the bone structure, arteries and targeted aneurysms. Thirty-two neurosurgery residents performed a craniotomy and aneurysm clipping using the model and then filled out a survey. The survey was designed in two parts: a 5-point Likert scale questionnaire and three questions requiring written responses [1]. Two dimensions of the model were evaluated by the questionnaire: the face validity, assessed by 5 questions about the realism of the model, and the content validity, assessed by 6 questions regarding the usefulness of the model during the different steps of the training procedure. The three questions requiring written responses referred to the strengths and weaknesses of the simulator and a global yes/no question as to whether or not they would repeat the experience. Demographic data, experience level and survey responses of the residents were grouped in a dataset [2]. A descriptive analysis was performed for each dimension. Then, the groups were compared according to their level of expertise (Junior and Senior groups) with an independent sample t-test. A Confirmatory Factor Analysis (CFA) was estimated, using a Weighted Least Squares Mean Variance adjusted (WLSMV) which works best for the ordinal data [3]. Fitness was calculated using chi-square (χ2) test, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and the Root Mean Square Error of Approximation (RMSEA). A non-significant χ2, CFI and TLI greater than 0.90 and RMSEA < 0.08 were considered an acceptable fit [4]. All data analysis was performed using IBM SPSS 23.0 statistical software. Data are reported as mean + standard deviation (SD). A probability p < 0.05 was considered significant. Exploratory Factor Analysis was done to explore the factorial structure of the 11-items scale in the sample, first we performed a principal components analysis. The Kaiser-Meyer-Olkin measure verified the sampling adequacy for the analysis (KMO = 0.784; Bartlett's Test of Sphericity χ2 (55) = 243.44, p < .001), indicating correlation is adequate for factor analysis. Considering Eigen values greater than 1, a two-factor solution explained 73.1% of the variance but left one item in factor 2 (Q 11). The results of this factor analysis are presented in Table 1. Confirmatory Factor Analysis, considering only the 10 items in the first factor (removing question 11 of our model), was performed. This model reached the following fit: χ2 (35) = 38.821, p > .05; CFI = 0.997; TLI = 0.996; RMSEA 0.058, without any error terms to exhibit covariance. Regarding the reliability of the questionnaire, the internal consistency was explored in the 10 items selected in the confirmatory factor analysis with an alpha coefficient (α = 0.941).
ABSTRACT
BACKGROUND: The neurosurgical boot camp has been fully incorporated into U.S. postgraduate education. This is the first implementation of the neurosurgical boot in a developing country. To advance neurosurgical education, we developed a similar boot camp program, in collaboration with Bolivian neurosurgeons, to determine its feasibility and effectiveness in an international setting. METHODS: In a collective effort, the Bolivian Society for Neurosurgery, Foundation for International Education in Neurological Surgery, Solidarity Bridge, and University of Massachusetts organized and executed the first South American neurosurgical boot camp in Bolivia in 2015. Both U.S. and Bolivian faculty led didactic lectures followed by a practicum day using mannequins and simulators. South American residents and faculty were surveyed after the course to determine levels of enthusiasm and their perceived improvement in fund of knowledge and course effectiveness. RESULTS: Twenty-four neurosurgery residents from 5 South American countries participated. Average survey scores ranged between 4.2 and 4.9 out of 5. Five Bolivian neurosurgeons completed the survey with average scores of 4.5-5. This event allowed for Bolivian leaders in the field to unify around education, resulting in the formation of an institute to continue similar initiatives. Total cost was estimated at $40 000 USD; however, significant faculty, industry, and donor support helped offset this amount. CONCLUSION: The first South American neurosurgical boot camp had significant value and was well received in Bolivia. This humanitarian model provides a sustainable solution to education needs and should be expanded to other regions as a means for standardizing the core competencies in neurosurgery.
Subject(s)
Developing Countries , Education, Medical, Graduate/organization & administration , Internationality , Neurosurgery/education , Bolivia , Curriculum , Faculty, Medical , Feasibility Studies , Humans , Internship and Residency , Societies, MedicalABSTRACT
Fundamento: la prótesis bucomaxilofacial comprende la rehabilitación morfofuncional de las estructuras intrabucales y parabucales por medios artificiales. Objetivo: identificar las necesidades de aprendizaje y las insuficiencias en el desarrollo de habilidades sobre rehabilitación bucomaxilofacial en residentes y especialistas de Neurocirugía. Métodos: se realizó una investigación descriptiva transversal en el Hospital Universitario "Arnaldo Milián Castro" de Villa Clara, entre enero-mayo de 2014. Se utilizaron métodos teóricos: analítico-sintético, histórico-lógico e inductivo-deductivo; empíricos: análisis documental del programa de la especialidad de Neurocirugía y el plan de superación de los últimos 5 años, y encuesta en forma de cuestionario de respuestas breves al total de la población de estudio y de entrevista a los 5 especialistas en Neurocirugía. Resultados: el plan de estudio trata los contenidos de rehabilitación bucomaxilofacial insuficientemente y en las formas de postgrado no se brinda superación sobre el tema en los últimos 5 años; la mayoría de los encuestados declara tener carencias de conocimientos en esta modalidad terapéutica. La generalidad no conoce la constitución del equipo multidisciplinario que incide en la rehabilitación de los pacientes e incluso muy pocos han visitado el centro especializado existente en la provincia. Todos abogaron por una modalidad de postgrado donde se apropien de los contenidos necesarios. Conclusiones: se constataron insuficiencias sobre rehabilitación bucomaxilofacial en residentes y especialistas en Neurocirugía, lo cual demostró que es necesario fortalecer su preparación para conformar un equipo multidisciplinario de gran complejidad como lo necesita esta modalidad terapéutica.
Background: bucco-maxillo-facial prostheses comprise the morfo-functional rehabilitation of the intraoral and paraoral structures using artificial means. Objective: to identify the learning necessities and the inadequacies in the development of abilities about bucco-maxillo-facial rehabilitation in residents and Neurosurgery specialists. Methods: it was carried out a cross-sectional descriptive research work in the University Hospital "Arnaldo Milián Castro" of Villa Clara, from January to May 2014. Theoretical methods were used: analytic-synthetic, historical-logical and inductive-deductive; empiric methods: documental analysis of the Neurosurgery specialty program and the upgrading plan of the last 5 years, and a survey in questionnaire form with brief answers was applied to the study population and the 5 specialists in Neurosurgery were interviewed Results: the study plan treats the contents of bucco-maxillo-facial-rehabilitation insufficiently and in the postgraduate forms don't offer any upgrading on the topic in the last 5 years; most of those interviewed declared to have lack of knowledge in this therapeutic modality. The generality doesn't know the constitution of the multidisciplinary team that participates in the rehabilitation of the patients and even very few of them have visited the existent specialized center in the province. All pled for a postgraduate modality where they can appropriate of the necessary contents. Conclusions: deficiencies were stated about bucco-maxillo-facial rehabilitation in residents and Neurosurgery specialists; it was shown that it is necessary to strengthen their preparation to conform a multidisciplinary team of great complexity that it is required in this therapeutic modality.