Neurosurgical operating room

Integrating medical students into the neurosurgical operating room (OR) presents significant pedagogical challenges, compounded by the phenomenon of neurophobia, or aversion to neuroscience. Despite the importance of early neurosurgical exposure, there is a lack of structured educational strategies for undergraduates.

Lawson et al. present twelve targeted strategies to optimize neurosurgical OR education. These include preoperative planning, fostering a positive learning environment, emphasizing technological integration, involving students in decision-making, prioritizing safety, providing regular feedback, facilitating active participation, leveraging teachable moments, managing time constraints, offering follow-up opportunities, emphasizing professionalism, and fostering a learning culture.

Discussion and conclusion: This framework addresses a critical gap in neurosurgical education for undergraduates, tackling neurophobia and enhancing learning experiences. Integrating educational theories with practical insights offers a robust, adaptable approach suitable for various global resource settings. Through continuous evaluation and refinement, these strategies can evolve to meet the dynamic demands of neurosurgical education, preparing students to navigate the complexities of modern neurosurgical practice with confidence and competence 1)



Residents in neurosurgery have to spend a lot of time in the operating room to become familiar with surgical anatomy and techniques and to develop practical skills 2) 3) 4). Although intraoperative surgical exposure represents the fundamental way to train surgeons, several drawbacks are encountered in every country. Differences between departments, hospitals, and nations are wide, and residents often do not have the same opportunity in their education and operation room in particular 5) 6) 7) 8) 9) 10) 11)


It is estimated that 70% of hospital revenue is generated in the operating room (OR) 12) and 30% of hospital waste.


The implementation of a universal surgical safety checklist protocol in 2004 was intended to minimize the prevalence of wrong site surgery (WSS). However, complete elimination of WSS in the operating room continues to be a challenge.


There is an urgent need in the acute health system to use resources as efficiently as possible. One such group of resources are operating theatres, which have an important impact on patient flow through a hospital. Data-driven insights into the use of operating theatres can suggest improvements to minimise wastage and improve theatre availability.

In a paper, a short extract of surgical data from participating Queensland public hospitals was statistically analysed to examine the effects of session type, session specialty, scheduling the longest case first and day of the week on theatre utilisation. It was found that day-long sessions (as opposed to separate morning or afternoon sessions), mid-week sessions, certain specialties (eg. neurosurgery sessions) and not doing the longest case first were most beneficial to theatre utilisation. Awareness of these findings is important in any redesign activity aimed at improving flow performance 13).


1)
Lawson McLean A, Yen TL, Gutiérrez Pineda F. Tailoring neurosurgical operating room education to medical undergraduates: Integrative review and meta-synthesis. Brain Spine. 2024 Nov 4;4:104131. doi: 10.1016/j.bas.2024.104131. PMID: 39582527; PMCID: PMC11584684.
2)
Yaşargil MG. A legacy of microneurosurgery: memoirs, lessons, and axioms. Neurosurgery. (1999) 45(5):1025–92. 10.1097/00006123-199911000-00014
3)
Yadav YR, Parihar V, Ratre S, Kher Y, Iqbal M. Microneurosurgical skills training. J Neurol Surg A Cent Eur Neurosurg. (2016) 77(2):146–54. 10.1055/s-0034-1376190
4)
Belykh E, Onaka NR, Abramov IT, Yağmurlu K, Byvaltsev VA, Spetzler RF, et al. Systematic review of factors influencing surgical performance: practical recommendations for microsurgical procedures in neurosurgery. World Neurosurg. (2018) 112:e182–207. 10.1016/j.wneu.2018.01.005
5)
Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, et al. Neurosurgical resident education in Europe—results of a multinational survey. Acta Neurochir. (2016) 158(1):3–15. 10.1007/s00701-015-2632-0
6)
Calderon C, Dos Santos Rubio EJ, Negida A, Park KB. Neurosurgical training in the Caribbean. Brain Spine. (2022) 2:101691. 10.1016/j.bas.2022.101691
7)
Ekhator C, Rak R. The need for improved recruitment to neurosurgery training: a systematic review of enrollment strategies. Cureus. (2022) 14(6):e26212. 10.7759/cureus.26212
8)
Ferraris KP, Matsumura H, Wardhana DPW, Vesagas T, Seng K, Mohd Ali MR, et al. The state of neurosurgical training and education in east Asia: analysis and strategy development for this frontier of the world. Neurosurg Focus. (2020) 48(3):E7. 10.3171/2019.12.FOCUS19814
9)
Hoffman C, Härtl R, Shlobin NA, Tshimbombu TN, Elbabaa SK, Haglund MM, et al. Future directions for global clinical neurosurgical training: challenges and opportunities. World Neurosurg. (2022) 166:e404–18. 10.1016/j.wneu.2022.07.030
10)
Ogbu II, Kaliaperumal C. The future of neurosurgical training in the United Kingdom. World Neurosurg. (2022) 168:89–93. 10.1016/j.wneu.2022.09.038
11)
Wang A, Shlobin NA, DiCesare JAT, Holly LT, Liau LM. Diversity in neurosurgical recruitment and training in the United States: a systematic review. World Neurosurg. (2022) 162:111–117.e1. 10.1016/j.wneu.2022.03.086
12)
Li F, Gupta D, Potthoff S. Improving operating room schedules. Health Care Manag Sci. 2016 Sep;19(3):261-78. doi: 10.1007/s10729-015-9318-2. Epub 2015 Feb 17. PMID: 25687390.
13)
Thorburn H, Khanna S, Boyle J, Good N, Steyn M. Analysis of operating theatre utilisation to drive efficiency and productivity improvements. Stud Health Technol Inform. 2014;204:163-8. PubMed PMID: 25087544.
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