2025 Proffered Presentations
S182: ESTABLISHMENT OF A CRANIAL DISSECTION CURRICULUM FOR JUNIOR NEUROSURGICAL RESIDENTS: A PILOT STUDY
Alankrita Raghavan, MD; Kennedy Carpenter, MD; Jordan Hatfield; Caroline Folz; Michael Haglund; Steven Cook, MD; Katherine McDaniel; Duke University Hospital
Historically, surgical education has largely relied on the apprenticeship model. However, with increased restrictions on resident work hours, improved outcomes and expectations, and the evolving healthcare landscape, a thoughtful and graduated approach to build resident autonomy, confidence, and skill is needed. In general surgery, adequate exposure and performance in skills labs is a requirement for boards certification and several studies have demonstrated the utility of practicing operative procedures in a low stakes environment to develop confidence and competence.
To develop basic cranial neurosurgical skills for junior residents in a simulation environment, we developed a cranial dissection curriculum (surgical coaching program or SCP) for our junior neurosurgery residents (PGY-2 and PGY-3) to enhance confidence and competence in basic cranial neurosurgery skills. The procedures included pinning and positioning, hemicraniectomy, and suboccipital craniectomy for the PGY-2s and microsuturing, pterional craniotomy, and retrosigmoid craniotomy for the PGY-3s. Each resident underwent one hour of one-on-one training with a faculty member on each skill/approach. Each resident had their own cadaveric specimen for practicing the approaches. We investigated the confidence in these skills from the resident and faculty perspective as well as faculty trust and autonomy for the residents in the program.
Initial data from the program suggests that each class met or exceeded faculty expectations during the coaching session (6/6) and all faculty felt that the residents had increased confidence over the course of the session (6/6). Importantly, all faculty who worked with the residents in the OR after the session felt that the residents had increased confidence in the OR (4/6) and would either keep the same amount of autonomy (1/6) or allow for increased autonomy for the residents (5/6) in the operating room. From the residents' perspective, there was significantly increased confidence in every aspect of the procedure they were coached in.
This program represents a successful pilot study looking at the impact of a one-on-one surgical coaching program on resident confidence and faculty trust. Ongoing work includes implementation of a comprehensive dissection curriculum for junior residents incorporating both cranial and spinal neurosurgical procedures and its effect on resident operative autonomy and performance.