• Alexander Winkler-Schwartz, Khalid Bajunaid, Mullah Muhammad A S MAS Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada., Ibrahim Marwa, Fahad E Alotaibi, Jawad Fares, Marta Baggiani, Hamed Azarnoush, Gmaan Al Zharni, Sommer Christie, Abdulrahman J Sabbagh, Penny Werthner, and Rolando F Del Maestro.
• Department of Neurosurgery, Neurosurgical Simulation Research and Training Center, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: alexander.winkler-schwartz@mail.mcgill.ca.
• J Surg Educ. 2016 Nov 1; 73 (6): 942-953.

ObjectiveCurrent selection methods for neurosurgical residents fail to include objective measurements of bimanual psychomotor performance. Advancements in computer-based simulation provide opportunities to assess cognitive and psychomotor skills in surgically naive populations during complex simulated neurosurgical tasks in risk-free environments. This pilot study was designed to answer 3 questions: (1) What are the differences in bimanual psychomotor performance among neurosurgical residency applicants using NeuroTouch? (2) Are there exceptionally skilled medical students in the applicant cohort? and (3) Is there an influence of previous surgical exposure on surgical performance?DesignParticipants were instructed to remove 3 simulated brain tumors with identical visual appearance, stiffness, and random bleeding points. Validated tier 1, tier 2, and advanced tier 2 metrics were used to assess bimanual psychomotor performance. Demographic data included weeks of neurosurgical elective and prior operative exposure.SettingThis pilot study was carried out at the McGill Neurosurgical Simulation Research and Training Center immediately following neurosurgical residency interviews at McGill University, Montreal, Canada.ParticipantsAll 17 medical students interviewed were asked to participate, of which 16 agreed.ResultsPerformances were clustered in definable top, middle, and bottom groups with significant differences for all metrics. Increased time spent playing music, increased applicant self-evaluated technical skills, high self-ratings of confidence, and increased skin closures statistically influenced performance on univariate analysis. A trend for both self-rated increased operating room confidence and increased weeks of neurosurgical exposure to increased blood loss was seen in multivariate analysis.ConclusionsSimulation technology identifies neurosurgical residency applicants with differing levels of technical ability. These results provide information for studies being developed for longitudinal studies on the acquisition, development, and maintenance of psychomotor skills. Technical abilities customized training programs that maximize individual resident bimanual psychomotor training dependant on continuously updated and validated metrics from virtual reality simulation studies should be explored.Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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