Problems of Endoneurosurgery Education: a Case Study in Turkey

Abstract

Endoneurosurgery consists of neurological operations performed using an endoscope. Unlike traditional surgery operations, natural body cavities are used as entry points, hence inflicting minimum damage to the patient. These operations are considered as minimal invasive surgeries (or MIS), where surgeons see the operation area in two-dimensional view on the monitor and perform the operation based on that view. Studies show that MIS causes minimal harm to human body and reduces the death risk and that these surgeries are at least as safe as those performed using microscopes. Despite having certain advantages, they also come with certain problems, one of which is that the endoscopic view is two-dimensional, not three; in other words, since endoneurosurgery is performed via the images from the endoscope, the surgeon's perception should enable them to transform those images seen through the endoscope and convert them mentally to their correct anatomical models. In that concern, lack of depth perception can cause serious injuries, even resulting in deaths if not dealt with in advance by training. To be successful in such an environment, the surgeon has to gain critical skills. Hence, the education programs of surgery and endoneurosurgery has unique problems. The main aim of this study is to better understand the problems of endoneurosurgery education in Turkey. For this, a survey study is conducted with 31 participants, who are either currently enrolled in endoneurosurgery education programs in Turkey or experts in the field. Supportively semi-structured individual interviews are also conducted with 5 participants. This data is collected to better understand the methods being used in these programs, their problems and the participants' preferred methods to be used. Additionally, the participants' attitudes towards are also investigated regarding the use of new technologies to enhance the current education programs. The results indicate that, in Turkey, endoneurosurgery training programs are still mostly offered in traditional ways while other educational methods are used in an extremely limited manner. Main problems of integrating new technologies into these education programs are highlighted as: the most widely used educational method for endoneurosurgery in Turkey is the traditional one, see one-do one-teach one, provided in the operating theatre on real patients with an extremely limited practice alternative for the assistants. To improve the practice educators and trainees are willing to use alternative education environments, such as virtual reality and box training. However, they are not available and there are no curriculum integration models for these technologies.