Simulation in neurosurgery: Past, present, and future.

Neurosurgery is one of the most technically demanding medical professions that warrants a high level of expertise. In the present context of competitive medical practice, high societal expectations regarding quality of patient care and medicolegal and financial constraints, there are fewer opportunities for a trainee to achieve competency in standard neurosurgical, microsurgical, and operative techniques. Practice on simulation models like cadavers has been a trend since antiquity; however, recent development of newer models with their strategic modifications has given simulation education a new dimension. It has allowed trainees to acquire and improve surgical skills and knowledge in specifically fabricated and controlled settings with no risk to real patients. Simulation also offers the opportunity for deliberate practice and repetition unlimited number of times so that psychomotor skills can be automated. There is ever-growing evidence showing the positive impact of simulation on resident training in various areas of health care. Advances in computer technology and imaging, development of sophisticated virtual reality simulators with haptic feedback and the recent addition of three-dimensional printing technology, have opened a wide arena for the development of high-fidelity patient-specific models to complement current neurosurgical training. Simulation training in neurosurgery in India is still elementary since its inception at the All India Institute of Medical Sciences, New Delhi. A structured modular training program has been developed which is yet to be implemented at a multi-institutional level. Stringent efforts are needed to establish a uniform resident training curriculum where simulators can be used to complement current neurosurgical training.