We greatly appreciate Dr Avila-Guerra's comments concerning our recent simulation supplement published in Neurosurgery.1 In his letter he referenced the financial expenses of starting a simulation laboratory provided by Dr Gasco. In that article, Dr Gasco and his team reflected on the cost of setting up a state-of-the-art simulation lab at their university located in the United States.2 Dr Avila-Guerra questioned, “Are the developing countries ready for this?” In response to that question, we would suspect that this “state-of-the-art laboratory” expense would be a significant endeavor for a department with limited resources. Further, if virtual reality simulation devices were employed, the cost would be exorbitant.
The goal of the supplement was not to emphasize the need to spend large amounts of resources on simulation, but rather to change our paradigm in how we teach and educate future neurosurgeons. We disagree with the conclusion that developing countries should not utilize this education paradigm. Rather, we reemphasize the conceptual change of education and importance of not only the simulator devices, but also the simulation curriculum. The simulation curriculum that we created defines didactic and technical abilities, and allows us to measure objective data. The individual models are less important, and in fact some models discussed in the supplement are rather inexpensive. For example, the CSF repair model uses a reusable frame and the latex tubing can be used numerous times. Further, in our own institution, we have gone on to use beef scapulas to teach drilling techniques with the residents. Lastly, the Congress of Neurological Surgeons (CNS) is especially interested in expanding simulation into developing countries and we have successfully completed our first international simulation experience at the recent EANS meeting. In fact, we have several future international simulation courses upcoming in India, China, and Brazil. In summary, the CNS is very interested and committed to expanding simulation to all members globally.
The authors have no personal financial or institutional interest in any of the drugs, materials, or devices described in this article.
1. Limbrick DD Jr, Dacey RG Jr. Simulation in Neurosurgery: possibilities and practicalities. Neurosurgery. 2013;73(suppl 1):1–3.
2. Gasco J, Holbrook TJ, Patel A, et al.. Neurosurgery simulation in residency training: feasibility, cost, and educational benefit. Neurosurgery. 2013;73(suppl 1):39–45.