External Ventricular Drain Training in Medical Students Improves Procedural Accuracy and Attitudes Toward Virtual Reality

Christina P. Rossitto, Ian C. Odland, Holly Oemke, Danna Cruz, Roshini Kalagara, Alexander J. Schupper, Trevor Hardigan, Brandon D. Philbrick, Braxton R. Schuldt, Margaret H. Downes, Vikram Vasan, Alex Devarajan, Muhammad Ali, Joshua B. Bederson, Christopher P. Kellner

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: Neurosurgery residents face a learning curve at the beginning of residency. Virtual reality (VR) training may alleviate challenges through an accessible, reusable, anatomical model. Methods: Medical students performed external ventricular drain placements in VR to characterize the learning curve from novice to proficient. Distance from catheter to foramen of Monro and location with respect to ventricle were recorded. Changes in attitudes toward VR were assessed. Neurosurgery residents performed external ventricular drain placements to validate proficiency benchmarks. Resident and student impressions of the VR model were compared. Results: Twenty-one students with no neurosurgical experience and 8 neurosurgery residents participated. Student performance improved significantly from trial 1 to 3 (15 mm [12.1–20.70] vs. 9.7 [5.8–15.3], P = 0.02). Student attitudes regarding VR utility improved significantly posttrial. The distance to foramen of Monro was significantly shorter for residents than for students in trial 1 (9.05 [8.25–10.73] vs. 15 [12.1–20.70], P = 0.007) and trial 2 (7.45 [6.43–8.3] vs. 19.5 [10.9–27.6], P = 0.002). By trial 3 there was no significant difference (10.1 [8.63–10.95 vs. 9.7 [5.8–15.3], P = 0.62). Residents and students provided similarly positive feedback for VR in resident curricula, patient consent, preoperative practice and planning. Residents provided more neutral-to-negative feedback regarding skill development, model fidelity, instrument movement, and haptic feedback. Conclusions: Students showed significant improvement in procedural efficacy which may simulate resident experiential learning. Improvements in fidelity are needed before VR can become a preferred training technique in neurosurgery.

Original languageEnglish
Pages (from-to)e1246-e1254
JournalWorld Neurosurgery
StatePublished - Jul 2023


  • Augmented reality
  • External ventricular drain
  • Hydrocephalus
  • Ventriculostomy
  • Virtual reality


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