210 Defining the Learning Curve for Cerebral Angiography Using a Novel Web-Based Feedback Application and Head-Mounted Video Review

INTRODUCTION: The milestones that a resident or fellow should reach to achieve competence in cerebral angiography have yet to be defined. METHODS: Two neurosurgical residents were given a written knowledge exam before and after rotating on the endovascular service. Cerebral angiography diagnostic and treatment cases were prospectively collected in a novel web-based, multi-institutional feedback application. These residents performed cerebral angiography cases under graduated supervision while wearing head-mounted cameras for subsequent review with direct feedback. Residents and reviewers independently utilized CaseCurve, a novel neurosurgical resident performance tracking application, as a platform for performance rating. Numerical scores were assigned ranging from 1 (novice) to 5 (masterful) in the following categories: access, catheter navigation, table operation, closure, efficiency, finesse, angiographic interpretation, and catheter knowledge. The number of times the supervising surgeon had to take over the case was recorded. Arch anatomy and vessel tortuosity were graded. Operative videos were analyzed for operator inefficiencies and time metrics for sheath insertion and target vessel selection. Angiographic efficiency was assessed with fluoroscopic doses/times and procedural durations. RESULTS: Both residents demonstrated improvement in cognitive performance as measured by written assessment scores. Significant improvements were observed in technical performance as measured by numerical scores assigned by self-evaluation, faculty review, objective measures of angiographic efficiency, and the number of times the supervising surgeon had to take over the procedure. Concordance between faculty and resident self-evaluations was 74.2%, with residents underestimating their performance in 21% and overestimating in 5%. CONCLUSIONS: There is significant educational value for the trainer and trainee offered by our novel web-based feedback application and head-mounted video review. This data allows for accurate assessments of skill acquisition and delineation of appropriate milestones/learning categories for trainees in endovascular neurosurgery.