Developing Neurosurgical Non-Technical Skills: A Tactical Decision Game Approach for Medical Students

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OBJECTIVE: Non-technical skills (NTS), such as clinical decision-making, are crucial in neurosurgery but underdeveloped in undergraduate curricula. This pilot study aimed to develop, implement, and evaluate the feasibility and perceived educational value of tactical decision games (TDGs) for enhancing NTS among medical students in neurosurgery. METHODS: A prospective, single-center pilot study was conducted with 27 fourth-year medical students during a compulsory neurosurgery module. Students, in small groups, engaged in a single 90-minute session covering three distinct, neurosurgery-specific TDG scenarios consecutively. Pre- and post-session questionnaires assessed self-perceived knowledge, decision-making confidence, and clinical readiness using 5-point Likert scales. Post-session cognitive load (Paas MERS) and qualitative feedback were also collected. Paired statistical tests compared pre/post scores, and directed content analysis was applied to free-text comments. RESULTS: Significant improvements were observed from pre- to post-session in perceived knowledge (median 3.0 vs 5.0, p < 0.001), decision-making confidence (mean 3.30 vs 4.37, p < 0.001), and readiness (median 3.0 vs 4.0, p < 0.001). Qualitative feedback highlighted TDGs' value in bridging theory and practice, enhancing clinical reasoning, and providing realistic simulation within a safe environment. The mean MERS score was high (7.30 ± 1.14), indicating significant cognitive demand, which was also noted in student comments acknowledging the session's intensity. CONCLUSION: Single-session, multi-scenario TDGs are a feasible and well-received pedagogical tool for undergraduate neurosurgery education, significantly enhancing students' self-perceived NTS. Despite the high cognitive load associated with this intensive format, TDGs show considerable promise for developing crucial clinical skills early. Further research using objective competence assessments and exploring optimal TDG formats is warranted.

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