Implementing a multimodal simulation-based curriculum in a neurosurgery residency program: The University of Milan experience.

Introduction: Neurosurgical training must balance progressive autonomy with patient safety. Simulation-based education, including 3D-printed models and digital platforms, offers standardized environments to practice key surgical skills. Research question: To evaluate the impact of a structured, PGY-adapted, multimodal simulation curriculum on neurosurgical residents' self-reported confidence. Material and methods: A one-day simulation curriculum was implemented at the Besta NeuroSim Center (University of Milan). Thirty-eight neurosurgical residents (PGY1-PGY5) completed modules on multilayer closure, ventriculostomy (EVD placement), and meningioma and glioma resection using patient-specific 3D-printed models and digital/haptic simulators, as well as intraoperative ultrasound (ioUS) training. Confidence was assessed pre- and post-course using a 5-point Likert scale; satisfaction was collected post-course. Results: Confidence increased across most tasks and training levels, with the greatest relative gains in tumor resection and ioUS interpretation, where baseline confidence was lowest. Overall confidence improved from 1.2 to 2.0 in PGY1 and from 3.0 to 3.67 in PGY5. Satisfaction was high, with enjoyment scores ranging from 4.2 to 4.75 and willingness to recommend from 4.6 to 4.9. Discussion and conclusion: A structured, multimodal simulation curriculum is feasible within a neurosurgical residency program and improves self-reported confidence across training levels. These findings support the integration of simulation-based training to enhance standardization and promote a patient safety-driven culture.