[Neuroendovascular Skill Training That Does Not Rely on Case Volume:Strategies to Maximize Learning Density per Case]

Neuroendovascular trainees face two constraints: limited time for procedural training and fewer cases per operator. Traditional volume-based apprenticeship is becoming untenable, yet case volume alone does not determine competence. The primary qualification for an operator is sound clinical judgment rather than manual dexterity, and judgment is cultivated through deliberate engagement with each case. Because thrombectomy allows little time for case-specific rehearsal, learning depends heavily on postprocedural reflection. Multisource recording of hand movements, fluoroscopy, and vital signs, together with frame-by-frame video editing, AI-transcribed audio recordings, and eye tracking, can increase the granularity of reflective analysis. For off-the-job training, methods should be selected based on a balance among anatomical fidelity, haptics, immersion, convenience, and cost. Polyvinyl alcohol vascular models offer realistic friction, while strain gauge-embedded phantoms can translate experts' subjective perceptions of resistance into quantitative feedback. During on-the-job training, real-time video monitoring, gaze sharing, and computer vision may augment the observational capacity of trainees and supervisors. Objective criteria for initiating or terminating procedures performed by trainees, together with an ethical framework for training-related practice, remain to be established.