====== Neurosurgical training ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1NGmwZeh8JwYIxlF_oiGlUaYw3jtbQHE4QR_EYBm30xKW6AQIE/?limit=15&utm_campaign=pubmed-2&fc=20240126034911}} ---- ---- A sustainable [[neurosurgical workforce]] depends on robust training [[pipeline]]s, but the size and distribution of the global neurosurgery [[trainee]] workforce have not been described. The objective of this study was to identify the types of training programs that exist in the global neurosurgery workforce, the support that trainees receive, the diversity of trainee experiences, and the accreditation processes that exist to regulate training programs. Methods: This study was a subanalysis of a cross-sectional survey administered online in all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank and the United Nations. Participants were identified through neurosurgery society leadership, the personal contacts of the coauthors, and bibliometric and search engine searches. Population-weighted statistics were constructed and segregated by country income level and WHO regions. Results: Data were obtained for 187 countries (96.9%) and 25 additional territories, states, and disputed regions (96.2%). There were an estimated 1261 training programs and 10,546 trainees within the regions sampled, representing a global pooled density of 0.14 neurosurgery trainees per 100,000 people and a median national density of 0.06 trainees per 100,000 people. There was a higher density in high-income countries (HICs; 0.48 trainees per 100,000 people) compared with upper-middle-income countries (0.09 per 100,000), lower-middle-income countries (0.06 per 100,000), and low-income countries (LICs; 0.07 per 100,000). The WHO European (0.36 per 100,000) and Americas (0.27 per 100,000) regions had the highest trainee densities, while Southeast Asia (0.04 per 100,000) and African (0.05 per 100,000) regions had the lowest densities. Among countries with training programs, LICs had the poorest availability of subspecialty training and resources such as cadaver laboratories and conference stipends for trainees. Training program accreditation processes were more common in HICs (81.8%) than in low- and middle-income countries (LMICs; 69.2%) with training programs. Conclusions: The authors estimate that there are at least 1261 neurosurgery training programs with 10,546 total trainees worldwide. The density of neurosurgery trainees was disproportionately higher in HICs than in LMICs, and the WHO European and Americas regions had the highest trainee densities. The trainee workforce in LICs had the poorest access to subspecialty training and advanced resources ((Gupta S, Gal ZT, Athni TS, Calderon C, Callison WÉ, Dada OE, Lie W, Qian C, Reddy R, Rolle M, Baticulon RE, Chaurasia B, Dos Santos Rubio EJ, Esquenazi Y, Golby AJ, Pirzad AF, Park KB; WFNS Global Neurosurgery Committee; EANS Global and Humanitarian Neurosurgery Committee; CAANS Executive Leadership Committee. Mapping the global neurosurgery workforce. Part 2: Trainee density. J Neurosurg. 2024 Jan 16;141(1):10-16. doi: 10.3171/2023.9.JNS231616. PMID: 39508227.)). ---- [[Resident]]s have a positive [[attitude]] towards [[research]]. However, research [[engagement]] among residents is low. Improving research [[mentorship]] and creating systems that enable protected time and [[institution]]al access to [[data]] are needed to increase research output of [[postgraduate]] [[trainee]]s ((Bakhshi SK, Abdul Rahim K, Merchant AAH, Afzal N, Qadeer Shaikh N, Noorali AA, Lakhdir MPA, Mahmood SBZ, Tariq M, Haider AH. Barriers to research productivity amongst postgraduate trainees: results from a survey of 333 medical and surgical residents. Postgrad Med J. 2023 Aug 7:qgad062. doi: 10.1093/postmj/qgad062. Epub ahead of print. PMID: 37544657.)) ---- In a [[retrospective]] [[analysis]] of [[patient]]s who have undergone [[Microvascular decompression]] by the trainee (07/2014-07/2017) and by the [[senior]] neurosurgeon (03/2011-04/2015). Data such as surgery time, [[length of stay]], [[outcome]]s and [[complication]]s were collected. Out of the 18 cases of MVD were performed by the trainee, 10 were supervisor trainer un[[scrub]]bed (STU) or performed (P) and 8 were supervisor trainer scrubbed (STS). Mean surgical [[time]] was 2:30 hrs and mean length of stay was 6.33 days. The mean outcome score was 2.33/3 with 89% cases a positive outcome. The complication rate was 16.7%, of which one had meningitis, one had CSF leak and one developed a pseudomeningocele. The trainee's surgery time, outcomes and complication rates were comparable to trainer and the literature. There was a statistically significant correlation between number MVD performed and operative time (R = -0.50, p < .05), intervals between MVDs and complication rates (R = 0.64, p < .05), and interval between MVDs and outcome scores (R = -0.66, p < .05). Phang et al., estimate the time between cases should be below 40 days. [[Training]] a trainee is safe and does not add much [[burden]] to the hospital. A trainee will benefit the most if they have the same supervisor at least for the first eight cases and that each case should be done within 40 days of each other ((Phang SY, Martin J, Zilani G. Assessing the safety and learning curve of a neurosurgical trainee in performing a microvascular decompression (MVD). Br J Neurosurg. 2019 May 21:1-4. doi: 10.1080/02688697.2019.1617401. [Epub ahead of print] PubMed PMID: 31111746.)). ---- Neurosurgical training is an intensive and highly specialized process that prepares doctors to diagnose, manage, and surgically treat conditions related to the central and peripheral nervous systems, including the brain, spinal cord, and spine. Here are the key stages and components typically involved: ===== Pre-Residency (Medical School) ===== Foundation in Medicine: Aspiring neurosurgeons begin with a medical degree, usually lasting four to six years. This includes general medical training with rotations in various specialties, including neurology and surgery. Exams and Requirements: Many regions require passing specific exams to qualify for a neurosurgical residency, and some may require additional research experience or internships in neurology or neurosurgery. ===== Neurosurgical Resident Training ===== [[Neurosurgical Resident Training]]. ===== Neurosurgical Training Program ===== [[Neurosurgical Training Program]] [[Fellowship]] and [[Subspecialty]] Training ---- A study demonstrated the high acceptance of augmented 360° VR videos as a valuable tool for early student [[neurosurgical education]]. While [[hands-on]] training remains indispensable, these [[video]]s promote conceptual knowledge, ignite interest in neurosurgery, and provide a much-needed orientation within the operating room. The incorporation of detailed explanations throughout the surgies with augmentation using superimposed elements, offers distinct advantages over simply observing live surgeries ((Truckenmueller P, Krantchev K, Rubarth K, Früh A, Mertens R, Bruening D, Stein C, Vajkoczy P, Picht T, Acker G. Augmented 360° 3D virtual reality for enhanced student training and education in neurosurgery. World Neurosurg. 2024 Jan 23:S1878-8750(24)00103-7. doi: 10.1016/j.wneu.2024.01.092. Epub ahead of print. PMID: 38272307.)) ---- [[Virtual Reality]] in Neurosurgery included their utility as a supplement and augment for [[neuronavigation]] in the fields of diagnosis for complex [[vascular]] [[intervention]]s, [[spine deformity]] correction, [[resident training]], procedural practice, [[pain management]], and [[rehabilitation]] of neurosurgical patients. These technologies have also shown promise in other area of neurosurgery, such as consent taking, training of ancillary personnel, and improving patient comfort during procedures, as well as a tool for [[training]] neurosurgeons in other advancements in the field, such as [[robotic neurosurgery]]. Mishra et al. present the first [[review]] of the immense possibilities of VR in [[neurosurgery]], beyond merely [[planning]] for [[neurosurgical procedure]]s. The [[importance]] of VR and AR, especially in "social distancing" in [[neurosurgery]] [[training]], for economically disadvantaged sections, for [[prevention]] of medicolegal claims and in [[pain management]] and [[rehabilitation]], is promising and warrants further research ((Mishra R, Narayanan MDK, Umana GE, Montemurro N, Chaurasia B, Deora H. [[Virtual Reality]] in Neurosurgery: Beyond [[Neurosurgical Planning]]. Int J Environ Res Public Health. 2022 Feb 2;19(3):1719. doi: 10.3390/ijerph19031719. PMID: 35162742; PMCID: PMC8835688.)). ---- Neurosurgeons undergo extensive education and training, typically requiring 7-8 years of postgraduate medical education, including medical school and residency. Many neurosurgeons also pursue additional fellowship training in subspecialties such as pediatric neurosurgery, neuro-oncology, or functional neurosurgery. ---- The [[Halstedian model]], named after Dr. William Stewart Halsted, is an approach to surgical [[education]] and [[training]] that was developed in the late 19th and early 20th centuries.