O Internato de Formação Especializada em Neurocirurgia: Qual o Atual Panorama Nacional?

Introduction: In Portugal, the number of neurosurgery residents has been rising steadily. However, there are no robust studies assessing the level of satisfaction and quality of the current training programs. The aim of this study was to describe and quantify the level of satisfaction about Neurosurgery residency in 2019, in Portugal.Material and Methods: Quantitative observational cross-sectional study based on an original questionnaire about the level of satisfaction of neurosurgical training in Portugal in 2019, sent electronically to residents and young consultants between October and December 2019.Results: A total of 37 responses were obtained from physicians aged around 29.0 (± 4.0) years old, of which 78.4% were men and 54.1% from centers in the center/south of the country/islands. Overall, 51.4% of the answers came from first three years’ residents. As for the theoretical training, there was dissatisfaction with the morbidity and mortality meetings (59.5%), existence of sessions/anatomical lab (89.2%), participation in medical education (64.9%) and in research (64.9%). As for practical training, there was dissatisfaction only towards outpatient clinics (56.8%). There is a tendency for the first surgery to occur in the first month of residency and, in ascending order, firstly a cranial trauma surgery (5.09 ± 4.59 months), then for cerebrospinal fluid diseases (5.95 ± 4.3 months), peripheral nerves (6.0 ± 7.0 months), craniotomy (6.59 ± 3.88 months) and lumbar spine diseases (11.41 ± 1.5 months). Pediatric surgery was the last type of surgery to begin (19.36 ± 20.0 months). There seems to be a generalized satisfaction with the annual (59.5%) but not with thefinal examination (37.8%).Conclusion: This study has succeed at being a better description of the Portuguese neurosurgical centers and of the level of satisfaction about neurosurgical training in Portugal.

Discrimination of residents during neurosurgical training in Mexico: Results of a survey prior to SARS-CoV-2

Background: Recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an important negative impact on global training of neurosurgery residents. Even before the pandemic, discrimination is a challenge that neurosurgical residents have consistently faced. In the present study, we evaluated discriminatory conditions experienced by residents during their neurosurgical training in Mexico before the SARS-CoV-2 pandemic. Methods: An electronic survey of 18 questions was sent among residents registered in the Mexican Society of Neurological Surgery (MSNS), between October 2019 and July 2020. Statistical analysis was made in IBM SPSS Statistics 25. The survey focused on demographic characteristics, discrimination, personal satisfaction, and expectations of residents. Results: A response rate of 50% (132 of 264 residents’ members of MSNS) was obtained and considered for analysis. Median age was 30.06 ± 2.48 years, 5.3% (n = 7) were female and 16.7% (n = 22) were foreigners undergoing neurosurgical training in Mexico. Approximately 27% of respondents suffered any form of discrimination, mainly by place of origin (9.1%), by gender (8.3%) or by physical appearance (6.1%). About 42.9% (n = 3) of female residents were discriminated by gender versus 6.4% (n = 8) of male residents (P = 0.001); while foreign residents mentioned having suffered 10 times more an event of discrimination by place of origin compared to native Mexican residents (36.4% vs. 3.6%, P < 0.001). Conclusion: This manuscript represents the first approximation to determine the impact of discrimination suffered by residents undergoing neurosurgical training in Mexico before the SARS-CoV-2 pandemic.

Women in pediatric neurosurgery

Pediatric neurosurgery is an ever-evolving field, and at the heart of it are talented and hardworking neurosurgeons who harness technology and research to enhance the standard of neurosurgical care for children. Recent studies have found that female neurosurgeons tend to choose a career focused on pediatric neurosurgery more than other subspecialties. However, the achievements and contributions of women in pediatric neurosurgery are not well known. To address this, an international working group of pediatric neurosurgeons was established from the World Federation of Neurosurgical Societies (WFNS) Women in Neurosurgery (WINS) group and Pediatric Neurosurgery Committee. The working group reviewed the current literature and collected information through personal communications with the global WINS network. Despite the increasing number of women entering neurosurgical training, the number of female pediatric neurosurgeons is still a mere handful worldwide. In this article, the authors summarize the current status of female pediatric neurosurgeons across the globe, highlighting their achievements as well as the gender bias and challenges that they face at every level of progression of their career. A better organized pediatric neurosurgery workforce, with more female representation and mentorship, would encourage future generations of diverse genders toward a career in this field.

P.178 Neurosurgical Faculty Expectations of Entrustable Professional Activities Evaluations

Background: Competence by Design (CBD), a new outcomes-based approach to medical education, has been recently introduced into neurosurgical programs across Canada. A cornerstone of this educational paradigm shift requires evaluation of residents’ performances of entrustable professional activities (EPAs). This study aimed to define Faculty expectations and markers of competence for resident EPA performances. Methods: Canada-wide survey of neurosurgical Faculty (NSF) with a 55-item online questionnaire referencing 15/45 available core neurosurgery EPAs. Results: Of the 52 respondents, majority believed that being able to perform safely (98%), effectively (92%) and independently (90%) and being able to adapt to contextual complexities of the case (88%) and unexpected events (88%) represented necessary qualities for demonstrating competence achievement of an EPA. Performing efficiently, without supervision and responding to rare events were all considered less important. On average, NSF believed that at least five separate assessments involving two or more different assessors were necessary for documenting competence achievement of each EPA. Proportion believing EPAs were representative of general neurosurgery competences varied significantly across all EPAs (p<0.00001) with >25% believing 5/15 EPAs required fellowship training. Conclusions: This study defined expectations and indicators of competent surgical performance and revealed a significant debate regarding perceived appropriateness of current EPAs for general neurosurgical training.

Realistic simulator for craniosynostosis endoscopic approach

Craniosynostosis is a premature fusion of cranial sutures, and it requires surgery to decrease cranial pressure and remodel the affected areas. However, mastering these procedures requires years of supervised training. Several neurosurgical training simulators have been created to shorten the learning curve. Laboratory training is fundamental for acquiring familiarity with the necessary techniques and skills to properly handle instruments. This video presents a novel simulator for training on the endoscopic treatment for scaphocephaly and trigonocephaly, covering all aspects of the procedure, from patient positioning to performing osteotomies. The video can be found here: https://vimeo.com/512526147.