Speakers

Expanding Global Neurosurgery Through Productivity Enhancement
1108 09:10-09:20
Education & Training/303A
Introduction: An estimated 50% more neurosurgeons than the current 50,000 worldwide are needed, primarily in low- and middle-income countries (LMICs). In Europe, the annual average number of operations per neurosurgeon ranges from 56 (Greece) to 300 (United Kingdom). If every neurosurgeon performed 200 or more procedures annually, increased productivity would address the unmet need much faster than relying only on training more neurosurgeons. Materials & Methods: Productivity limits are typically: (1) procedure-related; (2) infrastructure-related. Neurosurgeons control the former: neurosurgeons can employ cost-effective evidence-based (not inefficient tradition-based) techniques. The latter, typically site-specific “weak links”, requires interaction with other healthcare personnel (e.g. hospital administrators). Results: Evidence-based techniques that increase productivity: 1. Not shaving. This decreases infection risk and saves time (1) prior to surgery, (2) after surgery (no or minimal dressing required), (3) post-op (patients with hair intact feel less “disabled” and mobilize/discharge more rapidly). 2. Avoiding urinary catheters unless strictly indicated. 3. Making incisions parallel to scalp arteries. Not requiring Raney clips saves time and money. 4. Selective replacement of general endotracheal anesthesia with laryngeal mask anesthesia and local anesthesia. 5. Replacing many ventriculoperitoneal shunts with either third ventriculostomies (obstructive hydrocephalus) or lumboperitoneal shunts (communicating hydrocephalus). Surgery time is typically shorter, with fewer complications long-term. 6. Constant assessment of one’s surgical “habits” for more efficient techniques. Examples are presented of entrepreneurial neurosurgeons who work beyond neurosurgery alone (i.e. together with clinical and administrative partners) to bring improvements in overall healthcare for their region or country are presented. Conclusions: Neurosurgeon productivity can be enhanced through addressing inefficient “surgical habits” and improved interaction with the healthcare infrastructure.

Global Standards for Neurosurgical Training and Certification
1108 08:50-09:00
Education & Training/303A
Introduction: Standards for training and certification (T&C) vary greatly country-by-country. A European study involving nearly 40 countries found that variability in T&C across countries should be addressed. Materials & Methods: Standards for neurosurgical training and certification have been sought from the World Federation of Neurosurgical Societies (WFNS) continental societies and the individual societies, where possible, for countries globally. Information has been obtained from websites, e.g. American Board of Neurological Surgery (ABNS) and European Union of Medical Specialists (UEMS), and from PubMed articles. Results: The five continental neurosurgical societies vary greatly in number of countries: from two countries in North America to roughly 15 countries in Africa and Latin America to 30-40 countries in Asia and Europe. The Royal College of Physicians and Surgeons of Canada introduced competency-based (rather than time-based) neurosurgical training in 2019. The UEMS and EANS have an optional standardized competency-based curriculum for T&C alongside the European Board Examination in Neurological Surgery (FEBNS) examination within EANS member countries. A global competency-based curriculum might require modifications based on (1) local cases encountered (e.g. regions with a higher incidence of trauma, infections, or congenital disorders) and (2) resource-based limitations (e.g. radiosurgery, interventional neuroradiology, deep brain stimulation). All trainees should utilize digital case logs to document their clinical experience. Videos of surgical procedures could enable competency assessment but may raise problems related to authenticity and patient confidentiality. Conclusions: Global standards for neurosurgical T&C incorporating common curricula and digital/electronic techniques have the potential to augment the competency, interaction, and efficiency of the neurosurgical workforce worldwide.