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Samuel N, Philteos J, Alotaibi NM, Ahuja C, Mansouri A, Kulkarni AV. Canadian Neurosurgery Educators' Views on Stereotactic Radiosurgery in Residency Training. World Neurosurg 2018; 112:e208-e215. [PMID: 29331746 DOI: 10.1016/j.wneu.2018.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/02/2018] [Accepted: 01/04/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Despite the increasing prominence of stereotactic radiosurgery (SRS) in treating intracranial and spinal pathologies, there is currently a dearth of exposure to this modality in the neurosurgical residency. To address this gap, the aim of this study is to assess neurosurgery educators' views regarding the current state of SRS exposure, and to identify potential approaches to improve residency education in this domain. METHODS Qualitative thematic analysis and constructivist grounded theory methodology were employed. Semistructured telephone-based interviews were conducted with current or past residency program directors, as well as current departmental chairs across neurosurgical departments in Canada. Interviews were transcribed and subjected to thematic analysis using open and axial coding. RESULTS Of the 34 eligible participants, the overall response rate was 41.1% (14/34), with a 35.3% participation rate (12/34). Participants represented 9 of the 12 Canadian institutions surveyed. The majority of participants were current program directors (n = 8), followed by past program directors (n = 2), and departmental chairs (n = 2). Most respondents 75% (9/12) view an increasing role for SRS in neurosurgery. Unanimously, respondents endorse greater exposure to SRS during residency through formal residency rotations and engagement in interdisciplinary tumor boards to facilitate involvement in clinical decision-making. CONCLUSIONS This is the first study to systematically collate neurosurgery educators' views on SRS in residency in Canada and demonstrates recognition of the discordance between SRS in practice and residency training. Neurosurgery educators broadly endorse increased exposure to this modality. Future work is needed to delineate the requirements necessary to achieve adequate competency in SRS.
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Affiliation(s)
- Nardin Samuel
- MD/PhD Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justine Philteos
- Undergraduate Medical Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Naif M Alotaibi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Ahuja
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Mansouri
- Division of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Samuel N, Bernstein M, Alotaibi NM, Kalia SK, Shamji MF. Patient Perspectives Regarding Ethics of Spinal Column Stimulators in the Surgical Management of Persistent Postoperative Neuropathic Pain. Neuromodulation 2016; 20:274-278. [PMID: 27491346 DOI: 10.1111/ner.12470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/02/2016] [Accepted: 06/13/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this study is to better understand perspectives of patients with persistent postoperative neuropathic pain (PPNP) and assess perceptions of the ethical issues surrounding their structural spinal surgeon also performing spinal cord stimulation (SCS). METHODS Semistructured face-to-face interviews with 20 neurosurgical spine patients were conducted. Patients were recruited from the neurosurgery clinics at Toronto Western Hospital and were seen in consultation for PPNP. Interviews were transcribed and subjected to thematic analysis using open and axial coding. RESULTS The range of the duration of participants' preoperative symptoms varied from one month to more than 20 years, and was primarily back dominant (13/20). The median time since patients most recently underwent spinal surgery was three years. The majority of patients (15/20) do not view their current condition of PPNP as a failure of their initial spine surgeon. The most commonly reported reason for this is that patients trusted their physician and clear communication between the physician and the patient, prior to their surgery, ensured an understanding of the goals of the procedure. Nearly unanimously (19/20), patients did not perceive an ethical problem with a surgeon performing a structurally corrective spinal surgery and subsequently also implanting a SCS device if the same patient that develops medically refractory PPNP. CONCLUSIONS This is the first clinical qualitative study of values and ethical perceptions of patients with medically refractory PPNP. Our findings provide a framework for understanding the values of patients with PPNP and demonstrate that a strong surgeon-patient relationship can ameliorate concerns surrounding PPNP and SCS implantation.
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Affiliation(s)
- Nardin Samuel
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Naif M Alotaibi
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mohammed F Shamji
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Samuel N, Shamji MF, Bernstein M. Neurosurgical patients' perceptions of the "surgeon+": a qualitative study. J Neurosurg 2015; 124:849-53. [PMID: 26430837 DOI: 10.3171/2015.4.jns15113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Neurosurgical patients bear a varying degree of anxiety when confronted with having to undergo surgery or even visit with a neurosurgeon in consultation. Previous studies have suggested that patient perceptions can heavily influence the patient-physician encounter. Accordingly, a better understanding of these perceptions can marshal our knowledge regarding strategies for improving patient-physician interactions during such an apprehensive time. The aim of the present study was to qualitatively examine patient values and preferences for a neurosurgeon who participates in extraclinical activities (i.e., a "neurosurgeon+") and understand the factors that influence these perceptions. METHODS Semistructured face-to-face interviews with 47 neurosurgical patients were conducted. Patients were recruited from the Toronto Western Hospital neurosurgery clinics for cranial and spinal conditions. Descriptive summary statistics were used to characterize the study participants. Family members were encouraged to contribute to the interviews. Interviews were audio-recorded, transcribed, and subjected to thematic analysis by using open and axial coding. RESULTS Patients generally indicated that they want to feel confident in their neurosurgeon. A number of factors contribute to this confidence, including a strong positive referral from another physician. Patients are inclined to search for information pertaining to the qualifications of neurosurgeons online, and a perception of the neurosurgeon's adeptness given his or her qualifications is important for patients. Although there were some differences in patient values between those in the cranial and spinal groups, overall, neurosurgical patients tend to positively view their neurosurgeon's involvement in extraclinical duties. CONCLUSIONS This study details the first comprehensive clinical qualitative study of patient perceptions of neurosurgeons and provides a descriptive framework for understanding patient values in this clinical domain.
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Affiliation(s)
| | - Mohammed F Shamji
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto; and.,Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mark Bernstein
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Toronto; and.,Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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