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Mangham W, Parikh KA, Motiwala M, Gienapp AJ, Roach J, Barats M, Lillard J, Khan N, Arthur A, Michael LM. A Scoping Review of Professionalism in Neurosurgery. Neurosurgery 2024; 94:435-443. [PMID: 37819083 DOI: 10.1227/neu.0000000000002711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/10/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education's Milestones provides a foundation for professionalism in residency training. Specific professionalism concepts from neurosurgery could augment and expand milestones for the specialty. We reviewed the current literature and identified professionalism concepts within the context of neurosurgical practice and training. METHODS We used a scoping review methodology to search PubMed/MEDLINE and Scopus and identify English-language articles with the search terms "professionalism" and "neurosurgery." We excluded articles that were not in English, not relevant to professionalism within neurosurgery, or could not be accessed. Non-peer-reviewed and qualitative publications, such as commentaries, were included in the review. RESULTS A total of 193 articles were included in the review. We identified 6 professionalism themes among these results: professional identity (n = 53), burnout and wellness (n = 51), professional development (n = 34), ethics and conflicts of interest (n = 27), diversity and gender (n = 19), and misconduct (n = 9). CONCLUSION These 6 concepts illustrate concerns that neurosurgeons have concerning professionalism. Diversity and gender, professional identity, and misconduct are not specifically addressed in the Accreditation Council for Graduate Medical Education's Milestones. This review could be used to aid the development of organizational policy statements on professionalism.
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Affiliation(s)
- William Mangham
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Kara A Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Mustafa Motiwala
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Andrew J Gienapp
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis , Tennessee , USA
| | - Jordan Roach
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Michael Barats
- College of Medicine, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Jock Lillard
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
| | - Nickalus Khan
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - Adam Arthur
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
| | - L Madison Michael
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis , Tennessee , USA
- Semmes Murphey, Memphis , Tennessee , USA
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Abstract
OBJECTIVE To assess vestibular schwannoma (VS) practice patterns among providers. STUDY DESIGN Cross-sectional survey. SETTING 8th Quadrennial International Conference on Vestibular Schwannoma and Other CPA Tumors. SUBJECTS Clinicians who specialize in the management of VS. MAIN OUTCOME MEASURES Responses to questions on the management and anticipated outcomes of VS for a series of common clinical scenarios were compared by specialty (otolaryngology versus neurosurgery), level of experience, scope of practice (surgery versus radiation and surgery), and geographic location of practice (United States versus international). RESULTS Responses from 110 participants were analyzed. Overall, 53% of respondents were otolaryngologists, 60% had greater than 10 years of experience, and 57% practiced within the United States. In total, 86% of respondents would pursue initial observation for themselves if diagnosed with a 4 mm distal intracanalicular VS; however, practicing radiosurgeons were more likely to select stereotactic radiosurgery for this scenario compared with providers who solely practice surgery (14 versus 0%; p = 0.032). Otolaryngologists and neurosurgeons alike report that radiosurgery should not be considered a long-term hearing preservation strategy.Otolaryngologists were more optimistic regarding microsurgical hearing preservation outcomes for small distal intracanalicular tumors compared with neurosurgeons (11 versus 3% selected a high likelihood of maintaining class A/B hearing; p = 0.007). Ninety-five percent of respondents prioritized facial nerve outcome over complete disease removal in the context of microsurgical resection of large tumors. CONCLUSIONS Management decision-making and expected outcomes for various clinical scenarios were largely similar among providers; however, variances in several key clinical areas exist. This study points to the feasibility of developing a widely accepted consensus statement among VS experts across specialties.
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Khattab MH, Sherry AD, Cmelak AJ, Attia A. In Reply: A Retrospective Cohort Study of Longitudinal Audiologic Assessment in Single and Fractionated Stereotactic Radiosurgery for Vestibular Schwannoma. Neurosurgery 2019; 85:E1127-E1129. [PMID: 31529045 DOI: 10.1093/neuros/nyz373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mohamed H Khattab
- Department of Radiation Oncology Vanderbilt University Medical Center Nashville, Tennessee
| | | | - Anthony J Cmelak
- Department of Radiation Oncology Vanderbilt University Medical Center Nashville, Tennessee
| | - Albert Attia
- Department of Radiation Oncology Vanderbilt University Medical Center Nashville, Tennessee.,Department of Neurological Surgery Vanderbilt University Medical Center Nashville, Tennessee
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Roth C, Salehi M, Deinsberger W, Kaestner S, Engel H. Conservative versus operative treatment in supratentorial intracerebral hemorrhage - A survey among neurosurgeons and neurologists in Germany. Clin Neurol Neurosurg 2019; 186:105502. [PMID: 31494462 DOI: 10.1016/j.clineuro.2019.105502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/17/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Decision making for surgical therapy in patients with intracerebral hemorrhage is still controversial among neurologists and neurosurgeons. Whereas neurologists may favor conservative treatments, surgeons may opt for operations. This might lead to different therapy decisions. PATIENTS AND METHODS Between 2017 and 2018, we conducted a survey among the neurological and neurosurgical societies in Germany. An online questionnaire consisting of 10 fictive patients with spontaneous supratentorial intracerebral hemorrhage (including CT scans and brief case descriptions) was administered to the members of the societies. The participants were asked to decide whether conservative or surgical treatment would be preferred. Furthermore, the results from the neurosurgeons were compared to the results of our previous surveys in 1999 and 2009. RESULTS A total of 157 answers were collected (response rate of 16.2%). Nineteen had to be excluded, leaving 138 for analysis (84 neurosurgeons and 54 neurologists). There were no significant differences in therapy decisions between neurologists and neurosurgeons in all ten cases. Comparing the answers from neurosurgeons with our previous results, there were no significant differences between the results from 1999, 2009 and 2017. CONCLUSIONS Against common prejudices, the process of decision making for or against surgery in patients with spontaneous intracerebral hemorrhage is comparable among conservative physicians (neurologists) and neurosurgeons in Germany. This might be the result of joint efforts in spontaneous intracerebral hemorrhage (ICH) therapy, such as joint guidelines or a society of neurointensive care medicine.
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Affiliation(s)
- Christian Roth
- Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany; Department of Neurology, University of Marburg, Germany.
| | | | | | | | - Holger Engel
- Ethianum Clinic for Plastic and Reconstructive Surgery, Aesthetic and Preventive Medicine at Heidelberg University Hospital, Heidelberg, Germany; Department of Hand, Plastic and Reconstructive Surgery, Microsurgery Burn Centre, BG Trauma Centre, Ludwigshafen/Rhine, Germany, University of Heidelberg, Germany
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Darsaut TE, Fahed R, Macdonald RL, Arthur AS, Kalani MYS, Arikan F, Roy D, Weill A, Bilocq A, Rempel JL, Chow MM, Ashforth RA, Findlay JM, Castro-Afonso LH, Chagnon M, Gevry G, Raymond J. Surgical or endovascular management of ruptured intracranial aneurysms: an agreement study. J Neurosurg 2019; 131:25-31. [DOI: 10.3171/2018.1.jns172645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVERuptured intracranial aneurysms (RIAs) can be managed surgically or endovascularly. In this study, the authors aimed to measure the interobserver agreement in selecting the best management option for various patients with an RIA.METHODSThe authors constructed an electronic portfolio of 42 cases of RIA in which an angiographic image along with a brief clinical vignette for each patient were displayed. Undisclosed to the responders was that the RIAs had been categorized as International Subarachnoid Aneurysm Trial (ISAT) (small, anterior-circulation, non–middle cerebral artery location, n = 18) and non-ISAT (n = 22) aneurysms; the non-ISAT group also included 2 basilar apex aneurysms for which a high number of endovascular choices was expected. The portfolio was sent to 132 clinicians who manage patients with RIAs and circulated to members of an American surgical association. Judges were asked to choose between surgical and endovascular management, to indicate their level of confidence in the choice of treatment on a quantitative 0–10 scale, and to determine whether they would include the patient in a randomized trial in which both treatments are compared. Eleven clinicians were asked to respond twice at least 1 month apart. Responses were analyzed using kappa statistics.RESULTSEighty-five clinicians (58 cerebrovascular surgeons, 21 interventional neuroradiologists, and 6 interventional neurologists) answered the questionnaire. Overall, endovascular management was chosen more frequently (n = 2136 [59.8%] of 3570 answers). The proportions of decisions to clip were significantly higher for non-ISAT (50.8%) than for ISAT (26.2%) aneurysms (p = 0.0003). Interjudge agreement was only fair (kappa 0.210, 95% CI 0.158–0.276) for all cases and judges, despite high confidence levels (mean score > 8 for all cases). Agreement was no better within subgroups of clinicians with the same specialty, years of experience, or location of practice or across capability groups (ability to clip or coil, or both). When agreement was defined as > 80% of responders choosing the same option, agreement occurred for only 7 of 40 cases, all of which were ISAT aneurysms, for which coiling was preferred.CONCLUSIONSAgreement between clinicians regarding the best management option was infrequent but centered around coiling for some ISAT aneurysms. Surgical clipping was chosen more frequently for non-ISAT aneurysms than for ISAT aneurysms. Patients with such an aneurysm might be candidates for inclusion in randomized trials.
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Affiliation(s)
- Tim E. Darsaut
- 1Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Robert Fahed
- 2Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - R. Loch Macdonald
- 3Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital, University of Toronto, Ontario, Canada
| | - Adam S. Arthur
- 4Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - M. Yashar S. Kalani
- 5Departments of Neurosurgery, Neurology and Neuroscience, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Fuat Arikan
- 6Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Spain
| | - Daniel Roy
- 7Service of Neuroradiology, Department of Radiology, Centre Hospitalier de l’Université de Montréal (CHUM)
| | - Alain Weill
- 7Service of Neuroradiology, Department of Radiology, Centre Hospitalier de l’Université de Montréal (CHUM)
| | - Alain Bilocq
- 8Service of Neurosurgery, Centre Hospitalier Régional de Trois-Rivières, Québec
| | - Jeremy L. Rempel
- 9Department of Radiology & Diagnostic Imaging, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Michael M. Chow
- 1Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Robert A. Ashforth
- 9Department of Radiology & Diagnostic Imaging, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - J. Max Findlay
- 1Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Luis H. Castro-Afonso
- 10Division of Interventional Neuroradiology, Department of Internal Medicine, University of São Paulo, Ribeirao Preto, Brazil
| | - Miguel Chagnon
- 11Department of Mathematics and Statistics, Université de Montréal; and
| | - Guylaine Gevry
- 12Research Centre, Interventional Neuroradiology Laboratory, Centre Hospitalier de l’Université de Montréal (CHUM), Québec, Canada
| | - Jean Raymond
- 7Service of Neuroradiology, Department of Radiology, Centre Hospitalier de l’Université de Montréal (CHUM)
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Carlson ML, Tveiten ØV, Lund-Johansen M, Tombers NM, Lohse CM, Link MJ. Patient Motivation and Long-Term Satisfaction with Treatment Choice in Vestibular Schwannoma. World Neurosurg 2018; 114:e1245-e1252. [PMID: 29625305 DOI: 10.1016/j.wneu.2018.03.182] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To ascertain primary motivation and long-term satisfaction with treatment selection in patients with vestibular schwannoma. METHODS A multicenter, cross-sectional survey was performed. Patients with small- to medium-sized sporadic vestibular schwannoma who underwent stereotactic radiosurgery (SRS; n = 247), microsurgery (n = 144), or observation (n = 148) between 1998 and 2008 were surveyed regarding their motivation behind treatment selection and hindsight satisfaction with their choice of management. RESULTS "Physician recommendation" was the most commonly stated reason for modality selection in all 3 groups. The second and third most common reasons for selecting SRS included "less invasive option than surgery" in 80 patients (32%) and "less recovery time than surgery" in 16 patients (6%). The second and third most common reasons for selecting observation included "to avoid side-effects of treatment" in 25 patients (17%) and "symptoms not severe enough to warrant intervention" in 22 patients (15%). The second and third most common reasons for selecting microsurgery included "do not want tumor in head" in 35 patients (24%) and "most definitive treatment" in 15 patients (10%). Overall, 232 patients (96%) treated with SRS, 141 observed patients (97%), and 121 patients (85%) who underwent microsurgical treatment were satisfied with their original decision (P < 0.001). CONCLUSIONS Motivation behind treatment selection varies between individuals. Those who select observation and SRS commonly reference less invasiveness and lower risk, whereas those who select microsurgery are commonly motivated by having their tumor physically removed and the more definitive nature of treatment. Posttreatment satisfaction is highest in patients who undergo SRS and observation, although all 3 groups report high levels of satisfaction.
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Affiliation(s)
- Matthew L Carlson
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | - Øystein Vesterli Tveiten
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Morten Lund-Johansen
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Norway
| | - Nicole M Tombers
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Maldaner N, Burkhardt JK, Stienen MN, Goldberg J, Bervini D, Bijlenga P, Croci D, Zumofen D, D’Alonzo D, Marbacher S, Maduri R, Daniel RT, Serra C, Esposito G, Neidert MC, Bozinov O, Regli L. Decision-making and neurosurgeons' agreement in the management of aneurysmal subarachnoid haemorrhage based on computed tomography angiography. Acta Neurochir (Wien) 2018; 160:253-260. [PMID: 29214402 DOI: 10.1007/s00701-017-3415-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND To determine the neurosurgeon's agreement in aneurysmal subarachnoid haemorrhage (aSAH) management with special emphasis on the rater's level of experience. A secondary aim was to analyse potential aneurysm variables associated with the therapeutic recommendation. METHOD Basic clinical information and admission computed tomography angiography (CTA) images of 30 consecutive aSAH patients were provided. Twelve neurosurgeons independently evaluated aneurysm characteristics and gave recommendations regarding the emergency management and aneurysm occlusion therapy. Inter-rater variability and predictors of treatment recommendation were evaluated. RESULTS There was an overall moderate agreement in treatment decision [κ = 0.43; 95% confidence interval ((CI), 0.387-0.474] with moderate agreement for surgical (κ = 0.43; 95% CI, 0.386-0.479) and endovascular treatment recommendation (κ = 0.45; 95% CI, 0.398-0.49). Agreement on detailed treatment recommendations including clip, coil, bypass, stent, flow diverter and ventriculostomy was low to moderate. Inter-rater agreement did not significantly differ between residents and consultants. Middle cerebral artery (MCA) aneurysm location was a positive predictor of surgical treatment [odds ratio (OR), 49.57; 95% CI, 10.416-235.865; p < 0.001], while patients aged >65 years (OR, 0.12; 95% CI, 0.03-0.0434; p = 0.001), fusiform aneurysm type (OR, 0.18; 95% CI, 0.044-0.747; p = 0.018) and intracerebral haematoma (ICA) aneurysm location (OR, 0.24; 95% CI, 0.088-0.643; p = 0.005) were associated with a recommendation for endovascular treatment. CONCLUSIONS Agreement on aSAH management varies considerably across neurosurgeons, while therapeutic decision-making is challenging on an individual patient level. However, patients aged >65 years, fusiform aneurysm shape and ICA location were associated with endovascular treatment recommendation, while MCA aneurysm location remains a surgical domain in the opinion of neurosurgeons without formal endovascular training.
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