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Picht T, Roethe AL, Kersting K, Burzlaff M, Calvé ML, Schenk R, Chakkalakal D, Vajkoczy P, Ostherr K. Conceptualisation and Implementation of a Competency-based Multidisciplinary Course for Medical Students in Neurosurgery. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:565-573. [PMID: 38884013 PMCID: PMC11176525 DOI: 10.2147/amep.s443981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/11/2024] [Indexed: 06/18/2024]
Abstract
The field of medicine is quickly evolving and becoming increasingly more multidisciplinary and technologically demanding. Medical education, however, does not yet adequately reflect these developments and new challenges, which calls for a reform in the way aspiring medical professionals are taught and prepared for the workplace. The present article presents an attempt to address this shortcoming in the form of a newly conceptualized course for medical students with a focus on the current demands and trends in modern neurosurgery. Competency-based education is introduced as a conceptual framework comprising academic and operational competence as well as life-world becoming. This framework provides a sound educational foundation for future medical professionals, equipping them with the knowledge as well as skills needed to successfully navigate the medical field in the current day and age. Three competencies are identified that are central to day-to-day medical practice, namely digitalization, multidisciplinarity, and the impact of recent developments on the changing patient-practitioner relationship. These competencies are relevant for all medical disciplines, but are demonstrated here in a neurosurgical context and visualized using a real patient's case study. Students follow this sample patient's way through each step of the neurosurgical workflow, from planning to performing the procedure, and can see for themselves the importance and application of the aforementioned competencies based on this real-world example. Courses such as the one presented here may prepare medical students more adequately for their future work by combining theoretical and practical skills and critical reflection, thereby providing holistic and practical insights as well as a conceptual framework for their future careers.
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Affiliation(s)
- Thomas Picht
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna L Roethe
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Kersting
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Milena Burzlaff
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maxime Le Calvé
- Cluster of Excellence: “Matters of Activity. Image Space Material”, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Robert Schenk
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Denny Chakkalakal
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Ostherr
- Medical Humanities Research Institute, Rice University, Houston, TX, USA
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Waterkeyn F, Woodfield J, Massawe SL, Mzimbiri JM, Shabhay ZA, Bureta CA, Sommer F, Mndeme H, Magawa DG, Kwelukilwa D, Ndossi MY, Kinghomella AA, Kaale AJ, Ahmed S, Mtei J, Minja F, Moses M, Medary B, Hussain I, Ikwuegbuenyi CA, Petr O, Kiloloma WO, Rutabasibwa NB, Mangat HS, Mchome LL, Härtl R, Shabani HK. The effect of the Dar es Salaam neurosurgery training course on self-reported neurosurgical knowledge and confidence. BRAIN & SPINE 2023; 3:101727. [PMID: 37383451 PMCID: PMC10293233 DOI: 10.1016/j.bas.2023.101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/21/2023] [Accepted: 03/06/2023] [Indexed: 06/30/2023]
Abstract
Introduction The Muhimbili Orthopaedic Institute in collaboration with Weill Cornell Medicine organises an annual neurosurgery training course in Dar es Salaam, Tanzania. The course teaches theory and practical skills in neurotrauma, neurosurgery, and neurointensive care to attendees from across Tanzania and East Africa. This is the only neurosurgical course in Tanzania, where there are few neurosurgeons and limited access to neurosurgical care and equipment. Research question To investigate the change in self-reported knowledge and confidence in neurosurgical topics amongst the 2022 course attendees. Material and methods Course participants completed pre and post course questionnaires about their background and self-rated their knowledge and confidence in neurosurgical topics on a five point scale from one (poor) to five (excellent). Responses after the course were compared with those before the course. Results Four hundred and seventy participants registered for the course, of whom 395(84%) practiced in Tanzania. Experience ranged from students and newly qualified professionals to nurses with more than 10 years of experience and specialist doctors. Both doctors and nurses reported improved knowledge and confidence across all neurosurgical topics following the course. Topics with lower self-ratings prior to the course showed greater improvement. These included neurovascular, neuro-oncology, and minimally invasive spine surgery topics. Suggestions for improvement were mostly related to logistics and course delivery rather than content. Discussion and conclusion The course reached a wide range of health care professionals in the region and improved neurosurgical knowledge, which should benefit patient care in this underserved region.
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Affiliation(s)
- François Waterkeyn
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Julie Woodfield
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Sylvia Leon Massawe
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Juma Magogo Mzimbiri
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Department of Neurosurgery, Arusha Lutheran Medical Center, Arusha, Tanzania
| | - Zarina Ali Shabhay
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Fabian Sommer
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Hadija Mndeme
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Dorcas Gidion Magawa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Donatila Kwelukilwa
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | | | - Aingaya Jackson Kaale
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Shakeel Ahmed
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - John Mtei
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Fidelis Minja
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Moses Moses
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Branden Medary
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Ibrahim Hussain
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Chibuikem Anthony Ikwuegbuenyi
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
| | - Ondra Petr
- Charles University in Prague, Prague, Czech Republic
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Wanin Othman Kiloloma
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | | | - Halinder Singh Mangat
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- University of Kansas Medical Centre, Kansas, USA
| | - Laurent Lemeri Mchome
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
| | - Roger Härtl
- Weill Cornell Medicine, Department of Neurosurgery, New York, USA
- New York-Presbyterian - Och Spine, New York, USA
| | - Hamisi Kimaro Shabani
- Muhimbili Orthopaedic Institute, Department of Neurosurgery, Dar es Salaam, Tanzania
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Epps L, Ramachandran A, Yi S, Mayah A, Burkholder T, Jaung M, Haider A, Wesseh P, Shakpeh J, Bills C, Enriquez K. Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit. PLoS One 2023; 18:e0282690. [PMID: 36921009 PMCID: PMC10016633 DOI: 10.1371/journal.pone.0282690] [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: 12/25/2021] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Emergency care is vital in low- and middle-income countries (LMICs) but many frontline healthcare workers in low-resource settings have no formal training in emergency care. To address this gap, the World Health Organization (WHO) developed Basic Emergency Care (BEC): Approach to the acutely ill and injured, a multi-day, open-source course for healthcare workers in low-resource settings. Building on the BEC foundation, this study uses an implementation science (IS) lens to develop, implement, and evaluate a comprehensive emergency care curriculum in a single emergency facility in Liberia. METHODS A six-month emergency care curriculum consisting of BEC content, standardized WHO clinical documentation forms, African Federation of Emergency Medicine (AFEM) didactics, and clinical mentorship by visiting emergency medicine (EM) faculty was designed and implemented using IS frameworks at Redemption Hospital, a low-resource public referral hospital in Monrovia, the capital of Liberia. Healthcare worker performance on validated knowledge-based exams during pre- and post-intervention testing, post-course surveys, and patient outcomes were used to evaluate the program. RESULTS Nine visiting EM physicians provided 1400 hours of clinical mentorship and 560 hours of didactic training to fifty-six Redemption Hospital staff over six-months. Median test scores improved 20.0% (p<0.001) among the forty-three healthcare workers who took both the pre- and post-intervention tests. Participants reported increased confidence in caring for medical and trauma patients and comfort performing emergency care tasks on post-course surveys. Emergency unit (EU)/Isolation unit (IU) mortality decreased during the six-month implementation period, albeit non-significantly. Course satisfaction was high across multiple domains. DISCUSSION This study builds on prior research supporting WHO efforts to improve emergency care globally. BEC implementation over a six-month timeframe using IS principles is an effective alternative strategy for facilities in resource-constrained environments wishing to strengthen emergency care delivery.
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Affiliation(s)
- Lane Epps
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Anu Ramachandran
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Sojung Yi
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Alexander Mayah
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Taylor Burkholder
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Michael Jaung
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Ahson Haider
- San Francisco State University, San Francisco, CA, United States of America
| | | | | | - Corey Bills
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Kayla Enriquez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
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Jayaram A, Pawlak N, Kahanu A, Fallah P, Chung H, Valencia-Rojas N, Rodas EB, Abbaslou A, Alseidi A, Ameh EA, Bekele A, Casey K, Chu K, Dempsey R, Dodgion C, Jawa R, Jimenez MF, Johnson W, Krishnaswami S, Kwakye G, Lane R, Lakhoo K, Long K, Madani K, Nwariaku F, Nwomeh B, Price R, Roser S, Rees AB, Roy N, Ruzgar NM, Sacoto H, Sifri Z, Starr N, Swaroop M, Tarpley M, Tarpley J, Terfera G, Weiser T, Lipnick M, Nabukenya M, Ozgediz D, Jayaraman S. Academic Global Surgery Curricula: Current Status and a Call for a More Equitable Approach. J Surg Res 2021; 267:732-744. [PMID: 34905823 DOI: 10.1016/j.jss.2021.03.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We aimed to search the literature for global surgical curricula, assess if published resources align with existing competency frameworks in global health and surgical education, and determine if there is consensus around a fundamental set of competencies for the developing field of academic global surgery. METHODS We reviewed SciVerse SCOPUS, PubMed, African Medicus Index, African Journals Online (AJOL), SciELO, Latin American and Caribbean Health Sciences Literature (LILACS) and Bioline for manuscripts on global surgery curricula and evaluated the results using existing competency frameworks in global health and surgical education from Consortium of the Universities for Global Health (CUGH) and Accreditation Council for Graduate Medical Education (ACGME) professional competencies. RESULTS Our search generated 250 publications, of which 18 were eligible: (1) a total of 10 reported existing competency-based curricula that were concurrent with international experiences, (2) two reported existing pre-departure competency-based curricula, (3) six proposed theoretical competency-based curricula for future global surgery education. All, but one, were based in high-income countries (HICs) and focused on the needs of HIC trainees. None met all 17 competencies, none cited the CUGH competency on "Health Equity and Social Justice" and only one mentioned "Social and Environmental Determinants of Health." Only 22% (n = 4) were available as open-access. CONCLUSION Currently, there is no universally accepted set of competencies on the fundamentals of academic global surgery. Existing literature are predominantly by and for HIC institutions and trainees. Current frameworks are inadequate for this emerging academic field. The field needs competencies with explicit input from LMIC experts to ensure creation of educational resources that are accessible and relevant to trainees from around the world.
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Affiliation(s)
| | | | - Alexis Kahanu
- Hackensack University Medical Center, Edison, NJ, USA
| | - Parisa Fallah
- Department of OB/GYN, Brigham & Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Haniee Chung
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Edgar B Rodas
- Virginia Commonwealth University Department of Surgery, Richmond VA, USA
| | | | - Adnan Alseidi
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Emmanuel A Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- Addis Ababa University Department of Surgery, Addis Ababa, Ethiopia; University of Global Health Equity, Rwanda
| | | | - Kathryn Chu
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Robert Dempsey
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Chris Dodgion
- Medical College of Wisconsin Division of Trauma and Critical Care, Wauwatosa, WI, USA
| | - Randeep Jawa
- Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Maria F Jimenez
- Hospital Universitario Mayor Mederi, Department of Surgery. Universidad del Rosario, Bogota, Colombia
| | | | | | - Gifty Kwakye
- University of Michigan Department of Surgery, Ann Arbor, MI, USA
| | - Robert Lane
- International Federation of Surgical Colleges
| | - Kokila Lakhoo
- University of Oxford, Oxford University Hospitals, UK
| | - Kristin Long
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Katayoun Madani
- Northwestern University Department of Surgery, Chicago, IL, USA
| | | | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Raymond Price
- University of Utah Dept of Surgery, Salt Lake City, UT, USA
| | - Steven Roser
- Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew B Rees
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nobhojit Roy
- BARC Hospital, HBNI University, Mumbai, India/ CARE-India, Bihar Technical Support Unit, Patna, Bihar, India
| | | | | | - Ziad Sifri
- Rutgers New Jersey Medical School Department of Surgery, Newark, NJ, USA
| | - Nichole Starr
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Mamta Swaroop
- Northwestern University Department of Surgery, Chicago, IL, USA
| | - Margaret Tarpley
- University of Botswana Department of Medical Education, Gaborone, Botswana
| | - John Tarpley
- University of Botswana Department of Surgery, Gaborone, Botswana
| | - Girma Terfera
- University of Wisconsin School of Medicine and Public Health, Madison WI, USA
| | - Thomas Weiser
- Stanford University Medical Center Department of Surgery, Stanford, CA, USA
| | - Michael Lipnick
- University of California San Francisco Department of Anesthesia, San Francisco, CA, USA
| | - Mary Nabukenya
- Makerere University Department of Anesthesia, Kampala, Uganda
| | - Doruk Ozgediz
- University of California San Francisco Department of Surgery, San Francisco, CA, USA
| | - Sudha Jayaraman
- University of Utah Dept of Surgery, Salt Lake City, UT, USA.
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Kelly PD, Yengo-Kahn AM, Roth SG, Zuckerman SL, Chitale RV, Wellons JC, Chambless LB. Data-Driven Residency Training: A Scoping Review of Educational Interventions for Neurosurgery Residency Programs. Neurosurgery 2021; 89:750-759. [PMID: 34423828 DOI: 10.1093/neuros/nyab322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neurosurgery residency programs are tasked with imparting large volumes of both clinical knowledge and technical skill to trainees in limited time. Many investigators have described local practices, which may offer evidence-based interventions in neurosurgical residency education, but this literature has not been systematically reviewed. OBJECTIVE To perform a scoping review of educational practices in neurosurgery, which are supported by quantitative, peer-reviewed research. METHODS A scoping review of the literature was performed. PubMed, Embase, and Web of Science databases were queried for articles describing educational interventions for neurosurgery residents, which included a quantitative assessment of the effect on resident performance. RESULTS From an initial set of 1785 unique articles, 29 studies were ultimately screened and included. Studies were into the following 6 topics: (1) didactics and curricula (n = 13), (2) nontechnical skills (n = 6), (3) wellness and burnout (n = 4), (4) assessment and feedback (n = 2), (5) mentorship and career development (n = 2), and (6) research (n = 2). Individual study results were described. CONCLUSION Several educational interventions in neurosurgical training are supported by quantitative evidence. Methodological shortcomings are prevalent among studies of education, particularly in the selection of meaningful outcome measures. A summary of evidence-based considerations is provided for current and future program directors.
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Affiliation(s)
- Patrick D Kelly
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Aaron M Yengo-Kahn
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rohan V Chitale
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John C Wellons
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Nacoti M, Fazzi F, Biroli F, Zangari R, Barbui T, Kochanek PM. Addressing Key Clinical Care and Clinical Research Needs in Severe Pediatric Traumatic Brain Injury: Perspectives From a Focused International Conference. Front Pediatr 2021; 8:594425. [PMID: 33537259 PMCID: PMC7849211 DOI: 10.3389/fped.2020.594425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/06/2020] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children and adolescents. Survivors of severe TBI are more prone to functional deficits, resulting in poorer school performance, poor health-related quality of life (HRQoL), and increased risk of mental health problems. Critical gaps in knowledge of pathophysiological differences between children and adults concerning TBI outcomes, the paucity of pediatric trials and prognostic models and the uncertain extrapolation of adult data to pediatrics pose significant challenges and demand global efforts. Here, we explore the clinical and research unmet needs focusing on severe pediatric TBI to identify best practices in pathways of care and optimize both inpatient and outpatient management of children following TBI.
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Affiliation(s)
- Mirco Nacoti
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Fazzi
- Pediatric Intensive Care Unit, Department of Anesthesia and Intensive Care, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Francesco Biroli
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rosalia Zangari
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Tiziano Barbui
- Fondazione per la Ricerca dell'Ospedale di Bergamo Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Patrick M. Kochanek
- Department of Critical Care Medicine, Safar Center for Resuscitation Research, John G Rangos Research Center, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Andenmatten K, Provence F, Cunningham M, Sepehri A, Perka C, Ylänkö P, Masri BA. Development and Implementation of International Curricula for Joint Replacement and Preservation. Orthop Clin North Am 2021; 52:27-39. [PMID: 33222982 DOI: 10.1016/j.ocl.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The number of patients undergoing joint replacement and preservation procedures continues to increase worldwide. Globally, there is no standardized educational pathway, training program, or recognized certification program for surgeons in these procedures. Development and implementation of new competency-based curricula to deliver specific educational events and resources may help trainees and practicing surgeons be able to perform these procedures more effectively and therefore improve patient outcomes in their respective countries. Ideally, a curriculum would be globally standardized and professionally designed to interactively meet the needs of surgeons. A competency-based approach with built-in assessment and evaluation processes is today's educational standard.
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Affiliation(s)
- Kokeb Andenmatten
- AO Foundation - AO Education Institute, Stettbachstrasse 6, Dübendorf 8600, Switzerland
| | | | - Michael Cunningham
- AO Foundation - AO Education Institute, Stettbachstrasse 6, Dübendorf 8600, Switzerland
| | - Aresh Sepehri
- Department of Orthopaedics, University of British Columbia, Diamond Health Care Centre, 11th Floor - 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Carsten Perka
- Charité, University Medicine Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Pipsa Ylänkö
- AO Recon, Clavadelerstrasse 8, Davos Platz 7270, Switzerland
| | - Bassam A Masri
- Department of Orthopaedics, Complex Joint Reconstruction Clinic, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, 3rd Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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Rafter D, Vasdev R, Hurrelbrink D, Gormley M, Chettupally T, Shen FX, Samadani U. Litigation risks despite guideline adherence for acute spinal cord injury: time is spine. Neurosurg Focus 2020; 49:E17. [PMID: 33130619 DOI: 10.3171/2020.8.focus20607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Current guidelines do not specify timing for management of acute spinal cord injury (aSCI) due to lack of high-quality evidence supporting specific intervals for intervention. Randomized prospective trials may be unethical. Nonetheless, physicians have been sued for delays in diagnosis and intervention. METHODS The authors reviewed both the medical literature supporting the guidelines and the legal cases reported in the Westlaw and Lexis Advance databases from 1972 to 2018 resulting in awards or settlements, to identify whether surgeons are vulnerable to litigation despite the existence of guidelines not mandating specific timing of care. RESULTS Timing of intervention was related to claims in 59 (36%) of 163 cases involving SCI. All 22 trauma cases identified cited timing of intervention, sometimes related to delayed diagnosis, as a reason for the lawsuit. The mean award of 10 cases in which the plaintiffs' awards were disclosed was $4,294,384. In the majority of cases, award amounts were not disclosed. CONCLUSIONS Because conduct of a prospective, randomized trial to investigate surgical timing of intervention for aSCI may not be achievable, evidence-based guidelines will be unlikely to mandate specific timing. Nonetheless, surgeons who unreasonably delay intervention for aSCI may be at risk for litigation due to treatment delay. This is increasingly likely in an environment where "complete" SCI is difficult to verify. SCI may at some point be recognized as a surgical emergency, as brain injury generally is, despite a lack of prospective randomized trials supporting this implementation, challenging the feasibility of the US trauma infrastructure to provide care for these patients.
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Affiliation(s)
- Daniel Rafter
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Ranveer Vasdev
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Duncan Hurrelbrink
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Mark Gormley
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Tabitha Chettupally
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota
| | - Francis X Shen
- 2University of Minnesota Law School, Minneapolis, Minnesota.,3Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Uzma Samadani
- 1Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, Minnesota.,4Neurosurgery Section, Department of Neurosurgery, Minneapolis VA, Minneapolis, Minnesota
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