Training Neurosurgeons in Myanmar and Surrounding Countries: The Resident Perspective.

INTRODUCTION: In recent decades there has been a significant expansion of neurosurgical capabilities in low- and middle-income countries, particularly in Southeast Asia. Despite these developments, little is known about the structure and quality of local neurosurgical training paradigms. METHODS: A 36-question survey was administered to neurosurgical trainees in person at the Southeast Asian Neurosurgical Bootcamp to assess demographics, structure, and exposure of neurosurgical training in Southeast Asia. RESULTS: A total of 45 out of 47 possible respondents participated in the survey; 78% were men, with an age range of 26-40 years. Neurosurgical training most commonly consisted of 3 (n = 22, 49%) or 6 years (n = 14, 31%). The majority of respondents (70.5%) were from Myanmar, with the remainder coming from Indonesia, Cambodia, Thailand, and Nepal. Most residents (n = 38, 84%) used textbooks as their primary study resource. Only 24 (53%) residents indicated that they had free access to online neurosurgical journals via their training institution. The majority (n = 27, 60%) reported that fewer than 750 cases were performed at their institution per year; with a median of 70% (interquartile range: 50%-80%) being emergent. The most commonly reported procedures were trauma craniotomies and ventriculoperitoneal shunting. The least commonly reported procedures were endovascular techniques and spinal instrumentation. CONCLUSIONS: Although the unmet burden of neurosurgical disease remains high, local training programs are devoting significant efforts to provide a sustainable solution to the problem of neurosurgical workforce. High-income country institutions should partner with global colleagues to ensure high-quality neurosurgical care for all people regardless of location and income.

Construction and Validation of Educational Material for Children with Hydrocephalus and Their Informal Caregivers.

OBJECTIVE: To build and validate journal-type digital and printed educational material for informal caregivers (i.e., the parents who provide care) of children with hydrocephalus. METHODS: This is a methodologic study conducted in the children's neurosurgery outpatient clinic of a university hospital. The content validity index with a concordance of ≥0.78 was used for validation. Content was validated with the participation of 5 nurses and 3 neurosurgeons, and appearance was validated with the participation of 9 informal caregivers of children with hydrocephalus. RESULTS: A 21-page journal was created to address hydrocephalus and its treatment. The content and semantics of this material were validated with a universal content validity index of 0.90 and 0.98, respectively. CONCLUSIONS: Content and appearance of the educational material for informal caregivers of children with hydrocephalus were successfully validated and considered suitable and user-friendly for health education.

Shunts: Is Surgical Education Safe?

BACKGROUND: More data regarding complications in neurosurgery residents' cases are needed to assess patients' safety during hands-on surgical education. METHODS: A retrospective 2-center study was performed comparing consecutive patients undergoing shunt implantation by a supervised neurosurgery resident (teaching cases) versus a board-certified faculty neurosurgeon (nonteaching cases). The primary end point was surgical revision after shunting. Univariate and multivariate Cox proportional hazard models (Breslow method for ties) with time censored at 2 years were used to examine time-to-event data. Operation time, length of hospitalization, intracranial hemorrhage, and misplacement of the shunt catheter were other outcome measures to be compared between the groups. RESULTS: A total of 320 shunts (180 [56.3%] teaching and 140 [43.7%] nonteaching cases) with a mean follow-up of 563 ± 771 days (standard deviation) were analyzed. Revision rates for the entire cohort were 9.3% at 90 days, 13.3% at 6 months, 18.4% at 1 year, and 26.5% at 2 years. In univariate analysis, teaching cases were 96% as likely as nonteaching cases to be surgically revised (hazard ratio, 0.96; 95% confidence interval, 0.54-1.70; P = 0.877). In multivariate analysis adjusted for indication and shunt type, teaching cases were 94% as likely as nonteaching cases to undergo surgical revision (hazard ratio, 0.94; 95% confidence interval, 0.53-1.69; P = 0.847). There were no group differences in operation time, length of hospitalization, intracranial hemorrhage, and rates of shunt misplacement. CONCLUSIONS: The results of the current study in addition to the literature on neurosurgery resident training support the safety of supervised early surgical education for shunt surgery.