Gender Differences in Surgical Case Volume Among Neurosurgery Residents.

OBJECTIVES: Gender differences in surgical training opportunities, measured by case volume, have been demonstrated in the fields of otolaryngology and ophthalmology. We hypothesize that this gender disparity is not present among neurosurgery residents. This study compares median female and male case volumes stratified by postgraduate year (PGY) level for U.S. neurosurgery residents. METHODS: This retrospective analysis included case log data from two southern California neurosurgery residency training programs, Riverside University Health System (RUHS) and Desert Regional Medical Center (DRMC), from 2015 to 2021. For each PGY level, gender differences in case volumes were summarized using median, SD, and two-sided t-tests. RESULTS: Among 47 (19.1% female) neurosurgery residents, there were no significant gender differences in case volumes across any PGY levels. Female residents had greater median surgical cases during PGY-1 (median (SD), female 107.0 (13.1) vs male 102.0 (24.3); p=0.841) and PGY-7 (female 282.5 (17.7) vs male 246 (60.9); P=0.424), while male residents had greater median case volumes for all other PGY levels. CONCLUSIONS: Although previous studies have found significant gender differences in case volumes among surgical residents in otolaryngology and ophthalmology, case log data from two neurosurgery residency programs in southern California, RUHS and DRMC, does not reflect this gender disparity at any PGY level.

Using a Virtual Simulation Workshop to Teach Interns Evidence-Based Feedback Techniques.

Background The Accreditation Council for Graduate Medical Education requires residents to demonstrate competence in integrating feedback into their daily practice. With the shift to virtual medical education during the pandemic, the need for new skills in delivering effective feedback through virtual media has emerged. Methodology This study aimed to assess the feasibility of a virtual bootcamp for interns, utilizing virtual simulation workshops to teach effective feedback skills. The curriculum employed a situated learning-guided participation framework. Virtual standardized students participated, and interns engaged in activities such as providing virtual feedback, completing self-assessments, and receiving instruction on feedback principles, including the one-minute preceptor's five micro-skills. Interns repeated the feedback process, with virtual students providing assessments. Data were collected from 105 incoming interns at Arrowhead Regional Medical Center in June 2021 and June 2022, using Zoom® as the online platform. Results Competency assessments revealed a significant post-training increase in proficiency/expert milestones (88% versus 47%, p = 0.007). Interns' self-assessments also significantly improved (18.02 versus 16.74, p = 0.001), particularly for previously trained interns (18.27 versus 16.7). Non-primary care interns outperformed primary care interns in milestone scores. The majority of interns (80%) reported valuable learning experiences during the workshop, with 70% expressing confidence in using the one-minute preceptor technique during residency. The one-minute preceptor step "reinforce what was right" was deemed the easiest, while "obtain commitment" and "explore emotional reaction" presented significant challenges. Conclusions This study demonstrates the potential of virtual workshops to enhance intern competency in delivering effective feedback through formal processes and the one-minute preceptor. These virtual approaches offer innovative alternatives to in-person teaching, enabling evaluation at higher levels of Miller's pyramid of clinical competence.

Evaluating the Reliability of Neurological Pupillary Index as a Prognostic Measurement of Neurological Function in Critical Care Patients.

Background Neurological pupil index (NPi) is a novel method of assessing pupillary size and reactivity using pupillometry to reduce human subjectivity. This paper aims to evaluate the use of NPi as a potential prognostic tool in a broad population of neurocritical care patients by observing the correlation between NPi, modified Rankin Scale (mRS), and Glasgow Coma Scale (GCS). Methods Our data was collected from 194 patients in the neurosurgical intensive care unit (ICU) at Arrowhead Regional Medical Center (ARMC), as determined by the power calculation. We utilized the Kolmogorov-Smirnova and Shapiro-Wilk normality tests with Lilliefors significance correction. Pearson product-moment correlation was performed between average final NPi and final GCS. Multi-variate linear regression and analysis of variance (ANOVA) were used to evaluate the association and predictive capabilities of NPi on GCS and discharge mRS. Finally, we evaluated whether age, ethnicity, sex, length of stay (LOS), or discharge location were significantly associated with NPi.  Results We observed a significant correlation between final GCS and NPi (r=0.609, p<0.001). Our regression analysis revealed that NPi significantly predicted GCS and mRS scores; however, no associations were found between age, ethnicity, sex, LOS, or discharge location. Limitations of our study include a single institutional study with a lack of disease subtyping and the inability to quantify the predictive ability of NPi. Conclusion The analysis revealed a strong correlation between final GCS and average final NPi. NPi was also able to significantly predict GCS and mRS scores. The correlation between NPi and established methods to determine neurological function, such as mRS and GCS, suggests that NPi can be a good prognostication tool for neurological diseases.

The Ideal Time to Administer Pre-operative Antibiotics: Current and Future Practices.

Background Preoperative antibiotic prophylaxis is a method of administering antibiotics prior to surgical procedures to decrease surgical site infections. The Center for Disease Control and Prevention (CDC) guidelines recommend administering the chosen antibiotic within 60 minutes prior to incision. However, further research can be conducted to explore and determine a more precise and ideal time for preoperative antibiotic prophylaxis. Methods This paper explores the most used antibiotics within the Department of Neurosurgery at Arrowhead Regional Medical Center, which are cefazolin and clindamycin, and pinpoints the ideal time of preoperative antibiotic prophylaxis based on peak serum levels. It will present and discuss findings by analyzing the pharmacokinetic profiles of each antibiotic, focusing on the minimal inhibitory concentration (MIC), time to peak in the tissue, and duration of action to determine the appropriate time for redosing. Results Our findings indicate that based on the pharmacological profiles, the ideal time to administer preoperative antibiotics for cefazolin is 40 minutes prior to incision, and for clindamycin is 45 minutes prior to incision. Conclusions This study may help guide clinical decision-making and lead to minimizing the rate of infections and decreasing hospital stay.

Priority of Gender and Racial Disparity in Neurology Journals: A Bibliometric Analysis, 2016-2021.

INTRODUCTION: Medicine and the field of neurology are not immune to gender and racial disparities present more broadly in society. Even within academia there remains a persistent lack of representation of women and racial minorities, but with the recent spotlight on discrimination it is more necessary than ever that prevailing disparities are acknowledged by medical journals and reflected in their publication priorities. This bibliometric study assesses whether social justice trends have influenced the number of articles published that discuss gender and racial disparity in the past 5 years within the top three leading neurological journals. Our assumption is that any trend towards more publications related to gender and racial disparities are reflective of the publication priorities of, and thus the perceived relevance to, the editorial boards of the chosen journals. METHODS: Using key word search of "gender," "race," and "disparity" in the title or context of published papers, the archives of Lancet Neurology, Nature Reviews Neurology, and Alzheimer's & Dementia were reviewed. RESULTS: The results indicated that although there was a slight overall increase in coverage of the aforementioned topics, it was negligible compared to the broad impact of current social justice movements. CONCLUSION: Our data suggest an inadequate publication priority for scholarly work on gender and racial disparity in the chosen journals, over the latest 5 years reviewed.