Needs assessment of neurosurgery trainees: a survey study of two large training programs in the developing and developed worlds.

BACKGROUND: There are challenges facing surgical education in both the developing and the developed worlds. Few studies have examined trainee perceptions of their educational needs in a systematic way. We undertook a study to examine this issue, focusing on two large training programs, one in the developed world and one in the developing world. METHODS: Neurosurgical trainees at the University of Toronto, Toronto, Canada, and at Hasan Sadikin Hospital in Bandung, Indonesia, were surveyed with a comprehensive questionnaire assessing both the content and the methods of their training. The questionnaire had 37 quantitative questions requesting responses on a 7-point Likert scale and three open-ended questions to give more qualitative data. RESULTS: Sixty-four percent of all trainees responded. A number of interesting findings about the strengths and weaknesses of training emerged. For example, Bandung trainees felt they had excellent training in trauma but not in specialty areas, especially spine and vascular, with ample opportunity to operate as the primary surgeon. Toronto trainees felt that the volume and the variety of cases were excellent but they did not have enough ambulatory experience, and that they had suboptimal experience as the primary surgeon. Trainees in both centers agree that they will feel competent to practice neurosurgery upon completion of their training. CONCLUSION: This study defined different educational needs for neurosurgical trainees in two centers that reflect both their individual training environments and the local culture of medicine. As such, trainees' perceptions of these needs represent an important adjunct to program evaluation.

Primary intradural extraarachnoid hodgkin lymphoma of the cervical spine. Case report.

This 42-year-old man presented with an intradural extramedullary mass in his lower cervical spine. On imaging studies the lesion mimicked the appearance of a meningioma. At surgery, the mass was found to be an intradural extra-arachnoid tumor. An intraoperative pathological examination determined the lesion to be a Hodgkin lymphoma. The procedure was limited to biopsy sampling and the patient was treated further with adriamycin, bleomycin, vincristine, and dacarbazine chemotherapy, after which remission was demonstrated both clinically and on images. Analysis of a frozen section obtained during the procedure aided in the diagnosis of the tumor, thus preventing further resection and the potential neurological complications associated with more radical resection. To the authors' knowledge this is the first reported case of a presumed primary intradural extraarachnoid Hodgkin lymphoma.

Outcome evaluation of the operative management of lumbar disc herniation causing sciatica.

OBJECT: The authors conducted a study to assess health-related quality of life (HRQOL) and the appropriateness of surgery in patients who have undergone elective lumbar discectomy. METHODS: The study involved a prospective cohort of 82 surgically treated patients with lumbar disc herniation causing lower-extremity radiculopathy. An independent study coordinator recorded demographic data and administered the North American Spine Society (NASS) lumbar spine instrument and the Short Form-36 (SF-36) before treatment, and at 6 months and 1 year after surgery. The HRQOL results were also compared with normative data for the NASS and SF-36. The influence of baseline variables on HRQOL was determined using regression modeling. The InterQual Indicators for Surgery and Procedures (ISP) were used to compare surgeon practice patterns with standardized indications for surgery. The NASS neurogenic symptom (NSS) and pain/disability scores (PDSs) showed very significant improvement at 6 months and little change between 6 months and 1 year. The SF-36 physical function and bodily pain scale scores were associated with the greatest improvement. Interestingly, the 1-year NASS (NSS and PDS) and SF-36 (only PCS) scores remained lower than those of age-matched normative data. Other than preoperative HRQOL scores, the only other variable that inversely influenced HRQOL was the duration of time between symptom onset and surgery. Ninety-five percent of ISP forms were completed, and 97% of the indications recorded by the surgeon matched the criteria. CONCLUSIONS: The reporting of standardized outcomes in association with indications for surgery is feasible and may help elucidate the ideal rate for discectomy.