Defining activities in neurovascular microsurgery training: entrustable professional activities for vascular neurosurgery.

BACKGROUND: Entrustable professional activities (EPAs) represent an assessment framework with an increased focus on competency-based assessment. Originally developed and adopted for undergraduate medical education, concerns over resident ability to practice effectively after graduation have led to its implementation in residency training but yet not in vascular neurosurgery. Subjective assessment of resident or fellow performance can be problematic, and thus, we aim to define core EPAs for neurosurgical vascular training. METHODS: We used a nominal group technique in a multistep interaction between a team of experienced neurovascular specialists and a medical educator to identify relevant EPAs. Panel members provided feedback on the EPAs until they reached consent. RESULTS: The process produced seven core procedural EPAs for vascular residency and fellowship training, non-complex aneurysm surgery, complex aneurysm surgery, bypass surgery, arteriovenous malformation resection, spinal dural fistula surgery, perioperative management, and clinical decision-making. CONCLUSION: These seven EPAs for vascular neurosurgical training may support and guide the neurosurgical society in the development and implementation of EPAs as an evaluation tool and incorporate entrustment decisions in their training programs.

Predicting the Length of Stay in Neurosurgery with RuGPT-3 Language Model.

In this study, we update the evaluation of the Russian GPT3 model presented in our previous paper in predicting the length of stay (LOS) in neurosurgery. We aimed to assess the performance the Russian GPT-3 (ruGPT-3) language model in LOS prediction using narrative medical records in neurosurgery compared to doctors' and patients' expectations. Doctors appeared to have the most realistic LOS expectations (MAE = 2.54), while the model's predictions (MAE = 3.53) were closest to the patients' (MAE = 3.47) but inferior to them (p = 0.011). A detailed analysis showed a solid quality of ruGPT-3 performance based on narrative clinical texts. Considering our previous findings obtained with recurrent neural networks and FastText vector representation, we estimate the new result as important but probably improveable.

Length of Stay Prediction in Neurosurgery with Russian GPT-3 Language Model Compared to Human Expectations.

Patients, relatives, doctors, and healthcare providers anticipate the evidence-based length of stay (LOS) prediction in neurosurgery. This study aimed to assess the quality of LOS prediction with the GPT3 language model upon the narrative medical records in neurosurgery comparing to doctors' and patients' expectations. We found no significant difference (p = 0.109) between doctors', patients', and model's predictions with neurosurgeons tending to be more accurate in prognosis. The modern neural network language models demonstrate feasibility in LOS prediction.

Internal Carotid Artery Injury in Transsphenoidal Surgery: Tenets for Its Avoidance and Refit-A Clinical Study.

One of the most serious/potentially fatal complications of transsphenoidal surgery (TSS) is internal carotid artery (ICA) injury. Of 6230 patients who underwent TSS, ICA injury occurred in 8 (0.12%). The etiology, possible treatment options, and avoidance of ICA injury were analyzed. ICA injury occurred at two different stages: (1) during the exposure of the sella floor and dural incision over the sella and cavernous sinus and (2) during the resection of the cavernous sinus extension of the tumor. The angiographic collateral blood supply was categorized as good, sufficient, and nonsufficient to help with the decision making for repairing the injury. ICA occlusion with a balloon was performed at the injury site in two cases, microcoils in two patients, microcoils plus a single barrel extra-intracranial high-flow bypass in one case, stent grafting in one case, and no intervention in two cases. The risk of ICA injury diminishes with better preoperative preparation, intraoperative navigation, and ultrasound dopplerography. Reconstructive surgery for closing the defect and restoring the blood flow to the artery should be assessed depending on the site of the injury and the anatomical features of the ICA.