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Neurosurgery European Manual of Medicine Neurosurgery Bearbeitet von Christianto B. Lumenta, Concezio Di Rocco, Jens Haase, J.J.A. Mooij 1. Auflage 2009. Taschenbuch. xxviii, 660 S. Paperback ISBN 978 3 540 79564 3 Format (B x L): 19,3 x 26 cm Gewicht: 1404 g Weitere Fachgebiete > Medizin > Chirurgie > Neurochirurgie schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, eBooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte. Training and Education Edited by Christianto B. Lumenta 7 2.1 Training in Neurosurgery Hans-Jürgen Reulen 2.1.1 Introduction Of these four years at least three years should be spent in a UEMS member state and not less than three years in the same recognised programme. Training must include ad- National authorities and professional bodies have the re- equate exposure to intensive care and to paediatric neu- sponsibility for monitoring and recognising training in- rosurgery. Because of the future reduction in the hours of stitutions and to provide certification or recognition of work there may be a need to extend the training time in medical specialists. The European Union of Medical Spe- clinical neurosurgery from four to five years. cialists (UEMS) is the responsible authority in the EU for Up to a total of two years may be spent in related disci- harmonisation and improvement of the quality of train- plines (in a surgical discipline, neurology, neuropaediat- ing of medical specialists. Harmonisation is a necessary rics, neuroradiology, neuropathology, neurophysiology) prerequisite to enable free movement of medical special- and/or activities including research in neurosciences. ists in the countries of the EU. The European Neurosurgical Training Charter of the UEMS [1] summarises the requirements and standards 2.1.4 Contents of Training for training in neurosurgery. National organisations are strongly recommended to adopt these requirements in their national guidelines. In the following, all referrals are The contents of training are described in the classical made to the European Neurosurgical Training Charter. textbooks, encompassing knowledge in: Departments in the process of developing or improv- • General basics of surgery ing their training programme may find comprehensive • Complete neurological investigation tests and proce- information in Training in neurosurgery in the countries dures of the EU, a guide to organize a training program [2]. • Neurosurgical diseases, their diagnosis, prognosis, treatment indications, and their operative and non- operative treatment (including intensive care and pos- 2.1.2 Goals of a Neurosurgical sible complications) Training Programme • Conservative and operative treatment of head injuries and the spine/spinal cord • Microsurgical operative techniques and neuronaviga- The main goal is to provide a trainee with a broad knowl- tion edge base, the necessary operative and procedural skills • Indications for and the interpretation of modern neu- and experiences, as well as professional judgement as roradiological examination techniques (CT, MRI, my- preparation for independent neurosurgical practice. Fur- elography, angiography), as well as Doppler sonogra- ther goals are to teach self-criticism, critical assessment of phy and ultrasound his/her results, and the ability to undertake self-directed • Quality control (morbidity and mortality conference, learning, which will eventually lead to continued expert infection control, risk management) practice and professionalism. 2.1.5 The Training Programme 2.1.3 Length of Training • There should be a written Training Curriculum de- Neurosurgical training requires a minimum duration of scribing the contents and aims in each year of training. six years which includes a minimum of four years train- A structured Surgical Training Plan can be helpful to ing in clinical neurosurgery in an accredited programme. provide a systematic escalation of surgical competence 8 2.1 Training in Neurosurgery and responsibilities. Emphasis should be placed on 2.1.6.1 Requirements for Training adequate time allocated for study and tuition indepen- Institutions with Regard dent of clinical duties. to Equipment and • There should be established Rotation Periods covering Educational Facilities all main areas of neurosurgery. Each rotation should have clearly defined goals with regard to responsibilities • There must be a referral base sufficient to provide in patient care, knowledge and operative experience. an adequate case volume and mixture to support the • During each rotation a trainee should be assigned to a training programme. specific trainer. • There must be a minimum of four trainers (including • There should be a documented Education Programme the chairman/programme director). with lectures, clinical presentations, neuropathologi- • There must be at least 30 neurosurgical beds and in ad- cal and neuroradiological conferences, a journal club, dition critical care beds (7–10/million population). a morbidity and mortality conference, teaching meet- • There must be at least two designated, fully staffed op- ings including subspecialties, and teaching in ethics, erating theatres (neurosurgically trained staff), appro- administration, management and economics. priately equipped and with 24-h availability. • It is recommended that trainees participate at least • There must be an operating microscope with CCTV once a year in a national/European training course, in for each theatre. The following are deemed essential a hands-on course or a national neurosurgical meet- equipment: ultrasonic aspirator, image guidance and/ ing, respectively. or ultrasound, a stereotactic system, radiological im- • Each trainee must keep an authorised logbook (meet- aging, and endoscopy equipment. ing the standards of the UEMS/European Association • Neurosurgical theatres should be covered by anaesthe- of Neurosurgical Societies [EANS] logbook) for docu- tists with a special interest in neuroanaesthesia. An- mentation of his/her operative experience. The trainee aesthesia coverage should be available at all times for will have to demonstrate that he/she has assisted in a neurosurgery. wide range of cases, which should include a balance of • There must be designated and fully staffed neurosur- trainer-assisted and personal cases under supervision. gical intensive care beds. Neurosurgical intensive care The logbook must be supervised and signed regularly may be managed by neurosurgery or there may be by the respective trainer, and it must be available at joint responsibility between neurosurgery and anaes- Board examination. thesia. • Trainees should be encouraged to participate in re- • There must be an emergency unit with 24-h admis- search and to develop an understanding of research sion. methodology. In academic programmes, clinical and/ • There must be outpatient clinics where non-emergency or basic research opportunities must be available to patients are seen before and after surgery. trainees with appropriate faculty supervision. • There must be exposure to paediatric neurosurgery as a mandatory component of a training programme. Where this does not form part of the routine work of 2.1.6 The Training Institution a neurosurgical department, a 6-month secondment to an appropriate programme should be arranged (It must be recognised that in some European countries A training institution must have national recognition paediatrics requires special training and a protected in accordance with the standards of the UEMS Training environment). Charter. Participation of training institutions in the Euro- • There should be opportunity to obtain experience in pean accreditation process at present is voluntary and, if functional neurosurgery either within the department compliant, indicates that the department and the training or in another neurosurgical department specialising in programme fulfil the European Standards of Excellence this field. for Education in Neurosurgery. • All main specialities (neurology, surgery/traumatol- Units that cannot comply with the minimum stan- ogy, anaesthesiology, radiology, neuroradiology, neu- dards of the UEMS Training Charter (case volume and ropathology, radiotherapy, internal medicine, paediat- mixture, number of trainers and beds, etc. as listed below) rics) must be present to provide the trainee with the and cannot offer the full spectrum of neurosurgery can- opportunity of developing his/her skills in a team ap- not be training centres on their own. It is recommended proach to patient care. that they develop a common training programme in co- • There should be an easily accessible library, with an operation with a larger department. Highly specialised adequate selection of books and journals on neuro- centres can be included in the rotation of a recognised surgery, as well as facilities for computer literature training centre. searches. 2.1.6 The Training Institution 9 2.1.6.2 Institutional Quality 2.1.6.4 Responsibilities of Trainers Management Provisions Trainers should be certified specialists and possess the A training institution must have an internal system of necessary administrative, teaching and clinical skills, and quality assurance. There should be written guidelines commitment to instruct and support their trainees. They concerning
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