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David G. Kline and Stephen Mahaley Jr.

E ven in this age of specialized medical practice, important changes are occurring in training and certification patterns throughout most of postgraduate medicine. These changes have a great potential impact on neurosurgery. Increasingly, physicians whose practice, instruction, and/or research becomes focused in certain specialized sectors of a broader discipline want not only excellent training in their subspecialty or “super” specialty but also recognition of their special competence or qualifications. Such recognition usually begins with the establishment

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Marjorie C. Wang, Frederick A. Boop, Douglas Kondziolka, Daniel K. Resnick, Steven N. Kalkanis, Elizabeth Koehnen, Nathan R. Selden, Carl B. Heilman, Alex B. Valadka, Kevin M. Cockroft, John A. Wilson, Richard G. Ellenbogen, Anthony L. Asher, Richard W. Byrne, Paul J. Camarata, Judy Huang, John J. Knightly, Elad I. Levy, Russell R. Lonser, E. Sander Connolly Jr., Fredric B. Meyer and Linda M. Liau

. Glen Spurling. This founders group unanimously decided that a separate board should be formed for certification in neurological surgery. Dr. Naffziger drafted the initial articles of incorporation and served as the first chair. This group was later expanded to include representatives from the AMA’s Section on Nervous and Mental Diseases and Section on Surgery, the American Neurological Association, and the American College of Surgeons. Drs. Leo Davidoff, Temple Fay, and Paul Bucy designed the first certificate and seal of the board. The directors were not compensated

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Sidney Tolchin

The author presents a review of the process of peer evaluation in this century, as well as how certification and techniques of evaluation in the practice of medicine and neurosurgery have evolved. The effect of licensure on the workforce, the influence of trade laws on quality of education and training, and the new paradigm of competition and managed medical practices have made a remarkable impact on the nature of the care of patients in the United States. The author also discusses the effect of risk management and litigation on the quality of medical care, the nature of outcomes evaluation and economic credentials in the absence of appropriate instruments for such evaluation, and alternatives for the future of the credentials process.

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Byron Cone Pevehouse

programs was reduced to 86 and only eight were free of a medical school connection, but the number of positions had doubled from 270 in 1954 to 547 in 1969. In 1951, the Directory began to include information on the number of positions filled each year. A compilation of the number of programs, positions offered, and positions filled in 5-year segments over the 50 years from 1934 to 1984 shows a steady increase in the total number of residents in training ( Table 2 ). This trend is also reflected in the number of certificates issued by the ABNS since its inception in

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Neurosurgery: Considerations for strength and quality

The 1978 AANS presidential address

Charles G. Drake

examinations for certification, and then continues in practice, mellowing with experience and wisdom gained and through continuing education and self and peer review. Selection of Residents and Training The selection of residents should be straightforward. The students entering medical schools in the English-speaking world are the choice of all those in universities in regard to native intelligence and industry. Since, in my view, neurosurgery is the most fascinating and demanding and has the most need for enquiry, we should be attracting the best of the graduates

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Susan R. Durham and Scott A. Shipman

-length rotation in pediatric neurological surgery. There is concern that a limited exposure to pediatric patients during residency may not adequately prepare neurosurgeons for the unique aspects of pediatric neurosurgical care, including management of disease processes that are not encountered in older populations. 15 These factors, among others, have contributed to the development of pediatric neurological surgery as a well-defined medical specialty. 1 , 3 , 6 , 9 , 11 , 14 , 15 , 21 In 1991, the ABPNS was established to provide specialty certification in pediatric

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Jeffrey L. Nadel, R. Michael Scott, Susan R. Durham and Cormac O. Maher

(ACPNF), whose stated goals are to ascertain that those who profess to treat pediatric neurosurgical patients have an adequate fund of knowledge to provide their patients with optimum care. Nevertheless, their actions regarding the numbers of approved, accredited fellowships, and the evaluation of graduates of these fellowships for eventual certification do impact the number of trained pediatric neurosurgical specialists available to treat the pediatric neurosurgical patient. The former began its responsibility for certifying pediatric neurosurgeons in 1991, and the

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Pitfalls of bungee jumping

Case report and review of the literature

Deon Louw, Kesava K. V. Reddy, Carl Lauryssen and Gideon Louw

not require inspection of bungee equipment or certification of instructors. As neurosurgeons, we should play an active role in promoting safer jumping practices, perhaps through the forum of ThinkFirst. Suggestions for regulations include limitations on jumping heights and compulsory use of air cushions, as well as multiple jumping cords. 7 A greater proportion of injuries have occurred in jumpers who used ankle straps, and their use should be discouraged in favor of body harnessing. Clearly, it is an impossible task to eliminate completely the danger inherent in

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Gabrielle Lynch, Karina Nieto, Saumya Puthenveettil, Marleen Reyes, Michael Jureller, Jason H. Huang, M. Sean Grady, Odette A. Harris, Aruna Ganju, Isabelle M. Germano, Julie G. Pilitsis, Susan C. Pannullo, Deborah L. Benzil, Aviva Abosch, Sarah J. Fouke and Uzma Samadani

correction to optimize the potential of the neurosurgical workforce. 22 Board certification is a voluntary process. Upon completion of residency, a neurosurgeon becomes board eligible. After collecting independent surgical cases with more than 1 year of follow-up and several letters from board-certified neurosurgeons attesting to competency, a boardeligible neurosurgeon must pass an oral examination to become certified by the ABNS. Some neurosurgeons continue to practice without ABNS certification or seek certification from other credentialing organizations. The

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Toqir K. Mukhtar, Andrew J. Molyneux, Nick Hall, David R. G. Yeates, Raphael Goldacre, Mary Sneade, Alison Clarke and Michael J. Goldacre

which the HES database can be reliably linked is 1999, and the earliest data available to us in which all certified causes of death are on each death certificate are for the year 1995. As some deaths that occur in each year are not registered until the following year, we examined data including those for 2011 registrations, but we confined our analyses of mortality to data for deaths that occurred in 2010 (to avoid end-year incompleteness of registrations). Our analyses of admission and CFRs were confined to admissions up to and including 2010 (to permit 365-day