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Jia-Ping Zheng, Chu-Zhong Li, and Guo-Qiang Chen

convenient and practical model for anatomical learning and surgical training limits the development of EETSS. 3 , 11 , 17 There are many reports regarding skull base models for neurosurgical training. 1 , 15 , 24 According to a previous study, individualized models that reflect the anatomical relationship between the tumor and surrounding structures can effectively avoid surgical complications and shorten operation time. 14 However, due to the limitation of craftsmanship, 3D-printed models that are

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Giselle Coelho, Eduardo Vieira, Jose Hinojosa, and Hans Delye

: Coelho. Supervision: Coelho. Defining video content/format together with corresponding author: Delye. References 1 Coelho G , Warf B , Lyra M , Zanon N . Anatomical pediatric model for craniosynostosis surgical training . Childs Nerv Syst . 2014 ; 30 ( 12 ): 2009 – 2014 . 2 Coelho G , Figueiredo EG , Rabelo NN , . Development and evaluation of a new pediatric mixed-reality model for neurosurgical training . J Neurosurg Pediatr . 2019 ; 24 ( 4 ): 423 – 432 . 3

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Mihir Gupta, Allison Reichl, Luis Daniel Diaz-Aguilar, Pate J. Duddleston, Jamie S. Ullman, Karin M. Muraszko, Shelly D. Timmons, Isabelle M. Germano, Aviva Abosch, Jennifer A. Sweet, Susan C. Pannullo, Deborah L. Benzil, and Sharona Ben-Haim

attrition . J Neurosurg . 2019 ; 131 ( 5 ): 1668 – 1673 . 6 Rangel EL , Smink DS , Castillo-Angeles M , Pregnancy and motherhood during surgical training . JAMA Surg . 2018 ; 153 ( 7 ): 644 – 652 . 7 Cochran A , Hauschild T , Elder WB , Perceived gender-based barriers to careers in academic surgery . Am J Surg

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James K. C. Liu, Varun R. Kshettry, Pablo F. Recinos, Kambiz Kamian, Richard P. Schlenk, and Edward C. Benzel

T he establishment of formal surgical training in the US originated with William Stewart Halsted when he established the training program at The Johns Hopkins Hospital in 1889. According to Halsted’s philosophy, surgical training was predicated on an apprenticeship model based on several principles, among which included a close association between the resident and the professor, as well as an “indefinite tenure” of training. 7 Recently, greater scrutiny of residency education and

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Danyal Z. Khan, Imanol Luengo, Santiago Barbarisi, Carole Addis, Lucy Culshaw, Neil L. Dorward, Pinja Haikka, Abhiney Jain, Karen Kerr, Chan Hee Koh, Hugo Layard Horsfall, William Muirhead, Paolo Palmisciano, Baptiste Vasey, Danail Stoyanov, and Hani J. Marcus

indexing for education, facilitate the creation of simulations, and augment surgical training programs. 5–9 By integration with the wider surgical team (such as nursing staff and anesthesiologists), these ML systems may aid orchestration of the team to a common workflow, improving efficiency and resource management. 6 Additionally, this complements the potential for real-time intraoperative ML guidance for surgeons and facilitates progression through the surgical steps, potentially reducing operative

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Jay Riva-Cambrin, John R. W. Kestle, Curtis J. Rozzelle, Robert P. Naftel, Jessica S. Alvey, Ron W. Reeder, Richard Holubkov, Samuel R. Browd, D. Douglas Cochrane, David D. Limbrick Jr., Chevis N. Shannon, Tamara D. Simon, Mandeep S. Tamber, John C. Wellons III, William E. Whitehead, Abhaya V. Kulkarni, and for the Hydrocephalus Clinical Research Network

to identify independent patient selection, operative technique, or surgical training predictors of ETV+CPC success in the infant hydrocephalus population. This HCRN study represents the largest multicenter study of ETV+CPC ever conducted in a North American setting. Methods Study Population The study included all infants (age < 2 years) treated with an ETV+CPC procedure for hydrocephalus between June 9, 2006, and March 1, 2015, at 8 participating HCRN centers. Included infants could have had an

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José Piquer, Mubashir Mahmood Qureshi, Paul H. Young, and Robert J. Dempsey

OBJECT

A shortage of neurosurgeons and a lack of knowledge of neuroendoscopic management of hydrocephalus limits modern care in sub-Saharan Africa. Hence, a mobile teaching project for endoscopic third ventriculostomy (ETV) procedures and a subsequent program to develop neurosurgery as a permanent specialty in Kenya and Zanzibar were created and sponsored by the Neurosurgery Education and Development (NED) Foundation and the Foundation for International Education in Neurological Surgery. The objective of this work was to evaluate the results of surgical training and medical care in both projects from 2006 to 2013.

METHODS

Two portable neuroendoscopy systems were purchased and a total of 38 ETV workshops were organized in 21 hospitals in 7 different countries. Additionally, 49 medical expeditions were dispatched to the Coast General Hospital in Mombasa, Kenya, and to the Mnazi Moja Hospital in Zanzibar.

RESULTS

From the first project, a total of 376 infants with hydrocephalus received surgery. Six-month follow-up was achieved in 22%. In those who received follow-up, ETV efficacy was 51%. The best success rates were achieved with patients 1 year of age or older with aqueductal stenosis (73%). The main causes of hydrocephalus were infection (56%) and spina bifida (23%). The mobile education program interacted with 72 local surgeons and 122 nurses who were trained in ETV procedures. The second project involved 49 volunteer neurosurgeons who performed a total of 360 nonhydrocephalus neurosurgical operations since 2009. Furthermore, an agreement with the local government was signed to create the Mnazi Mmoja NED Institute in Zanzibar.

CONCLUSIONS

Mobile endoscopic treatment of hydrocephalus in East Africa results in reasonable success rates and has also led to major developments in medicine, particularly in the development of neurosurgery specialty care sites.

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Roee Ber, Dennis London, Samya Senan, Yasmin Youssefi, David H. Harter, John G. Golfinos, and Donato Pacione

OBJECTIVE

Miscommunication and poor coordination among surgical teams are known causes of preventable medical harms and operating room inefficiencies and inhibit surgical training. Technology may help overcome these challenges. This study used the personal experience of one of the authors as a former Air Force F-15 pilot to design a combat aviation pre- and postoperative communication workflow in the neurosurgery department and tested its effect on safety, efficiency, and education. The authors hypothesized that the adoption of this workflow through a tailored technological platform will increase compliance and improve the chances of sustainability.

METHODS

Data were prospectively collected from neurosurgery cases before (January–May 2020) and after (June–October 2020) implementation of this workflow. Briefing and debriefing were executed using a custom mobile platform and were defined as nonmandatory for all participants. All faculty and residents who operated at NYU Langone Medical Center (Tisch campus) during the intervention period were enrolled on the platform. Primary outcomes were morbidity and mortality per the department’s criteria, and intraoperative last-minute requests as reported by operating room staff in a double-blinded fashion. Secondary outcomes were user responses on the subjective questionnaires.

RESULTS

Data were collected from 637 and 893 cases during the preintervention and intervention periods, respectively. The average briefing rates for residents and surgeons were 71% and 81%, respectively, and the average debriefing rates for residents and surgeons were 67% and 88%. There was no significant difference in preoperative risk score between the preintervention and intervention patient populations (p = 0.24). The rate of intraoperative last-minute requests significantly decreased from 16.6% (35/211) to 10.5% (35/334, p = 0.048). There was no significant change in morbidity and mortality between the preintervention and intervention periods. On subjective questionnaires there was a statistically significant improvement in safety, efficiency, and educational aspects of the cases during the intervention period.

CONCLUSIONS

Implementation of aviation-like structured team communication practices in the neurosurgery department through a technological platform improved education and communication between surgical teams and led to a reduction in last-minute surgical requests that could impact costs.

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Ajay Hegde

, examination patterns, work hours, surgical training, and medium of learning in their article. The authors noted that despite working long hours, residents were dissatisfied with their operative training and hands-on exposure. As a surgical resident, one of the most important aspects of training is the surgical skills they develop through the period. The authors in their study state that more than 60% of the respondents felt the need for better hands-on exposure during the training. This is a concern with

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Rebecca A. Reynolds and John C. Wellons III

motherhood during surgical training . JAMA Surg . 2018 ; 153 ( 7 ): 644 – 652 . 6 Hope C , Reilly JJ , Griffiths G , Lund J , Humes D . Factors associated with attrition and performance throughout surgical training: a systematic review and meta-analysis . World J Surg . 2021 ; 45 ( 2 ): 429 – 442 .