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AANS Neurosurgeon | Volume 29, Number 1, 2020

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Multidisciplinary Education in Neurosurgery: The Stereotactic Radiosurgery Perspective

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Educating the neurosurgeons of tomorrow is an important process that needs to reflect the dynamic shifts in contemporary practice as well as personal preference. It is our belief there is a growing, collective need to incorporate a multidisciplinary approach in medical education to maximize the knowledge of tomorrow’s neurosurgeons. In the field of stereotactic radiosurgery (SRS), there is increasing evidence that such an approach is effective in enhancing educational and research opportunities, as well as patient outcomes.1 This follows on from the more established models of the neuro-oncological2 and cerebrovascular3 board meetings in which neurosurgical residents are constantly exposed to other disciplines during their training.

The field of SRS is distinguished. It requires a technical skillset and scientific knowledge different from open neurosurgery and to otherwise limit a trainee’s education from the more niche areas of neurosurgical subspecialties is to limit their potential as a clinician. In addition to the standard neurological and anatomical knowledge expected of a neurosurgical resident, SRS requires expertise in the areas of radiobiology, radiation oncology, medical physics, cancer medicine, neuroimaging, and stereotaxis. As SRS is a tool utilized in skull base, functional, cerebrovascular, spine and pediatric neurosurgery, the teaching of SRS not only mandates a multidisciplinary approach between clinical and scientific disciplines but also between neurosurgical specialties.

One could draw parallels to SRS, as closed brain and spine procedures, to neuro-interventional neurosurgery, as catheter-based closed procedures, and other emerging non-invasive neurosurgical techniques (e.g. magnetic resonance guided focused ultrasound). The knowledge and skills required for proficiency and mastery of these closed approaches are distinct from traditional, open, neurosurgery. Moreover, they require collaboration with clinical partners in practice. Thus, the education of neurosurgical residents in these approaches requires multidisciplinary training that ideally would integrate into neurosurgical residency training and Committee of Advanced Subspecialty Training (CAST) accredited fellowships to maximize trainee knowledge and competency.

The optimization of SRS education in neurosurgical residency remains an ongoing effort, titrating exposure to the necessary training specific to SRS without overwhelming the already established educational commitments of a residency program.4 Avenues to do so are multiple. Increased exposure during research, elective, and fellowship years of training represents the most direct method, allowing residents to interact with the various clinical and scientific disciplines on a regular basis. This includes externships wounationally and internationally allowing for a comprehensive perspective to SRS – clinically, academically and culturally. However, these avenues favor those residents with an obvious interest in SRS. In development of the future neurosurgeon, baseline SRS competencies may prove useful irrespective of interest level.

The AANS/American Society for Therapeutic Radiology and Oncology (ASTRO) resident course in SRS may be one such educational tool to deliver a broader SRS education for all residents. This three-day course is undertaken at one’s home institution; it is designed to provide key basic knowledge from multiple disciplines in a focused learning environment.5 Bringing together experts and other residents from multiple disciplines to teach those who would otherwise not have access to such diverse, but critical, expertise in one place is the benefit of such a course. Dr. Brian Kavanagh will host the next AANS and ASTRO resident course in Denver in January 2021.

The practice of neurosurgery is often multidisciplinary; its education is no different. In regards to SRS, many methods exist for imparting this knowledge to residents; these methods may modify in time and intensity to suit their needs. Nevertheless, to enable a standard baseline of SRS understanding, conscientious efforts towards incorporating multiple disciplines into the education today of neurosurgical residents is highly recommended to best prepare the neurosurgeons of the future for the expanding field of stereotactic radiosurgery.

References

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1. Chidambaram S, Winston GM, Knisely JPS, et al. A Multidisciplinary Team Approach to Brain and Spine Stereotactic Radiosurgery Conferences: A Unique Institutional Model. World Neurosurg. Nov 2019;131:159-162.

2. Snyder J, Schultz L, Walbert T. The role of tumor board conferences in neuro-oncology: a nationwide provider survey. J Neurooncol. 2017;133(1):1-7.

3. Leys D, Ringelstein EB, Kaste M, Hacke W, European Stroke Initiative Executive C. The main components of stroke unit care: results of a European expert survey. Cerebrovasc Dis. 2007;23(5-6):344-352.

4. Sheehan JP. Resident perceptions of radiosurgical training and the effect of a focused resident training seminar. J Neurosurg. 2010;113(1):59-63.

5. Sheehan J, Suh JH, Kavanagh B, et al. Training Neurosurgery and Radiation Oncology Residents in Stereotactic Radiosurgery: Assessment Gathered from Participants in AANS and ASTRO Training Course. World neurosurgery. 2018;109:e669-e675.

 

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