脳血管外科医教育

Neurosurgery has now reached a mature stage in Japan, and the baby-boomer generation who initially established Japanese neurosurgery is leaving the operating theater. Therefore, effective education to pass techniques, knowledge, and experience on to the next generation is becoming more and more important year by year. Specific questions in the field of education such as “What should be taught?” “How much should it be taught?” and “What teaching methods are best?” must be answered in order to design a framework for educating and assigning neurovascular surgeons, neuro-endovascular surgeons, and so-called “two-swords surgeons” (trained as both neurovascular and neuro-endovascular surgeons) to satisfy future requirements for neurosurgical care in Japan. Here we give an overview of these problems. <br> Recently, surgical simulators based on physical virtual reality have been developed based on rapid advances in materials, technology, and IT knowledge, and laboratory training using such simulators has been widely accepted in medical education. However, many unsolved issues still remain in applying such laboratory training to the problems of actual neurosurgery. Surgical experience should be optimized for each trainee during residency, but the problems of individual needs have not yet been solved. For example, training may illustrate how to avoid serious bleeding from an aneurysm, but how to recover after this emergency by point aspiration, temporary clipping, or compression of the carotid artery at the neck portion is rather difficult to teach. Surgical manipulation during such a crisis by a clinical trainee sometimes results in a disaster even under direction of an experienced surgeon. Recently, awareness of patients’ rights has increased, so certification of surgeon’s skill has become an important issue. In this context, the clinical outcomes of the teaching hospital should be maintained to acceptable standards, and standardized education should be provided to each trainee. <br> Further, overall and long-term views are essential for resolving these issues because of the large discrepancies in the population density in Japan of physicians from clinical specialties related to stroke, such as strokology, emergency medicine, neurology, rehabilitation, neurovascular surgery, and neuroendovascular surgery. The prefectural discrepancy ratio for neuroendovascular surgery is the largest at 21.5, but is 4-6 in most other specialties. Therefore, no rigid framework can be established to educate residents and to assign neurovascular surgeons, neuroendovascular surgeons, and two-swords surgeons. However, we must decide how to resolve these issues in the near future despite the many problems. <br>