Learning and Career Development in Neurosurgery: Values-Based Medical Education

Preface
Introduction
Acknowledgments
Contents
About the Editor
Part I: First Section: Current and Traditional Root Analysis of the Learning Process
	The Culture of Surgical Training
		1 Introduction
		2 History of Surgical Residency
		3 Stakeholders
		4 Practical Realities of Surgical Training
			4.1 Working Conditions
			4.2 Hierarchy, Power Dynamics, and Mentorship
		5 Worldwide Heterogeneity of Surgical Culture
		6 Conclusion
		References
	What Is the Training in Neurosurgery All About? Lessons Learned from Japanese Culture
		1 Introduction
			1.1 Neurosurgical Training: Personal Experience with Training
			1.2 The Characteristics of Neurosurgery Training from the Point of View of Japanese Traditional Culture
		2 In Closing
		References
	Training of Trainers in Medicine, Surgery, and Neurosurgery
		1 Introduction
		2 The Values and Importance of Training of Trainers’ Programs
		3 Structural Training Programs and Curricula
		4 Why an Open-End Curriculum?
		5 Who Should Be Trained, the Admission to the Training of Trainers’ Programs?
		6 The Professional Trainer of Trainers
		7 Training of Trainers Regulatory Board
		8 The Pedagogy
			8.1 Training of trainers’ courses structured format pedagogy
				8.1.1 Methods of Assessment and Evaluation
			8.2 The Frequency of Courses
		9 Certifications and Certifying Body
		10 Ethical Issues
		11 E-Learning
		12 Conflict of Interest
		13 Conclusion
		References
	The Anatomy of Education and Learning Process: The Indian Perspective
		1 Academy
		2 Ancient Indian Education System
		3 Modern Neurosurgical Training
			3.1 Rich Clinical Arena of Indian Neurosurgery
		4 Cadaveric Training
		5 Philosophy and Technology in Neurosurgery
		6 Virtual Training
		7 Importance of Publications
		8 Conclusion
		References
	The Progress of the Teaching and Learning Process in Neurosurgery over the Years
		1 Historical Background
		2 Current Situation in Neurosurgical Training and Education
		3 Future Opportunities and Unmet Needs in Neurosurgical Training
		References
Part II: Ethics and Metacognition of Education Learning and Career Development
	My Patients Have Taught Me!
		1 Introduction
		2 Doctors in Students’ Chairs and Patient Is the Teacher
		3 What Do Patients Teach Us?
			3.1 Session I
				3.1.1 Lessons Have Been Learned from Session I
			3.2 Session II
				3.2.1 Lessons Learned from Session II
		4 Why Do We Need to Learn from the Patients?
		5 How Do We Teach Trainees and Fellows the Secrets, the Arts and Skills to Listening and Learning from Patients and Patients’ Family?
		6 Conclusions
		References
	Metacognition in Neurosurgery
		1 Background
		2 What Is Metacognition?
		3 What Is Critical Thinking?
		4 Can We Teach Strategies to Improve Metacognition in Neurosurgery?
			4.1 General Strategies to Enhance Metacognition in Neurosurgical Trainees
				4.1.1 Planning
				4.1.2 Monitoring
				4.1.3 Evaluation
				4.1.4 Reviewing the Questions
				4.1.5 Thinking Out Loud
				4.1.6 Reflection
				4.1.7 Performance Self Judgment
			4.2 Strategies to Enhance Metacognition in a Practical Setting
				4.2.1 Mastery Goal Setting
				4.2.2 Questioning and Feedback
				4.2.3 Clinical Documentation and Rotation Structure
		5 Conclusions
		References
	The Ethics of Neurosurgical Training
		1 Introduction
		2 Surgical Training: A Principlism Approach
		3 Surgical Training: An Alternative Approach
			3.1 Point No. 1: Reconciling Ethical Conflicts
			3.2 Point No 2: Surgical Training and Insight
			3.3 Point 3: Creating Ethical Conflict
			3.4 Point 4: Integrity
			3.5 Point 5: Transparency
		4 Conclusion
		References
	Ethics of Clinical Research
		1 Introduction
		2 Guidelines for Ethically Sound Research
			2.1 Care, Innovation, or Research?
			2.2 Learning Health System and Ethics
		References
	Utilitarianism and Consequentialism in Learning
		1 Introduction
		2 Moral Education
		3 Method of Ethical Deliberation and Theoretical Foundation of Decision-Making
		4 Consequentialism: Which Consequences and for Whom—Value and Distribution
		5 Summary
		References
	Neurochips: An Ethical Consideration
		1 Introduction
		2 The Scope of Neuroethics
		3 A Brief Description of Technical Aspects of Neurochips for Neurosurgeons
		4 Future Directions of Neurochips Applications
		5 Bioethical Considerations and the Expected Implications on the Neurosurgical Education
		6 Final Reflections
		References
	Values-Based Medical Education (VsBME): Trainee Is the Center of the Training System
		1 Introduction
			1.1 Values-Based Medicine (VsBM) and Values-Based Medical Education (VsBME)
				1.1.1 Definition and the Concept of Values-Based Medicine
			1.2 Values-Based Medicine in Education, Learning, and Career Development
		2 Conclusion
		References
	The Integration of Values-Based Medical Education (VsBME) in the Education and Training Processes: A Conceptual Framework for Neurosurgical/Surgical/Medical Education and Training
		1 Introduction
		2 Integration of the Principles and Concept of Values-Based Medical Education (VsBME) in Medical Education and Training
			2.1 Vision, Strategic Plans
			2.2 Trainees
			2.3 The Trainers (Training and Program, Instructors/Teachers)
		3 Value of Metacognition
		4 Transferring Experiences
		5 What Does it Mean to Be an Ethical Teacher/Trainer/Program Instructor?
		6 Professional Ethics and Professionalism
		7 Professional Ethics
			7.1 Curriculum
			7.2 Education, Training and Practice Premises, Logistic, and Litigations
		8 Discussion and Conclusions
		References
Part III: Global Challenges in Learning and Career Development
	Cross-Border Learning and Career Development
		1 Introduction
		2 What Is Cross-Border Education?
		3 Approaches to Cross-Border Higher Education, Training and Career Development
		4 The Exodus/Brain Drain
		5 The Supply and Demand
			5.1 Demand
			5.2 Supply
		6 Challenges Facing Cross-Border Learning
		7 Migrating Doctors/the NHS Reality
		8 Virtual Cross-Border Learning
		9 The Role of Culture in Cross-Border Learning and Career Development
		10 Conclusion
		References
	The Difficult Trainee: Strategies for Recognizing and Addressing Training Challenges
		1 Introduction
		2 A Difficult Trainee or a Trainee in Difficulty: Is There a Difference?
			2.1 Recognition and Remediation of a Difficulty Trainee
			2.2 Identifying and Supporting the Trainee in Difficulty: Stress Factors and Burnout
		3 Strategies for Resolution
		References
	Difficult Trainers: The Toxic, the Rigid, and the Impaired
		1 Introduction
			1.1 Toxic Managers
				1.1.1 The Narcissist
					Occupation and Narcissism
				1.1.2 Control Freaks
				1.1.3 Aggressive Trainers
					Bullying in Medicine
					Workplace Bullying Consequences
					Reasons for Turning Toxic
					Common Behaviors in the Toxic Working Environment
					Changing the Bullying Culture in Medicine
			1.2 Rigid Managers
				1.2.1 Authoritarian Leaders
				1.2.2 Passive and Passive-Aggressive Surgeons
			1.3 Impaired Trainers
				1.3.1 Burnout
				1.3.2 Surgeons with Mental Illness
				1.3.3 Trainers with Alcohol and Substance Abuse
					Treatment for Doctors with Substance Abuse
		2 Conclusion
		References
	Moral Injury and Education Trauma! Moral Injury Seriously Hinders the Education and Career Development
		1 Introduction
		2 Moral Injury Is a Serious Disorder That Should Be Stopped!
			2.1 What Is Moral Injury?
			2.2 Illustrative Case 1
				2.2.1 Discussion
			2.3 Illustrative Case 2
				2.3.1 Discussion
		3 Moral Injury in Medical/Surgical/Neurosurgical Training
			3.1 The Etiology and Emerges, Presentation, Impact, Management of Moral Injuries Among Trainees
			3.2 Symptoms of Moral Injuries Between the Medical and Neurosurgical Trainees
			3.3 The Impact of Moral Injury on the Progress in Training and Career Development
			3.4 Management of Moral Injury
		4 Moral Distress
			4.1 Symptoms of the Moral Distress
			4.2 Impact of Moral Distress on the Education and Learning Process
			4.3 Management of Moral Distress
		5 Compassion Fatigue
			5.1 The Emerges, Presentation, Impact, Management of Compassion Fatigue Within Medical and Neurosurgical Trainees
			5.2 The Impact of Compassion Fatigues on the Education and Learning Environment
			5.3 Management
		6 Burnout
			6.1 Emotional Signs and Symptoms of Burnout
			6.2 Impact on the Training Process
		7 PTSD in Medical Education
			7.1 Symptoms
			7.2 The Impact of PTSD on the Trainees and Trainers
		8 Discussion
			8.1 Values-Based Medical Education
			8.2 Dignity and Autonomy
		9 Conclusion
		References
	Learning from Errors/Mistakes
		1 Introduction
		2 Some Rules
		3 Learning from Errors
			3.1 Some Examples
		References
	Neurosurgeon Is the Second Victim of Surgical Adverse Events and Errors: A Road Map for Mitigation and Learning Opportunity
		1 Introduction
		2 The Concept of Second Victim/ Second Victim Phenomenon
		3 Are Neurosurgeons at Risk of Being Legally Used?
			3.1 Definitions
			3.2 What Is Medical or Surgical Error?
			3.3 What Are the Causes of Medical and Surgical Errors?
			3.4 What Is Adverse Event (AE)?
			3.5 What Is Complication?
		4 Neurosurgical Standard of Care and Evidence-Based Medicine
			4.1 Mitigation/Recovery Process and Lessons Learned
		5 Ethical Considerations
		6 Conclusion
		References
	Dreams and Realities! Challenges in Low- and Middle-Income Countries
		1 Introduction
		2 The Dream
		3 The Training
			3.1 Challenges and Realities
			3.2 Academic Neurosurgery and Career Progression
		4 Conclusions
		References
	Neurosurgical Training in LMIC: Opportunities and Challenges
		1 Introduction
			1.1 History and Impact of Colonialism
			1.2 Past Training Models and Challenges
			1.3 Online Learning and Inverted-Learning
			1.4 Career Development and Wellness
		2 Conclusion
		References
	Career Development and Talent Education
		1 Introduction
		2 Undergraduate Training
			2.1 Enrollment in Programs
		3 Postgraduate Training
			3.1 New Modalities Affected the Ways of Training
				3.1.1 Artificial Intelligence (AI)
				3.1.2 Virtual Reality Training
				3.1.3 3D Printed Models
		4 The Impact of Ethics on the Training Process, Value-Based Medicine (VsBM)
		5 Conclusion
		References
Part IV: Learning in the Digital Era
	Hybrid Learning in Neurosurgery
		1 Introduction
		2 The Theories of Learning
		3 Hybrid Learning Frameworks
			3.1 Hybrid Learning in Advanced Diagnostics
			3.2 The Hybrid Learning of Modern Intraoperative Infrastructure
			3.3 Accelerated Research Through Hybrid Learning
			3.4 Hybrid Learning for Virtual Neurosurgial Simulation
			3.5 Ethical Considerations in Hybrid Learning in Neurosurgery
			3.6 The Limitations of Hybrid Learning in Neurosurgery
		4 Conclusions
		References
	Robotic Surgery and Artificial Intelligence in Spine and Brain Surgery: Ethical Challenges
		1 Background
		2 Drivers for the Use of AI and RA Surgery
		3 General Ethical Concerns Related to the Use of AI and Surgical Robots
			3.1 Non-maleficence
			3.2 Beneficence
			3.3 Autonomy
		4 Specific Ethical Concerns Related to the Use of AI and Surgical Robots
			4.1 Compromised Informed Consent
				4.1.1 Patient Misconception
				4.1.2 Surgeon’s Robotic Experience and Learning Curve
				4.1.3 Access to Robotic Systems
				4.1.4 Surgeon’s Preference
			4.2 Conflicts of Interest
			4.3 Unfair Allocation of Health care Resources
			4.4 Relationships Between Surgeon and Patient and Long-Distance Surgery
		5 Ethical Nuances Associated with AI and Robotic Surgery
			5.1 Surgical Innovation
			5.2 Patient Information and Media Coverage
			5.3 Responsibility and Liability
			5.4 Confidentiality and Privacy of Data
			5.5 Transparency, Explicability, Auditability, and Traceability of AI Platforms
			5.6 Neutrality, Fairness, and Algorithmic Bias in AI
		6 Ethical Challenges for the Future
		7 Conclusions
	Artificial Intelligence (AI) in Neurosurgery
		1 Introduction
		2 AI in Neurosurgical Diseases
			2.1 Diagnosis
				2.1.1 AI in Pathological Analysis
				2.1.2 AI in Neuroimaging Analysis
				2.1.3 Other Applications
			2.2 Treatment
				2.2.1 AI Facilitates Neurosurgical Operations
				2.2.2 AI for Automated Seizure Detection and Seizure Prediction
				2.2.3 Application in the Surgical Management of Epilepsy
				2.2.4 AI in Controlling Parkinson’s Disease
			2.3 Prognosis
		3 AI in Neurosurgical Training and Education
		4 Expectations
			4.1 Surgical Adjuncts
			4.2 Surgical Robots
			4.3 Brain–computer Interface for Clinical Purpose
		5 Conclusion
		References
	Application Status and Prospect of Artificial Intelligence in Neurosurgery
		1 Background
		2 Application Status of AI in Neurosurgery
			2.1 Risk Assessment of Neurosurgical Diseases
			2.2 Diagnosis of Neurosurgical Diseases
			2.3 Treatment of Neurosurgical Diseases
			2.4 Prognosis of Neurosurgical Diseases
			2.5 Intensive Care
		3 Application Status of AI in Cerebrovascular Diseases
			3.1 Diagnosis
			3.2 Treatment
			3.3 Prognosis
		4 Prospect
		References
	Application of AI Diagnosis and Treatment for Cerebral Diseases
		1 Development of Artificial Intelligence
			1.1 Artificial Intelligence, Machine Learning, and Deep Learning
			1.2 Computer Vision
			1.3 Natural Language Processing
			1.4 AI’s Promising Future
		2 AI in Acute Ischemic Stroke
			2.1 Introduction of Ischemic Stroke
			2.2 Systematic Review of Alberta Stroke Program Early CT Score Based on NCCT
			2.3 Systematic Review of Infarct Core and Penumbra Segmentation Based on CT Perfusion and MR Perfusion
			2.4 Systematic Review of Large Vessel Occlusion Detection Based on CT Angiography
			2.5 Open-Source Datasets of Stroke for AI
			2.6 Commercially Available Software Platforms for Stroke
		3 Application of AI in Auxiliary Diagnosis of Intracranial Aneurysms
			3.1 Segmentation of Intracranial Aneurysms
			3.2 Object Detection of Intracranial Aneurysms
			3.3 Prediction of Intracranial Aneurysms Rupture Stability
		4 The Research and Application of AI in Other Intracranial Neuro-interventional Therapy
			4.1 The Research and Application of AI in Brain Tumor Recognition
			4.2 The Research and Application of AI in Multiple Sclerosis
			4.3 The Research and Application of AI in Traumatic Brain Injury
			4.4 A Brief Introduction to the Research and Application of AI in Other Intracranial Diseases
		References
	Voxel-Based Morphometry of Brain Tumors
		1 Introduction
		2 Our Workflow
		3 Voxel-Based Morphometry of Meningioma
		4 Voxel-Based Morphometry of Adult and Pediatric Gliomas
			4.1 Probabilistic Spatial Distribution in Adult Glioblastoma
			4.2 Immune Checkpoint-Associated Locations of Diffuse Gliomas in Children
		5 Voxel-Based Morphometry of Brain Metastatic Tumors
		6 Conclusion
		References
	Simulation in Operative Neurosurgery: Past, Present, and Future
		1 Introduction
		2 Educational Theory
		3 Training in Neurosurgery: The Past
		4 Simulation in Neurosurgery: The Present
		5 The Future of Simulation in Neurosurgery
			5.1 The Changing Availability and Fidelity of Neurosurgical Simulation
			5.2 The Evaluation of Neurosurgical Simulation
			5.3 Operative Neurosurgery Simulation Beyond Procedural Skills
			5.4 Current Challenges in Neurosurgical Simulation
		6 Conclusion
		References
	Current and Future Microsurgical Skills Assessment
		1 Introduction
			1.1 Setup and Scoring
			1.2 Outcomes
			1.3 Considerations for Objective Standardized Skill Assessment and Contests
		2 Engineered Microsurgical Skill Assessment
			2.1 Step 1 (Fig. 2)
			2.2 Step 2 (Fig. 3)
			2.3 Outcomes of Step 2
			2.4 Considerations for Engineered Skill Assessment
		3 Future of Microsurgical Training and Assessment
		4 Conclusions
		References
	Intelligent Operating Theater: Smart Cyber Operating Theater (SCOT)
		1 Introduction
		2 The SCOT and OPeLiNK system
		3 Illustrative Case
		4 Results
		5 Discussion
		6 Conclusions
		References
	Current and Future Training for Endovascular Neurosurgery: Global Neurology, Neurosurgery, and Neuroradiology
		1 Brief History of the Field
		2 Training Paradigms in the United States
			2.1 CAST
		3 Training Paradigms in Europe and the United Kingdom
		4 Training Paradigms in Japan
		5 Training
		6 Conclusions
		References
	Distance Learning and on Job Training From a Messenger Pigeon to Implanted Brain Microchips Interface and Metaverse
		1 Introduction
		2 Current and Future Challenges
			2.1 Objectives and Aims of Distance Learning, on Job Training, and Patients’ Management
		3 Methods of Distal Education and Training
			3.1 Participants
			3.2 Education, Healthcare Planners and Stakeholders, Curriculum Developers, and Medical Allegation Authorities
		4 Distance Patients’ Care/Telemedicine and Telesurgery (Robotic Surgery)
			4.1 First: Telemedicine
			4.2 Second: Telesurgery, Remote Surgery, Robotic Surgery
		5 The Challenges and Ethics of Telemedicine and Tele Surgery
		6 Advantages of Telemedicine and Telesurgery (Distance Patients’ Care)
		7 Disadvantages of Distance Medical Education
			7.1 Implanted Brain Chips/Microchips
		8 Are We Heading to Create Half Robot Half Human?!
			8.1 Metaverse
		9 Discussion and Conclusions
		References
	The Future Tools for Medical Training, Assessment, and Certification
		1 Introduction
		2 Trainees Development
		3 Trainers Development
		4 Curriculum Development
		5 Learning Methods Development
		6 Knowledge and Skills Enhancement Tools
			6.1 Virtual and Augmented Reality
			6.2 Virtual and Augmented Reality Applications in Medical Education
				6.2.1 Preclinical Teaching [7–9]
				6.2.2 Surgical Training [7–10]
				6.2.3 Neurosurgery Training [8, 11, 12]
				6.2.4 Robotic Surgery [8, 13, 14]
				6.2.5 Other Fields [8]
			6.3 Advantages of Virtual and Augmented Reality in Medical Education
			6.4 Disadvantages of Virtual and Augmented Reality in Medical Education
			6.5 3D Modeling
			6.6 Advantages and Disadvantages of 3D Modeling in Medical Education
		7 Decision-Making Tools
			7.1 Gamification
			7.2 Advantages and Disadvantages of Gamification in Medical Education
			7.3 Artificial Intelligence
			7.4 Advantages and Disadvantages of AI in Medical Education
		8 Communication Tools
			8.1 Telemedicine
		9 Mentoring Development
		References
	Harnessing Technology, A Step Forward to Become “Der Herr der Welt” of Neurosurgery
		1 Introduction
			1.1 Properties of An Effective Method for Neurosurgical Education with Special Reference to LMIC
			1.2 Ideal Properties of Modern Technological Aids in Operation Theater
			1.3 Types of Aids
		2 A. Technological Aids for Neurosurgical Education
			2.1 Meeting Apps
			2.2 Social Media and Online Community Groups
			2.3 Apps Assisting Academics
			2.4 Dedicated Websites and YouTube Channels
			2.5 Skill Learning Through Gaming Simulators
			2.6 Holography for Concept Building
			2.7 Virtual Reality
			2.8 AR-Based Training
			2.9 Robots
			2.10 D Printed Models for Practice
		3 B. Latest Technology in Clinical Assistance
			3.1 Robotic Assistance in Surgery
			3.2 The Concept of “Cobots”
			3.3 Holographic Assistance in Blind Procedures
			3.4 Radiographical Aid
			3.5 Robotic Nursing
		4 The Role of VR And AR in Neurosurgery
			4.1 AR in Neurosurgery
			4.2 AR in Endoscopic Surgery
			4.3 AR Endovascular Surgery
			4.4 AR-Supported Microscope
		5 Further Benefits of AR in Neurosurgery
			5.1 AR in Spinal Surgery
			5.2 Virtual interactive presence and augmented reality (VIPAR) for remote surgical assistance
			5.3 Equipment Required
			5.4 The Scope of Discussion
			5.5 The Future
		6 Some Established Uses
			6.1 Neuronavigation
			6.2 Neurostimulation for Epilepsy
				6.2.1 Vagal Nerve Stimulation
				6.2.2 Responsive Neurostimulation
				6.2.3 DB
		7 Telemedicine
		8 Quick Review of Few Famous Apps
			8.1 Neuromind
			8.2 Brain Tutor HD
			8.3 Neurosurgical Atlas App
			8.4 Scoliometer
		9 The Strategy We Need
		References