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Current Educational Issues in the Clinical Neurosciences

  • R. Desbiens (a1), M.G. Elleker (a2), G. Goldsand (a2), J. Max Findlay (a2), H. Hugenholtz (a3), D. Puddester (a4) and B. Toyota (a5)...

Abstract

Objective:

Canadian training in the clinical neurosciences, neurology and neurosurgery, faces significant challenges. New balances are being set by residents, their associations and the Royal College of Physicians and Surgeons of Canada between clinical service, education and personal time. The nature of hospital-provided medical service has changed significantly over the past decade, impacting importantly on resident training. Finally, future manpower needs are of concern, especially in the field of neurosurgery, where it appears that soon more specialists will be trained than can be absorbed into the Canadian health care system.

Methods:

A special symposium on current challenges in clinical neuroscience training was held at the Canadian Congress of Neurological Sciences in June 2000. Representatives from the Canadian Association of Interns and Residents, the Royal College of Physicians and Surgeons of Canada and English and French neurology and neurosurgery training programs made presentations, which are summarized in this report.

Results:

Residency training has become less service-oriented, and this trend will continue. In order to manage the increasingly sophisticated hospital services of neurology and neurosurgery, resident-alternatives in the form of physician “moonlighters” or more permanent hospital-based clinicians or “hospitalists” will be necessary in order to operate major neuroclinical units. Health authorities and hospitals will need to recognize and assume this responsibility. As clinical experience diminishes during residency training, inevitably so will the concept of the fully competent “generalist” at the end of specialty training. Additional subspecialty training is being increasingly sought by graduates, particularly in neurosurgery.

Conclusion:

Training in neurology and neurosurgery, as in all medical specialties, has changed significantly in recent years and continues to change. Programs and hospitals need to adapt to these changes in order to ensure the production of fully qualified specialists in neurology and neurosurgery and the provision of optimal care to patients in clinical teaching units.

RÉSUMÉ:

Sujets d'actualité dans l'enseignement des neurosciences cliniques. But: La formation en neurosciences cliniques, en neurologie et en neurochirurgie fait face à des défis importants. Les résidents, leurs associations et le Collège Royal sont à mettre en place un nouvel équilibre entre le service clinique, l'éducation médicale et la vie personnelle. La nature du service médical fourni par l'hôpital a changé de façon importante pendant la dernière décennie, ce qui a eu un impact majeur sur la formation des résidents. Enfin, les besoins futurs en effectifs médicaux sont un sujet de préoccupation, spécialement dans le domaine de la neurochirurgie o� il semble qu'on formera bientôt plus de spécialistes que le système de santé canadien n'en a besoin.

Méthodes:

Un symposium spécial sur les défis actuels dans la formation en neurosciences cliniques a été tenu au Congrès canadien des sciences neurologiques en juin 2000. Des représentants de l'Association canadienne des internes et résidents, du Collège royal des médecins et chirurgiens du Canada et des programmes de formation de langue anglaise et française en neurologie et en neurochirurgie ont fait des présentations dont le contenu est résumé dans ce rapport.

Résultats:

La formation au niveau de la résidence est moins orientée vers le service et cette tendance continuera. Dans la gestion des services hospitaliers de plus en plus sophistiqués en neurologie et en neurochirurgie, il sera nécessaire d'avoir recours à des substituts tels des médecins qui exercent ce travail médical en dehors des tâches exigées dans le cadre de la formation (moonlighting) ou des cliniciens hospitaliers plus permanents ou "hospitalistes" pour faire fonctionner les unités neurocliniques importantes. Les gestionnaires dans le domaine de la santé et les hôpitaux devront reconna�tre et assumer cette responsabilité. � mesure que l'expérience clinique diminuera pendant la résidence, le concept du généraliste totalement compétent à la fin de la formation en spécialité s'estompera. Une formation en sous-spécialités additionnelles est de plus en plus courue par les gradués, particulièrement en neurochirurgie.

Conclusions:

La formation en neurologie et en neurochirurgie, comme dans toutes les spécialités médicales, a changé de façon importante dans les dernières années et continue de changer. Les programmes et les hôpitaux doivent s'adapter à ces changements afin d'assurer la formation de spécialistes pleinement qualifiés en neurologie et en neurochirurgie et le traitement optimal des patients dans les unités d'enseignement clinique.

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References

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1. Hugenholtz, H: Neurosurgery Workforce in Canada, 1996 to 2011. Can Med Assoc J 1996; 155(1):3948.
3. National Specialty Physician Review, Royal College of Physicians and Surgeons of Canada, Ottawa, 1988.
2. Williams, P, Dominick-Pierre, K, Vayda, E et al. Women in medicine: practice patterns and attitudes. Can Med Assoc J 1990; 143:977984.

Current Educational Issues in the Clinical Neurosciences

  • R. Desbiens (a1), M.G. Elleker (a2), G. Goldsand (a2), J. Max Findlay (a2), H. Hugenholtz (a3), D. Puddester (a4) and B. Toyota (a5)...

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