Master of Paediatric Neurosurgery

Purpose

The purpose of the qualification is to train practising neurosurgeons to develop foundational skills in treating and managing children with commonly encountered paediatric neurosurgical conditions, particularly those from vulnerable populations most affected by the neglected diseases of poverty. This training will be a significant advancement on the current level of skill available.

Students will engage in a high level of theoretical interaction, encouraging intellectual independence and application of the concepts learnt. The research component of the qualification will be an independent study aimed at enabling students to critically appraise analytical manuscripts, appropriately collect and analyse data, and clearly communicate their conclusions, thereby fulfilling the criteria for a professional master's level qualification.

The qualification will, therefore, empower students to deal with certain complex clinical issues appropriately, act autonomously in planning and implementing decisions, and stimulate advancement of knowledge with the potential for progression towards a Doctoral Degree.

The student will have specific skills in the management of children with neurosurgical conditions. These skills should enable the student to introduce this knowledge in day-to-day practices on return to the relevant practice environment, establishing focused approaches towards the diagnosis and management of children with neurosurgical conditions.

Rationale

The Paediatric Neurosurgery Unit at the Red Cross War Memorial Children's Hospital is unique in Southern Africa. It provides many clinical services and subsequent learning opportunities for trainees that cannot be accessed anywhere else in Southern Africa. The national training requirement for the speciality of neurosurgery concentrates on adult neurosurgical conditions and requires minimal exposure of trainees to paediatric conditions. This is often thought to be reflective of the environment in private practice, where paediatrics forms a very small component of the workload. This, however, results in paediatric neurosurgical cases often being inadequately managed.

The rationale for this qualification is to encourage neurosurgeons to improve their understanding of paediatric neurosurgery, strengthen their management capability of paediatric neurosurgical conditions and enable them to recognise which conditions need to be referred ab initio to a specialist centre. The immediate need lies in providing clinical training and expertise in the basic care and specific skills aimed at reducing the morbidity associated with treating paediatric neurosurgical patients in Africa and, in particular, in rural or under-resourced areas where local clinical services may not sufficiently provide for the management of children suffering from paediatric neurosurgical diseases.

Building skills in paediatric neurosurgery will target a major area which is currently resource-poor in South Africa and further afield in Africa. The institution thus aims to create a network of skilled local and African healthcare professionals who can develop capacity in paediatric neurosurgery through clinical service provision, training and research. The graduates, after acquiring the qualification and on return to their primary institution or practice environment, would benefit from greater support, exposure and a broader network of resources.

Recognition of Prior Learning (RPL)

Access via RPL is not applicable. Applicants must be qualified Specialist Neurosurgeons.

Entry Requirements

The minimum admission requirement for this qualification is

• A specialist qualification in Neurosurgery.

And

• Eligibility to register with the Health Professions Council of South Africa.
• Appropriate work experience and training in neurosurgery.

This qualification comprises compulsory modules at Level 9 totalling 180 Credits.

• Basic Anatomy and Physiology in Paediatric Neurosurgery, 50 Credits.
• Management of Clinical Conditions in Paediatric Neurosurgery, 45 Credits.
• Surgical and Critical Care Management in Paediatric Neurosurgery, 40 Credits.
• Research Component, 45 Credits.

• Demonstrate a comprehensive and systematic knowledge base in general paediatric neurosurgery and greater depth of knowledge in some of the more complex conditions.
• Demonstrate a coherent and critical understanding of the principles and theories of paediatric neurosurgery.
• Apply sufficient developed surgical skill to deal with a wide range of basic paediatric neurosurgical conditions, and a selected number of more complex conditions.
• Show the ability to identify, analyse and appropriately deal with complex and/or real world problems and apply these in routine practice.
• Display efficient and effective information retrieval and processing skills, and the ability to engage with current research and scholarly or professional literature in this discipline.
• Present and communicate work effectively, catering for a range of audiences.
• Demonstrate professional development in the clinical and surgical management of basic paediatric neurosurgery, specifically in the recognition and diagnosis, development of clinical skill, acquisition of basic surgical techniques relevant to paediatric neurosurgical conditions, counselling of parents, and recognising and dealing with complications.

The following Associated Assessment Criteria will be applied in an integrated manner across the Exit Level Outcomes

- Demonstrate an understanding of the relevant anatomy, pathophysiology, pathology, diagnosis and management of

> Hydrocephalus - a structured approach including

> Clinical assessment of patients.

> Appropriate patient and therapy selection.

> Knowledge of available shunt systems and techniques.

> Knowledge of endoscopic techniques.

> Knowledge of possible medical options of management.

> Postoperative care of patients.

> Follow-up of patients.

> Spinal dysraphism - particularly the management of myelomeningocoele

> Diagnosis of myelomeningocoele - antenatal and postnatal.

> Counselling of parents.

> Preoperative preparation.

> Surgical management aimed at prevention of infection and preservation of function.

> Management of associated hydrocephalus and Chiari II malformation.

> Multidisciplinary management strategy.

• Demonstrate thorough knowledge of the epidemiology, classification, natural history and management options of Intracranial tumours:

> Hemispheral tumours.

> Differential diagnosis.

> Appropriate surgical options and approaches.

> Adjunctive treatment, i.e. chemotherapy and radiotherapy, other modification therapies.

> Follow-up - including risks of recurrence, regrowth, spread, requiring lifelong follow-up.

> Ventricular tumours.

> Emergency management of hydrocephalus.

> Differential diagnosis.

> Appropriate surgical options and approaches including position and the risks associated with these techniques, as well as intra-operative monitoring techniques.

> Adjunctive treatment, i.e. chemotherapy and radiotherapy, other modification therapies.

> Follow-up - including risks of recurrence, regrowth, spread, requiring lifelong follow-up.

> Midline tumours.

> Differential diagnosis.

> Laboratory serum and CSF marlers for appropriate workup.

> Appropriate surgical options and approaches.

> Adjunctive treatment, i.e. chemotherapy and radiotherapy, other modification therapies.

> Follow-up - including risks of recurrence, regrowth, spread, requiring lifelong follow-up.

> Posterior fossa tumours.

> Differential diagnosis.

> Laboratory investigations and imaging workup.

> Surgical techniques, i.e prone and sitting position and the risks associated with these techniques, intra-operative monitoring techniques.

> Adjunctive treatment, i.e. chemotherapy and radiotherapy, other modification therapies.

> Follow-up - including risks of recurrence, regrowth, spread, requiring lifelong follow-up

> Spinal cord tumours.

> Differential diagnosis.

> Laboratory investigations and imaging workup.

> Surgical techniques, i.e prone and sitting position and the risks associated with these techniques, intra-operative monitoring techniques.

> Adjunctive treatment, i.e. chemotherapy and radiotherapy, other modification therapies.

> Follow-up - including risks of recurrence, regrowth, spread, requiring lifelong follow-up.

> Paediatric traumatic brain injury

> Emergency care management.

> Surgical techniques.

> Critical care management.

> Infections of the paediatric central nervous system - especially tuberculosis and HIV

> Assessment, diagnosis and preventive strategies.

> Appropriate surgical management.

> Appropriate medical management.

> Follow-up plans.

> Neurovascular conditions of childhood, including Moyamoya disease

> Essential knowledge of theoretical concepts.

> Diagnosis and workup.

> Interact with relevant disciplines.

> Learn basic surgical technique.

> Follow-up plan.

> Functional disorders of the paediatric central nervous system, especially epilepsy and spasticity

> Diagnosis and workup of patients.

> Interaction with relevant disciplines to plan and co-ordinate treatment.

> Core knowledge of medical and surgical treatment options and indications.

> Adequate knowledge of pre-operative workup.

> Familiarity with surgical techniques.

> Follow-up plan.

> Congenital disorders including craniofacial disorders

> Theoretical knowledge of basic concepts.

> Diagnosis and workup, and counselling of families.

> Interact with various disciplines to facilitate multi-disciplinary team approach.

> Pre-operative planning.

> Surgical technique.

> Follow-up plan.

• Demonstrate confidence in the clinical skills required to formulate an approach to the overall management of the paediatric neurosurgical patient. These include the following:
• Take an adequate history from the paediatric neurosurgical patient or the family.
• Conduct clinical evaluation and examination of the paediatric neurosurgical patient, with a recognition of the particular anatomical and physiological differences between adults and children.
• Request appropriate special investigations.
• Laboratory blood tests.
• CSF evaluation.
• Imaging, including ultrasound, CT scans, MRI scans.
• Formulating a differential diagnosis.
• Referral to and interaction with relevant specialities and disciplines in order to facilitate a multidisciplinary team approach. These disciplines include:
• Nursing.
• Physiotherapy.
• Occupational therapy.
• Paediatric medicine.
• Paediatric oncology.
• Paediatric radiotherapy.
• Paediatric surgical specialities.
• Emergency care.
• Genetics.
• Radiology.
• Critical care.
• Palliative care.
• Counselling of families based on sound knowledge of natural history, indications for treatment, possible complications and likely outcomes.
• Preparation of patient for surgery, including.
• Pre-operative workup.
• Intraoperative planning.
• Anaesthetic issues.
• Theatre arrangements.
• Post-operative care and planning.
• Management of the post-operative patient, including.

> Management in the critical care unit.

> Management in the high care and general care sections of the ward.

> Indications for discharge.

> Arrangements for follow-up.

> Follow-up of patients in the outpatient unit.

- Develop appropriate surgical proficiency in the paediatric patient to perform (or assist with)

> CSF diversion procedures to treat hydrocephalus, including ventriculoperitoneal shunt insertion, external ventricular drain insertion and endoscopic third ventriculostomy.

> Closure of myelomeningocoele.

> Craniotomy for surgical resection of supratentorial hemispheral tumours.

> Craniotomy for surgical resection of supratentorial ventricular tumours.

> Craniotomy for surgical resection of supratentorial midline tumours.

> Craniotomy for resection of posterior fossa tumours.

> Insertion of monitors for intracranial pressure monitoring.

> Insertion of monitors for brain tissue oxygenation monitoring.

> Laminectomy for spinal cord untethering - fatty filum.

> Burrholes for drainage of intracranial septic collections.

> Surgical decompression for raised intracranial pressure.

> Cranial vault remodelling for craniosynostosis.

> Closure of encephalocoele.

> Posterior fossa craniotomy for Chiari decompression.

• Demonstrate appropriate knowledge of current recommended international guidelines relevant to practice in the field.
• Complete a logbook of cases managed.
• Complete a logbook of surgical procedures performed.
• Pass an oral case-based exit examination.
• Pass a written exam, comprising essay and short questions.
• Complete a research component, which is publishable in a peer-reviewed journal.

Integrated Assessment

Assessment is both formative and summative. Formative assessment is built on continuous feedback on both knowledge and clinical competence. Knowledge is then applied and such application assessed in a written and oral examination.

There are three formative assessments (case-based oral and written tests) that will be conducted after completion of every module which will be completed in three monthly cycles. A student who fails two of these after intensive remedial training may be required to withdraw from the programme.

A Duly Performed (DP) requirement for the final examination includes passing written and oral examinations for all three modules and completion of a logbook. The final written and oral examinations will be externally monitored.

The research component will entail a mini-dissertation, publishable in a peer-reviewed journal.