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Mendes G, Poppe AY, Lima FO, Morais A, Pontes-Neto O, Silva GS, Martins SO, Carvalho F. Comprehensive portrait of stroke fellowship training in Brazil: A national survey study. J Stroke Cerebrovasc Dis 2024; 33:107697. [PMID: 38561168 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/15/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The field of vascular neurology has undergone significant advances over the last decade, and care has become more complex. However, vascular neurology training programs remain underdeveloped in many countries, despite stroke impact on health care. There are efforts towards building a nationally regulated curricula in some countries. Still, comprehensive planning and implementation of these programs may be needed on a global scale, especially in countries where stroke treatment is not fully implemented. We aim to comprehensively analyze vascular neurology trainees' profiles in Brazil to describe training program contents from trainees and program directors' perspectives. METHODS We performed an observational, cross-sectional, web-based survey study to describe trainee and program-specific characteristics at vascular neurology fellowship training programs in Brazil. The study was conducted from June to September 2023 using a secure web-based survey sent to active fellows and program directors from all known vascular neurology fellowship programs in the country. All respondents were required to provide informed consent. RESULTS We obtained a 100 % response rate of a total of 12 programs distributed in 7 federal states. Notably, 57 % of the 28 surveyed fellows were women, 60 % were aged 25-30, and 70 % self-identified as White. All fellows had prior neurology training, and 60 % engaged in the program just following residency. Exposure to various training experiences was favorable, except for simulation-based learning and telestroke training. Program directors perceived exposure to be sufficient for most components but similarly found deficiencies in telestroke and simulation-based learning. Scientific productivity was low, with about two-thirds of fellows having no publications or abstracts. Most fellows (92.6 %) reported performing non-fellowship medical activities to supplement their incomes. DISCUSSION In conclusion, the number of vascular neurology training programs and trainees in Brazil is currently insufficient and exhibits an uneven geographic distribution. Despite this, the clinical training provided is extensive, and there is generally some funding available for fellows. These insights highlight the need for strategic improvements in Brazil's stroke education and could inform similar developments in other nations.
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Affiliation(s)
- Gnn Mendes
- Hospital Geral de Fortaleza - HGF - Cerebrovascular Diseases Clinical Research Center; Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montreal - CHUM.
| | - A Y Poppe
- Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montreal - CHUM
| | - F O Lima
- Hospital Geral de Fortaleza - HGF - Cerebrovascular Diseases Clinical Research Center
| | - Abcg Morais
- Hospital Geral de Fortaleza - HGF - Cerebrovascular Diseases Clinical Research Center; Universidade Federal de São Paulo - UNIFESP
| | - O Pontes-Neto
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - FMRP-USP
| | - G S Silva
- Universidade Federal de São Paulo - UNIFESP; Hospital Israelita Albert Einstein - HIAE
| | - S O Martins
- Universidade Federal do Rio Grande do Sul - UFRGS
| | - Fmm Carvalho
- Hospital Geral de Fortaleza - HGF - Cerebrovascular Diseases Clinical Research Center; Graduate Program in Medical Sciences, Universidade de Fortaleza - UNIFOR
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Meretoja A, Acciarresi M, Akinyemi RO, Campbell B, Dowlatshahi D, English C, Henninger N, Poppe A, Putaala J, Saini M, Sato S, Wu B, Brainin M, Norrving B, Davis S. Stroke doctors: Who are we? A World Stroke Organization survey. Int J Stroke 2017; 12:858-868. [PMID: 28350278 DOI: 10.1177/1747493017701150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Specialist training provides skilled workforce for service delivery. Stroke medicine has evolved rapidly in the past years. No prior information exists on background or training of stroke doctors globally. Aims To describe the specialties that represent stroke doctors, their training requirements, and the scientific organizations ensuring continuous medical education. Methods The World Stroke Organization conducted an expert survey between June and November 2014 using e-mailed questionnaires. All Organization for Economic Co-operation and Development countries with >1 million population and other countries with >50 million population were included ( n = 49, total 5.6 billion inhabitants, 85% of global strokes). Two stroke experts from each selected country were surveyed, discrepancies resolved, and further information on identified stroke-specific curricula sought. Results We received responses from 48 (98%) countries. Of ischemic stroke patients, 64% were reportedly treated by neurologists, ranging from 5% in Ireland to 95% in the Netherlands. Per thousand annual strokes there were average six neurologists, ranging from 0.3 in Ethiopia to 33 in Israel. Of intracerebral hemorrhage patients, 29% were reportedly treated by neurosurgeons, ranging from 5% in Sweden to 79% in Japan, with three neurosurgeons per thousand strokes, ranging from 0.1 in Ethiopia to 24 in South Korea. Most countries had a stroke society (86%) while only 10 (21%) had a degree or subspecialty for stroke medicine. Conclusions Stroke doctor numbers, background specialties, and opportunities to specialize in stroke vary across the globe. Most countries have a scientific society to pursue advancement of stroke medicine, but few have stroke curricula.
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Affiliation(s)
- Atte Meretoja
- 1 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,2 The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.,3 Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Monica Acciarresi
- 4 Stroke Unit and Division of Cardiovascular Medicine, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Rufus O Akinyemi
- 5 Neurosciences and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Campbell
- 1 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Dar Dowlatshahi
- 6 Department of Medicine (Neurology), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Coralie English
- 7 School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, NSW, Australia
| | - Nils Henninger
- 8 Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.,9 Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alexandre Poppe
- 10 Department of Medicine (Neurology), Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada
| | - Jukka Putaala
- 3 Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Monica Saini
- 11 Department of Medicine, Changi General Hospital, Singapore, Singapore.,12 Memory Ageing and Cognition Centre, National University of Singapore, Singapore, Singapore
| | - Shoichiro Sato
- 13 Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,14 Neurological and Mental Health Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Bo Wu
- 15 Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Michael Brainin
- 16 Center of Clinical Neurosciences, Danube University of Krems, Krems, Austria
| | - Bo Norrving
- 17 Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Stephen Davis
- 1 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
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