Child's Nerv Syst (1993) 9:203-204

mGNS �9 Springer-Verlag 1993

Symposium on the education and identification of a pediatric neurosurgeon at an international level

Osamu Sato

Department of Neurosurgery, Tokai University, Bohseidai, Isehara, 259-11 Japan

Received: 4 January 1993

Abstract. In Japan, pediatric neurosurgery is well covered in the medical schools, and clinical training in this field is included in most programs. However, there are few full- time pediatric neurosurgeons, and there is no specialty board for pediatric neurosurgery. It is included in the general neurosurgery board examination.

Key words: Pediatric neurosurgeons - Japan - Educa- t ion - Board examination

with various disease entities including hydrocephalus, meningomyelocele, t rauma cases, etc. At Tokai Universi- ty a standard knowledge of pediatric neurosurgery is given to students. Several well-written textbooks are also available for students: The Standard Textbook o f Neuro- surgery and others. For advanced requirements, a new book entitled Pediatric Neurosurgery (730 pages), edited by Dr. Satoshi Matsumoto and Dr. Shizuo Oi, is also available.

I would like to discuss the issue of the education and identification of a pediatric neurosurgeon from a slightly different point of view from others. Namely, I would like to describe how much pediatric neurosurgery is being taught in Japan, particularly at the Tokai University School of Medicine.

In our country children go to elementary or primary school after kindergarten at age 6. At age 12 they then go to junior high school for 3 years. This much education is compulsory and must be finished. After that, 90% of ju- nior high school graduates go to senior high school, also a 3-year course. Seventy percent of high school graduates go on to colleges or universities today. Those who want to be a doctor apply directly to medical schools. Thus, our system is quite different from that of the US and Canada. Any medical school provides a 6-year course and we have now 80 medical schools in the whole country.

At Tokai University we revised our medical school curriculum 5 years ago and this has been quite successful in many respects. Some 25% of the curriculum is elective and students can choose subjects they want to learn after registering at the Dean's Office. However, 75% of the curriculum remains didactic and compulsory. Table 1 shows the hours spent on compulsory and elective classes. At the bedside students are exposed to pediatric patients

Table 1. Training for neuroscience related to pediatric neurosurgery in Japan

Hours

I Medical School Curriculum

A Compulsory lectures and laboratory practices Neuroanatomy: central nervous system 18 Neuroanatomy: head and neck (laboratory work) 29 Neuroanatomy: spinal cord 3 Neurophysiology 17 Visual and hearing systems (laboratory work) 9 Embryology: central nervous system 2 Medical English for central nervous system 2 Physiology and chemistry of cerebrospinal fluid 2 Raised intracranial pressure 1 Head injury 3 Intracranial neoplasms 4 Vascular disorders of the central nervous system 4 Dysrhaphic states, craniosynostosis, etc. 1

B Elective Normal anatomy of central nervous system; computed 2

tomography and magnetic resonance imaging Plain skull films in neurosurgery 1 Cerebral angiography 1 Emergency medicine in pediatric age group 1 Hydrocephalus: pathophysiology 1

C Bedside teaching Medical students spend 2 weeks in neurosurgery ward

clerkship, including pediatric neurosurgery

Presented at the Founders' Meeting of the Academia, Salzburg, H Postgraduate training 12-15 December 1992

204

The junior residency program at Tokai University Medical Center lasts 2 years and rotates anesthesiology, general surgery, radiology, emergency medicine, and so on. The rotation includes at least 6 months on neuro- surgical wards. Then we have a 3-year residency program for neurosurgery. During these 3 years the residents take care of pediatric cases as well. They have the opportunity to attend many meetings, such as the Japanese Society of Neurological Surgeons, Congress of Neurological Sur- geons, Society for Pediatric Neurosurgery, etc. Some of them present papers and submit papers to various jour- nals. They read in many journals such as Child's Nervous System, Journal of Pediatric Neurosurgery, Journal of Neurosurgery, Neurosurgery, and many others. After 6 full years of training they are eligible to take the board examination in neurosurgery. The pass rate is something

like 60%, and both written and oral examinations are taken. The examination, of course, includes pediatric neurosurgery. At present, however, we do not have a specialty board for pediatric neurosurgery.

In Japan there are 11 children's hospitals at present, and seven of them provide neurosurgical services. The estimated number of full-time pediatric neurosurgeons in these hospitals would be some 20, including trainees.

In conclusion, pediatric neurosurgery is being relative- ly well taught at medical schools and fair clinical training for pediatric neurosurgery is included in most programs. However, full-time pediatric neurosurgeons are few in number and beds for sick children in specialized hospitals are lacking. Most of the patients are treated in university and major hospitals.