The crucial role of ethical hospital administration in neurosurgery education

Sociocognitive research has demonstrated that power affects how people feel, think, and act. In this article, I review literature from social psychology, neuroscience, management, and animal research and propose an integrated framework of power as an intensifier of goal-related approach motivation. A growing literature shows that power energizes thought, speech, and action and orients individuals toward salient goals linked to power roles, predispositions, tasks, and opportunities. Power magnifies self-expression linked to active parts of the self (the active self), enhancing confidence, self-regulation, and prioritization of efforts toward advancing focal goals. The effects of power on cognitive processes, goal preferences, performance, and corruption are discussed, and its potentially detrimental effects on social attention, perspective taking, and objectification of subordinates are examined. Several inconsistencies in the literature are explained by viewing power holders as more flexible and dynamic than is usually assumed.

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has an impact also on neurosurgical training and education, especially in most affected countries. We surveyed Italian neurosurgical residents, asking them to provide a brief description and analyze the situation they are experiencing and how the educational system reacted to the pandemic in one of the most affected countries all over the world. Methods An 18-question, web-based survey was administered to Italian neurosurgical residents from May 3 to May 11, 2020, by web-link or e-mail invitation. Closed-ended, multiple choice questions were focused on the experience of neurosurgical residents in the last 2 months (from March to May 2020) concerning both clinical and educational aspects. Results Among 331 Italian neurosurgical residents invited to participate, 192 responded to the survey (58%). According to the participants’ responses, in the whole country, only 29.7% of residents were directly involved in the clinical management of COVID-19 patients. Time spent in the clinic and surgical activity was significantly reduced in most of the cases. Educational activities as well as scientific activity and time spent for studying, on the other hand, were reported to be significantly increased by the majority of respondents. Conclusions Most Italian neurosurgical residents reported significant changes on both training and education, highlighting a prompt reaction of the educational system in the whole country, regardless the local and regional diffusion of the pandemic. Electronic supplementary material The online version of this article (10.1007/s00701-020-04460-0) contains supplementary material, which is available to authorized users.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. Methods We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. Results We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. Conclusion Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries. Electronic supplementary material The online version of this article (10.1007/s00701-020-04482-8) contains supplementary material, which is available to authorized users.