Aaron Lawson McLean

Leadership in neurosurgical training is pivotal for educational quality and workforce development, yet gender and regional disparities remain poorly characterized in Germany. A nationwide cross-sectional study analyzed publicly available data from all 17 state medical chambers. Neurosurgical training program directors (TPDs) were identified, and data were collected on gender, shared training authorizations, and maximum approved training duration. Comparisons between the Old (former West) and New (former East) German states were performed using chi-square and Mann–Whitney U tests. A total of 329 TPDs were identified, of whom 26 (7.9%) were women and 303 (92.1%) men. Female representation did not differ significantly between regions (Old States 8.5% vs. New States 5.2%; p = 0.40). Shared training authorizations were significantly more frequent in the Old States (46.9%) than in the New States (20.7%; p < 0.001). Among female TPDs, 42.3% held shared authorizations, though no female-only arrangements existed. The median training duration authorized was 27 months overall (female 39 vs. male 24; p = 0.081). Only 37.6% of training sites offered the full 72-month curriculum required for certification, while 25.9% operated exclusively as outpatient centers. Women remain markedly underrepresented in German neurosurgical training leadership. Regional variation in shared authorizations reflects the predominance of private hospital networks in western Germany rather than differences in educational culture. Addressing these disparities will require targeted mentorship, transparent advancement pathways, and infrastructural investment to promote equitable leadership representation and standardized national training capacity.

Outcome-based medical education (OBME) has become the dominant reform paradigm across health professions, promising transparency, equity, and accountability. Yet beneath its procedural appeal lies a deeper ideological transformation that curriculum theorists in education have long identified. This essay interprets OBME as a manifestation of neoliberal rationality, tracing how the managerial logic of New Public Management has reconstituted medical education as a domain of audit. Portfolios, milestones, and entrustment ratings—originally tools for formative assessment—now function as technologies of visibility through which learning is rendered measurable, comparable, and governable. Drawing on Foucault’s analyses of disciplinary power and governmentality, Lyotard’s concept of performativity, and Deleuze’s notion of societies of control, the paper situates OBME within a wider moral economy of measurement in which legitimacy derives from demonstrable performance rather than interpretive judgment. This critique is informed by a substantial body of curriculum theory—including the work of Biesta, Pinar, Aoki, and Schwab—that has long challenged the reduction of education to measurable outcomes. Empirical evidence reveals the ambivalence of this transformation: while OBME improves procedural reliability and institutional alignment, it has not demonstrated consistent improvements in patient outcomes or long-term professional competence, and ethnographic studies document assessment fatigue, instrumental learning, and erosion of professional identity. In contrast, longitudinal integrated clerkships exemplify pedagogical designs that preserve relational continuity, narrative coherence, and civic engagement—features largely invisible to audit metrics. The essay concludes that a post-neoliberal pedagogy must reclaim three neglected dimensions of professional formation: relationality, duration, and civic purpose. Such a reframing would preserve accountability while resisting epistemic reduction, restoring education’s capacity to cultivate judgment under uncertainty.

Neurosurgical patient care is inherently complex, characterized by high rates of polypharmacy, advanced age, and significant comorbidities, all of which increase the risk of medication errors. These challenges are compounded by dynamic treatment plans and intensive care demands. In response, clinical pharmacist-led “pharmaceutical interventions” have emerged as a promising strategy to enhance medication safety. This study aimed to evaluate the impact of a structured weekly pharmacist-led medication review programme on prescribing practices and patient outcomes in a tertiary academic neurosurgical department. In this 12-month prospective study, a pharmacist performed weekly medication reviews on the neurosurgical ward and HDU. Interventions were coded in ADKA-DokuPIK and relayed to the team; 10% were re-audited to confirm uptake. The year was split into two six-month epochs to assess temporal trends. Administrative data from the intervention year were compared with a historical control for length of stay (LOS) and in-hospital mortality. Adverse-drug-event rates were not prospectively collected. A total of 996 interventions were documented among 1795 patients (0.55/patient). Intervention rates declined from 0.7 to 0.4 per patient between periods ( p = 0.016), suggesting a learning effect. Implementation of recommendations was confirmed in 78% of audited cases. The most commonly affected drugs were pantoprazole ( n = 77), amlodipine ( n = 47), ciprofloxacin ( n = 44). Median LOS decreased from 8.1 to 7.3 days ( p = 0.032), the proportion of prolonged hospitalisations (> 14 days) fell from 18.9% to 14.8% ( p = 0.002), and in-hospital mortality declined from 4.6% to 3.0% ( p = 0.014). Routine integration of a clinical pharmacist into neurosurgical care was associated with fewer medication-related issues, measurable improvements in LOS and mortality, and evidence of progressive prescriber adaptation. These findings support broader implementation of pharmacist-led interventions in high-risk surgical environments. Controlled multicenter trials are warranted.

Effective Question Answering (QA) on large biomedical document collections requires effective document retrieval techniques. The latter remains a challenging task due to the domain-specific vocabulary and semantic ambiguity in user queries. We propose BMQExpander, a novel ontology-aware query expansion pipeline that combines medical knowledge - definitions and relationships - from the UMLS Metathesaurus with the generative capabilities of large language models (LLMs) to enhance retrieval effectiveness. We implemented several state-of-the-art baselines, including sparse and dense retrievers, query expansion methods, and biomedical-specific solutions. We show that BMQExpander has superior retrieval performance on three popular biomedical Information Retrieval (IR) benchmarks: NFCorpus, TREC-COVID, and SciFact - with improvements of up to 22.1% in NDCG@10 over sparse baselines and up to 6.5% over the strongest baseline. Further, BMQExpander generalizes robustly under query perturbation settings, in contrast to supervised baselines, achieving up to 15.7% improvement over the strongest baseline. As a side contribution, we publish our paraphrased benchmarks. Finally, our qualitative analysis shows that BMQExpander has fewer hallucinations compared to other LLM-based query expansion baselines.

Background: Patients with oligodendroglioma have a relatively favorable prognosis. The long-term impacts of the tumor itself and its treatment on health-related quality of life (HRQOL) and cognition remain largely unclear. We investigated associations between treatment and functioning of survivors of oligodendroglioma. Methods: In this cross-sectional observational study, patients with oligodendroglioma, isocitrate dehydrogenase-mutant and 1p/19q-codeleted, diagnosed ≥ 5 years ago, were recruited. Patients completed patient-reported outcome measures (EORTC QLQ-C30; BN20; MOS Cognitive Complaints Scale) and cognitive tests (HVLT-R, TMT, COWAT). Associations between HRQOL and cognition outcomes, and clinical variables (time since diagnosis; age at diagnosis; progression; tumor location; treatments delivered; time since treatment; current medication) were explored with regression analyses. Results: In total, 237 patients M = 9.9 years postdiagnosis (SD = 4.2, range 5.0-25.8) took part from 33 sites across 9 countries. Clinically relevant levels of impairment were noted in >40% of patients on EORTC QLQ-C30 scales for cognitive functioning (56.1%), emotional functioning (49.8%), fatigue (45.1%), and physical functioning (40.5%). In individuals, cognitive impairment ranged from 17.7% for processing speed to 46.0% for episodic verbal memory (delayed recall). Among other clinical factors such as current use of antiseizure medication or antidepressants, age, disease progression, time since diagnosis and time since treatment, and radiotherapy treatment (ever received) was linked to HRQOL and cognitive functioning outcomes (posthoc analyses for cumulative radiotherapy dose: not significant). Conclusions: In oligodendroglioma survivors, HRQOL and cognitive impairment are prevalent even years into follow-up. Supportive care and rehabilitation should be prioritized to mitigate these challenges and improve daily functioning. Trial registration: NCT04708548