# Is it time to develop neurocritical care education in Brazil? Analysis of the Brazilian national survey on education in neurocritical care

## TL;DR

This study assesses the state of neurocritical care education in Brazil, finding it to be inconsistent and lacking in advanced training.

## Contribution

The paper provides the first national survey on neurocritical care education in Brazil, highlighting gaps in training and confidence among medical professionals.

## Key findings

- Only 50.5% of respondents reported receiving neurocritical care training during residency.
- Confidence in managing complex neurocritical cases was low, with less than 50% confidence in key areas like postcardiac arrest care.
- Training in advanced skills such as EEG interpretation and multimodal neuromonitoring was limited to less than 25% of respondents.

## Abstract

Neurocritical care (NCC) education involves integrating knowledge and skills into various complex areas. While the USA, Canada, and Europe regulate didactic core training for medical residencies and fellowships, the quantity and quality of these training programs in Brazil remain unclear.

To assess how NCC training is currently integrated into neurology and intensive care residency programs in Brazil.

A cross-sectional survey composed of 27 multiple-choice and short-answer questions was distributed by email to professionals registered in national congresses and medical organizations. Data regarding exposure to NCC training, duration, supervision, infrastructure, and self-perceived competencies were analyzed.

A total of 208 responses from 82 centers across 14 Brazilian states were included. Respondents were primarily neurologists (58.2%) and intensivists (28.2%). Only 50.5% reported receiving NCC training during residency, typically lasting more than 4 weeks. Training predominantly occurred in intensive care units with 5 to 20 beds, supervised by intensivists. However, exposure to specialized skills was limited: 23% to transcranial Doppler, 21% to electroencephalogram (EEG) interpretation, and 24% to multimodal neuromonitoring. Confidence in managing complex cases was suboptimal, with 56% reporting confidence in postcardiac arrest care, 47% in refractory intracranial hypertension, and 40% in spinal cord trauma.

Neurocritical care education in Brazil is heterogeneous and remains at an early stage of development. Most residents receive limited exposure to advanced neurocritical skills, resulting in low confidence to independently manage highly complex conditions. Standardized, competency-based training programs are urgently needed to enhance professional preparedness and potentially improve patient outcomes in NCC.