The situation of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability.

A call to prove or justify something.

A task or situation that tests someone's abilities.

Surgical repair for severe peripheral nerve injury treatment represents not only a pressing medical need but also a great clinical challenge.

Traditionally, the ideal academic neurosurgeon has been a “quadruple threat,” with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery.

This paradigm will probably have to change as academic neurosurgeons face major challenges. Inpatient care, these include increasing regulatory control, increasing malpractice costs, consolidation of expensive care in academic centers, and decreasing reimbursement; in resident teaching, work hour limitations and changing resident culture; in research, the increasing dominance of basic scientists in governmental funding decisions and decreased involvement of neurosurgeons in scientific review committees; and in administration, problems of relationships in the workplace, patient safety, and employment compliance in an increasingly bureaucratic system. To meet these challenges, the new academic neurosurgeon will probably not be a quadruple threat personally but will be part of a quadruple threat in a department and institution. Neurosurgeons in such a setting will have to work with hospitals, medical schools, and national and international groups to address malpractice, reimbursement, subspecialization, and training problems; find supplemental sources of income through grants, development funds, and hospital support; lead in the development of multidisciplinary centers for neuroscience, brain tumor, spine, and other initiatives; and focus on training leaders for hospital, regional, and national groups to reconfigure neurosurgery. Collaboration, flexibility, and leadership will be characteristic of the academic neurosurgeon in this new era 1).

Black PM. Challenges in contemporary academic neurosurgery. Neurosurgery. 2006 Mar;58(3):419-25; discussion 419-25. PubMed PMID: 16528180.
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