1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India.
2Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
Neurosurg Focus. 2020 Mar 1;48(3):E11. doi: 10.3171/2019.12.FOCUS19852.
The evolution of the neurosurgical specialty in lower-middle-income countries is uniformly a narrative of continuous struggle for recognition and resource allocation. Therefore, it is not surprising that neurosurgical education and residency training in these countries is relatively nascent. Dr. Harvey Cushing in 1901 declared that he would specialize in neurosurgery and gave his greatest contribution to the advancement of neurosurgical education by laying the foundations of a structured residency training program. Similar efforts in lower-middle-income countries have been impeded by economic instability and the lack of well-established medical education paradigms. The authors sought to evaluate the residency programs in these nations by conducting a survey among the biggest stakeholders in these educational programs: the neurosurgical residents.
A questionnaire addressing various aspects of the residency program from a resident's perspective was prepared with Google Forms and circulated among neurosurgery residents through social media and email groups. Where applicable, a 5-point Likert scale was used to grade the responses to the questions. Responses were collected from May to October 2019 and analyzed using descriptive statistics. Complete anonymity of the respondents was ensured to keep the responses unbiased.
A total of 195 responses were received, with 189 of them from lower-middle-income countries (LMICs). The majority of these were from India (75%), followed by Brazil and Pakistan. An abiding concern among residents was lack of work hour regulations, inadequate exposure to emerging subspecialties, and the need for better hands-on training (> 60% each). Of the training institutions represented, 89% were offering more than 500 major neurosurgical surgeries per year, and 40% of the respondents never got exposure to any subspecialty. The popularity of electronic learning resources was discernible and most residents seemed to be satisfied with the existent system of evaluation. Significant differences (p < 0.05) among responses from India compared with those from other countries were found in terms of work hour regulations and subspecialty exposure.
It is prudent that concerned authorities in LMICs recognize and address the deficiencies perceived by neurosurgery residents in their training programs. A determined effort in this direction would be endorsed and assisted by a host of international neurosurgical societies when it is felt that domestic resources may not be adequate. Quality control and close scrutiny of training programs should ensure that the interests of neurosurgical trainees are best served.
中低收入国家神经外科学专业的发展历程，普遍是一个不断争取认可和资源配置的故事。因此，这些国家的神经外科教育和住院医师培训相对较新，也就不足为奇了。哈维·库欣（Harvey Cushing）医生在 1901 年宣布他将专门从事神经外科，并通过为结构化住院医师培训计划奠定基础，为神经外科学教育的发展做出了最大贡献。中低收入国家的类似努力受到经济不稳定和缺乏成熟的医学教育模式的阻碍。作者试图通过对这些教育项目中最大的利益相关者——神经外科住院医师进行调查，来评估这些国家的住院医师培训计划。
使用 Google 表单准备了一份从住院医师角度出发的关于住院医师培训计划各个方面的问卷，并通过社交媒体和电子邮件小组在神经外科住院医师中进行了分发。在适用的情况下，使用 5 分李克特量表对问题的回答进行评分。从 2019 年 5 月至 10 月收集了回复，并使用描述性统计进行了分析。为了保持回复的公正性，确保了受访者的完全匿名。
共收到 195 份回复，其中 189 份来自中低收入国家（LMICs）。其中大多数来自印度（75%），其次是巴西和巴基斯坦。住院医师普遍关注工作时间规定不足、新兴亚专业接触不足以及需要更好的实践培训（各占 60%以上）。在所代表的培训机构中，89%的机构每年提供超过 500 例主要神经外科手术，而 40%的受访者从未接触过任何亚专业。电子学习资源的普及是显而易见的，大多数住院医师似乎对现有的评估系统感到满意。与来自其他国家的受访者相比，来自印度的受访者在工作时间规定和亚专业接触方面的回答存在显著差异（p<0.05）。
中低收入国家的有关当局应该认识到并解决神经外科住院医师在培训计划中发现的不足之处。当认为国内资源可能不足时，许多国际神经外科学会将支持并协助这方面的努力。质量控制和对培训计划的密切审查应确保神经外科受训者的利益得到最好的服务。
