Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Department of Global Health and Social Medicine, Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
World Neurosurg. 2020 Jul;139:75-82. doi: 10.1016/j.wneu.2020.03.114. Epub 2020 Apr 3.
In recent decades there has been a significant expansion of neurosurgical capabilities in low- and middle-income countries, particularly in Southeast Asia. Despite these developments, little is known about the structure and quality of local neurosurgical training paradigms.
A 36-question survey was administered to neurosurgical trainees in person at the Southeast Asian Neurosurgical Bootcamp to assess demographics, structure, and exposure of neurosurgical training in Southeast Asia.
A total of 45 out of 47 possible respondents participated in the survey; 78% were men, with an age range of 26-40 years. Neurosurgical training most commonly consisted of 3 (n = 22, 49%) or 6 years (n = 14, 31%). The majority of respondents (70.5%) were from Myanmar, with the remainder coming from Indonesia, Cambodia, Thailand, and Nepal. Most residents (n = 38, 84%) used textbooks as their primary study resource. Only 24 (53%) residents indicated that they had free access to online neurosurgical journals via their training institution. The majority (n = 27, 60%) reported that fewer than 750 cases were performed at their institution per year; with a median of 70% (interquartile range: 50%-80%) being emergent. The most commonly reported procedures were trauma craniotomies and ventriculoperitoneal shunting. The least commonly reported procedures were endovascular techniques and spinal instrumentation.
Although the unmet burden of neurosurgical disease remains high, local training programs are devoting significant efforts to provide a sustainable solution to the problem of neurosurgical workforce. High-income country institutions should partner with global colleagues to ensure high-quality neurosurgical care for all people regardless of location and income.
近几十年来,中低收入国家(尤其是东南亚国家)的神经外科技能得到了显著扩展。尽管取得了这些进展,但对当地神经外科培训模式的结构和质量却知之甚少。
在东南亚神经外科训练营,通过对神经外科受训者进行的一项 36 个问题的调查,评估东南亚神经外科培训的人口统计学、结构和暴露情况。
共有 47 名可能的受访者中的 45 人参加了调查;其中 78%为男性,年龄在 26-40 岁之间。神经外科培训最常见的是 3 年(n=22,49%)或 6 年(n=14,31%)。大多数受访者(n=70.5%)来自缅甸,其余来自印度尼西亚、柬埔寨、泰国和尼泊尔。大多数住院医师(n=38,84%)将教科书作为主要学习资源。只有 24 名住院医师(53%)表示他们可以通过培训机构免费访问在线神经外科期刊。大多数住院医师(n=27,60%)报告说,他们所在机构每年的手术量少于 750 例;中位数为 70%(四分位距:50%-80%)为紧急手术。最常报告的手术是创伤性开颅术和脑室-腹腔分流术。最不常报告的手术是血管内技术和脊柱器械。
尽管神经外科疾病的未满足需求仍然很高,但当地培训计划正在为提供可持续解决神经外科劳动力问题做出重大努力。高收入国家的机构应与全球同行合作,确保所有人都能获得高质量的神经外科护理,无论其位置和收入如何。