Lu Zhuoyan, Tshimbombu Tshibambe N, Abu-Bonsrah Nancy, Kanmouyne Ulrick Sidney, Hesson Donna, Edward Anbrasi, Dewan Michael C, Ukachukwu Alvan-Emeka K, Fuller Anthony T, Groves Mari L, Rhee Daniel S
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
World Neurosurg. 2023 May;173:188-198.e3. doi: 10.1016/j.wneu.2023.01.120. Epub 2023 Feb 4.
Neurosurgical capacity building efforts attempt to address the shortage of neurosurgeons and lack of neurosurgical capacity in low- and middle-income countries. This review sought to characterize neurosurgical capacity building efforts in low- and middle-income countries and the challenges they face, and identify factors that predict higher engagement, better training, and performance of high-impact activities.
A scoping review using PubMed and Embase databases was performed and relevant articles were identified. Programs were classified into 6 categories and the activities they performed were classified as having a high-, medium-, or mild impact on capacity. Programs were also classified using the Olivieri engagement and training criteria.
Fifty-seven articles representing 42 unique efforts were included. The most important determinant of impact was a program's design and intent. Furthermore, 91% of training and twinning programs received high (class 2 or 3) engagement classifications compared to 17% of mission trips and training camps (P < 0.001); 91% of training and twinning programs received high training classifications compared to 64% of mission trips and training camps (P = 0.015); and 91% of training and twinning programs reported performing high-impact activities compared to 29% of mission trips and training camps (P < 0.001).
Training and twinning programs are more engaged, offer better training, and are more likely to perform high-impact activities compared to mission trips and training camps, suggesting that these types of programs offer the greatest chance of producing substantial and sustainable improvements to neurosurgical capacity.
神经外科能力建设工作旨在解决低收入和中等收入国家神经外科医生短缺以及神经外科能力不足的问题。本综述旨在描述低收入和中等收入国家的神经外科能力建设工作及其面临的挑战，并确定能够预测更高参与度、更好培训以及高影响力活动表现的因素。
利用PubMed和Embase数据库进行了一项范围综述，并确定了相关文章。项目被分为6类，其开展的活动被分类为对能力有高、中或轻度影响。项目还根据奥利维耶里参与度和培训标准进行分类。
纳入了代表42项独特工作的57篇文章。影响的最重要决定因素是项目的设计和意图。此外，91%的培训和结对项目获得了高（2级或3级）参与度分类，而短期任务旅行和训练营的这一比例为17%（P<0.001）；91%的培训和结对项目获得了高培训分类，而短期任务旅行和训练营的这一比例为64%（P = 0.015）；91%的培训和结对项目报告开展了高影响力活动，而短期任务旅行和训练营的这一比例为29%（P<0.001）。
与短期任务旅行和训练营相比，培训和结对项目的参与度更高，提供更好的培训，并且更有可能开展高影响力活动，这表明这些类型的项目最有可能对神经外科能力产生实质性和可持续的改善。
