Residency perception survey among neurosurgery residents in lower-middle-income countries: grassroots evaluation of neurosurgery education

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>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 (&gt; 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 &lt; 0.05) among responses from India compared with those from other countries were found in terms of work hour regulations and subspecialty exposure.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>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.</jats:p></jats:sec>

Benchmarking of neurosurgery training in Pakistan

“…However, with the evolution of surgical education, a marked shift was observed from mentor-based learning to structured institution-based learning. [ 6 ] With this shift, structured neurosurgery training evolved in Pakistan, certified by accreditation council for graduate medical education (ACGME)[ 7 ] and accredited by the World Federation of Neurosurgical Societies. [ 8 ]…”

“…A study conducted in March 2020 showed that in lower-middle-income countries 86% of trainees consider these morbidity and mortality meetings to be essential and beneficial to neurosurgery training. [ 6 12 ] Academic morning meetings and resident assessment tests are essential teaching components of any surgical training programs. 90% of the response (94 weekly and 41 for daily) for conducting academic morning meetings for resident education.…”

New adaptation of neurosurgical practice and residency programs during the Covid-19 pandemic and their effects on neurosurgery resident satisfaction and welfare at the National General Hospital, Jakarta, Indonesia

“…Deora et al. stated that the lower cost of electronic media and information makes them very popular tools among residents, although each resident still needs better hands-on surgical exposure [ 14 ]. In a study reported by Rana T et al., nonsurgical specialty residents were more comfortable using telemedicine than surgical residents.…”

“…The strength of this study is that it describes the condition of neurosurgical services, the education process, and the residents’ perspectives and welfare during the pandemic in a national referral center. Until now, only three studies that explored physician burnout during this pandemic using the Maslach Burnout Inventory Score as their indicator [ 8 , 14 , 16 ]. In addition, very few studies have discussed the effect of the pandemic on neurosurgery education in developing countries.…”

“…In addition, very few studies have discussed the effect of the pandemic on neurosurgery education in developing countries. One study that has looked at these issues was conducted by Deora et al., who described the neurosurgery resident perceptions in low-to-middle-income countries [ 14 ].…”