State of global pediatric neurosurgery outreach: survey by the International Education Subcommittee

Self Cite

OBJECTIVEThe recognition that neurosurgeons harbor great potential to advocate for the care of individuals with neural tube defects (NTDs) globally has sounded as a clear call to action; however, neurosurgical care and training in low- and middle-income countries (LMICs) present unique challenges that must be considered. The objective of this study was to systematically review publications that describe the challenges and benefits of participating in neurosurgery-related training programs in LMICs in the service of individuals with NTDs.METHODSUsing MEDLINE (PubMed), the authors conducted a systematic review of English- and Spanish-language articles published from 1974 to 2019 that describe the experiences of in-country neurosurgery-related training programs in LMICs. The inclusion criteria were as follows—1) population/exposure: US residents, US neurosurgeons, and local in-country medical staff participating in neurosurgical training programs aimed at improving healthcare for individuals with NTDs; 2) comparison: qualitative studies; and 3) outcome: description of the challenges and benefits of neurosurgical training programs. Articles meeting these criteria were assessed within a global health education conceptual framework.RESULTSNine articles met the inclusion criteria, with the majority of the in-country neurosurgical training programs being seen in subregions of Africa (8/9 [89%]) and one in South/Central America. US-based residents and neurosurgeons who participated in global health neurosurgical training had increased exposure to rare diseases not common in the US, were given the opportunity to work with a collaborative team to educate local healthcare professionals, and had increased exposure to neurosurgical procedures involved in treating NTDs. US neurosurgeons agreed that participating in international training improved their own clinical practices but also recognized that identifying international partners, travel expenses, and interference with their current practice are major barriers to participating in global health education. In contrast, the local medical personnel learned surgical techniques from visiting neurosurgeons, had increased exposure to intraoperative decision-making, and were given guidance to improve postoperative care. The most significant challenges identified were difficulties in local long-term retention of trained fellows and staff, deficient infrastructure, and lower compensation offered for pediatric neurosurgery in comparison to adult care.CONCLUSIONSThe challenges and benefits of international neurosurgical training programs need to be considered to effectively promote the development of neurosurgical care for individuals with NTDs in LMICs. In this global health paradigm, future work needs to investigate further the in-country professionals’ perspective, as well as the related outcomes.

“…The majority of the incountry neurosurgical training programs were found in subregions of Africa (8/9 [89%]), with 1 (11%) in South/ Central America. 1,2,8,9,16,17,20,22,27…”

Section: Resultsmentioning

confidence: 99%

Section: Us Residents' and Neurosurgeons' Perspectivesmentioning

confidence: 99%

Neurosurgical training and global health education: systematic review of challenges and benefits of in-country programs in the care of neural tube defects

Gandy

Castillo

Rocque

et al. 2020

Self Cite

“…13 Although neurosurgery resident participation seems low, evidence exists supporting an increase in participation as faculty; in a survey conducted among pediatric neurosurgeons, 61% of respondents stated they had participated in surgery or teaching in developing countries, with 49% participating annually. 7 Resident participation, however, has not been a focus of significant discussion. Many ethical concerns of residents participating in international humanitarian rotations have been thoroughly discussed.…”

Section: Resident Interestmentioning

confidence: 99%

“…Despite the existence of certain funding opportunities, many residents and faculty cover their expenses when participating in LMIC electives. 7 Financial concerns were also identified as a barrier to participation among otorhinolaryngology residents, who would often use personal funds to participate in global surgery electives. 11 Personal safety concerns and fear of contracting diseases were less frequently cited barriers to participation, among both the neurosurgery residents in this study and surgical residents from other surveys.…”

Section: Barriers To Participationmentioning

confidence: 99%

Interest and participation in global neurosurgery: a survey of Canadian neurosurgery residents

Westwick

Elkaim

Obaid

et al. 2020

OBJECTIVEThe lack of access to primary neurosurgical care presents a significant burden for patients in low- and middle-income countries (LMICs). Efforts to decrease the inequities in access to surgical care have become an increasing focus of initiatives and advocacy within the international neurosurgery community. Although residents may represent highly active members of international teams, the extent of their availability for and interest in global neurosurgery opportunities remains unclear. The objectives of this study were to assess the degree of participation, the level of interest, and the perceived barriers for residents of Canadian neurosurgery programs in engaging in neurosurgery initiatives in LMICs.METHODSA cross-sectional survey was administered to 144 residents from all accredited Canadian neurosurgery residency programs. The survey was used to determine the level of participation and interest in global neurosurgery initiatives.RESULTSThe survey response rate from residents at Canadian neurosurgery programs was 45/144 (31%), although not all respondents answered every question; thus, the denominator for each question is not always 45. Most neurosurgery residents (n = 30, 68%) were unaware of any global neurosurgery opportunities available during residency. Despite 64% of residents having an interest in participation (strongly agree/agree; n = 28), with most residents planning on participating as attending staff (strongly agree/agree; n = 28, 64%), only 3 residents (7%) had taken part in LMIC neurosurgery initiatives. The most cited perceived limitations for participation were lack of time (n = 37, 84%) and finances (n = 26, 59%).CONCLUSIONSAmong surveyed residents from Canadian neurosurgery programs, there was a low participation rate in global neurosurgery initiatives and limited knowledge of available opportunities, despite relatively high interest. Many respondents identified time and financial constraints as barriers to participation. Many residents felt that interest could increase were there a structured program dedicated to global neurosurgery available in their residency program.

“…19 A recent survey of pediatric neurosurgeons found that of those who had taught or performed neurosurgery in a developing country, 71% agreed that their international work improved their overall surgical practice, and 31% agreed that international neurosurgical experiences should be a part of neurosurgical residency or fellowship. 4 Neurosurgery residents join residents in other specialties with regard to interest and increasing involvement abroad. Our data agrees that among neurosurgical resi-dents who have not yet participated, 81.3% (156/192) are interested in pursuing these opportunities.…”

Section: Interest and Valuementioning

confidence: 99%

Current US neurosurgical resident involvement, interest, and barriers in global neurosurgery

Lundy¹,

Miller²,

Woodrow³

2020

OBJECTIVEIt is estimated that nearly 47 million preventable deaths occur annually due the current worldwide deficit in surgical care; subsequently, the World Health Organization resolved unanimously to endorse a decree to address this deficit. Neurosurgeons from industrialized nations can help address the needs of underserved regions. Exposure during training is critical for young neurosurgeons to gain experience in international work and to cultivate career-long interest. Here, the authors explore the opinions of current residents and interest in global neurosurgery as well as the current state of international involvement, opportunities, and barriers in North American residency training.METHODSAn internet-based questionnaire was developed using the authors’ university’s REDCap database and distributed to neurosurgical residents from US ACGME (Accreditation Council for Graduate Medical Education)–approved programs. Questions focused on the resident’s program’s involvement and logistics regarding international rotations and the resident’s interest level in pursuing these opportunities.RESULTSA 15% response rate was obtained from a broad range of training locations. Twenty-nine percent of respondents reported that their residency program offered elective training opportunities in developing countries, and 7.6% reported having participated in these programs. This cohort unanimously felt that the international rotation was a beneficial experience and agreed that they would do it again. Of those who had not participated, 81.3% reported interest or strong interest in international rotations.CONCLUSIONSThe authors’ results indicate that, despite a high level of desire for involvement in international rotations, there is limited opportunity for residents to become involved. Barriers such as funding and rotation approval were recognized. It is the authors’ hope that governing organizations and residency programs will work to break down these barriers and help establish rotations for trainees to learn abroad and begin to join the cause of meeting global surgical needs. To meet overarching international neurosurgical needs, neurosurgeons of the future must be trained in global neurosurgery.