Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities

Caitlin Hoffman; Roger Härtl; Nathan A Shlobin; Tshibambe N Tshimbombu; Samer K Elbabaa; Michael M Haglund; Andrés M Rubiano; Michael C Dewan; Martina Stippler; Muhammad Raji Mahmud; Ernest J Barthélemy; Dylan P Griswold; Richard Wohns; Hamisi K Shabani; Brandon Rocque; David I Sandberg; Jesús Lafuente; Robert Dempsey; Gail Rosseau

doi:10.1016/j.wneu.2022.07.030

Future Directions for Global Clinical Neurosurgical Training: Challenges and Opportunities

World Neurosurg. 2022 Oct:166:e404-e418. doi: 10.1016/j.wneu.2022.07.030. Epub 2022 Jul 19.

Authors

Caitlin Hoffman¹, Roger Härtl¹, Nathan A Shlobin², Tshibambe N Tshimbombu³, Samer K Elbabaa⁴, Michael M Haglund⁵, Andrés M Rubiano⁶, Michael C Dewan⁷, Martina Stippler⁸, Muhammad Raji Mahmud⁹, Ernest J Barthélemy¹⁰, Dylan P Griswold¹¹, Richard Wohns¹², Hamisi K Shabani¹³, Brandon Rocque¹⁴, David I Sandberg¹⁵, Jesús Lafuente¹⁶, Robert Dempsey¹⁷, Gail Rosseau¹⁸

Affiliations

¹ Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA.
² Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
³ Department of Neurosurgery, Geisel School of Medicine, Dartmouth University, Hannover, New Hampshire, USA.
⁴ Section of Pediatric and Fetal Neurosurgery, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, USA.
⁵ Division of Global Neurosurgery and Neurology and Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
⁶ Neurosciences Institute, Neurosurgery Service, El Bosque University, El Bosque Clinic, MEDITECH-INUB Research Group, Bogotá, Colombia.
⁷ Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁸ Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
⁹ Neurosurgery Unit, Department of Surgery, Ahmadu Bello University, Zaria Kaduna, Nigeria; Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA; Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA.
¹⁰ Division of Neurosurgery, Department of Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.
¹¹ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK; NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; School of Medicine, Stanford School of Medicine, Stanford, California, USA.
¹² NeoSpine, Pallyup, Washington, USA.
¹³ Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
¹⁴ Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁵ Division of Pediatric Neurosurgery, University of Texas Health Sciences Center, McGovern Medical School and Children's Memorial Hermann Hospital, Houston, Texas, USA.
¹⁶ Department of Neurosurgery, Hospital Universitario del Mar, Barcelona, Spain.
¹⁷ Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, USA.
¹⁸ Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA. Electronic address: [email protected].

PMID: 35868506
DOI: 10.1016/j.wneu.2022.07.030

Abstract

Objective: Expanded access to training opportunities is necessary to address 5 million essential neurosurgical cases not performed annually, nearly all in low- and middle-income countries. To target this critical neurosurgical workforce issue and advance positive collaborations, a summit (Global Neurosurgery 2019: A Practical Symposium) was designed to assemble stakeholders in global neurosurgical clinical education to discuss innovative platforms for clinical neurosurgery fellowships.

Methods: The Global Neurosurgery Education Summit was held in November 2021, with 30 presentations from directors and trainees in existing global neurosurgical clinical fellowships. Presenters were selected based on chain referral sampling from suggestions made primarily from young neurosurgeons in low- and middle-income countries. Presentations focused on the perspectives of hosts, local champions, and trainees on clinical global neurosurgery fellowships and virtual learning resources. This conference sought to identify factors for success in overcoming barriers to improving access, equity, throughput, and quality of clinical global neurosurgery fellowships. A preconference survey was disseminated to attendees.

Results: Presentations included in-country training courses, twinning programs, provision of surgical laboratories and resources, existing virtual educational resources, and virtual teaching technologies, with reference to their applicability to hybrid training fellowships. Virtual learning resources developed during the coronavirus disease 2019 pandemic and high-fidelity surgical simulators were presented, some for the first time to this audience.

Conclusions: The summit provided a forum for discussion of challenges and opportunities for developing a collaborative consortium capable of designing a pilot program for efficient, sustainable, accessible, and affordable clinical neurosurgery fellowship models for the future.

Keywords: Global health; Global neurosurgery; Global surgery; International development; Public health.

MeSH terms

COVID-19*
Humans
Internship and Residency*
Neurosurgeons
Neurosurgery* / education
Neurosurgical Procedures / education