Abstract
Objective: Shortage of general neurosurgery and specialized neurotrauma care in low resource settings is a critical setback in the national surgical plans of low and middle-income countries (LMIC). Neurotrauma fellowship programs typically exist in high-income countries (HIC), where surgeons who fulfill the requirements for positions regularly stay to practice. Due to this issue, neurosurgery residents and medical students from LMICs do not have regular access to this kind of specialized training and knowledge-hubs. The objective of this paper is to present the results of a recently established neurotrauma fellowship program for neurosurgeons of LMICs in the framework of global neurosurgery collaborations, including the involvement of specialized parallel education for neurosurgery residents and medical students.Methods: The Global Neurotrauma Fellowship (GNTF) program was inaugurated in 2015 by a multi-institutional collaboration between a HIC and an LMIC. The course organizers designed it to be a 12-month program based on adapted neurotrauma international competencies with the academic support of the Barrow Neurological Institute at Phoenix Children's Hospital and Meditech Foundation in Colombia. Since 2018, additional support from the UK, National Institute of Health Research (NIHR) Global Health Research in Neurotrauma Project from the University of Cambridge enhanced the infrastructure of the program, adding a research component in global neurosurgery and system science.Results: Eight fellows from Brazil, Venezuela, Cuba, Pakistan, and Colombia have been trained and certified via the fellowship program. The integration of international competencies and exposure to different systems of care in high-income and low-income environments creates a unique environment for training within a global neurosurgery framework. Additionally, 18 residents (Venezuela, Colombia, Ecuador, Peru, Cuba, Germany, Spain, and the USA), and ten medical students (the United Kingdom, USA, Australia, and Colombia) have also participated in elective rotations of neurotrauma and critical care during the time of the fellowship program, as well as in research projects as part of an established global surgery initiative.Conclusion: We have shown that it is possible to establish a neurotrauma fellowship program in an LMIC based on the structure of HIC formal training programs. Adaptation of the international competencies focusing on neurotrauma care in low resource settings and maintaining international mentoring and academic support will allow the participants to return to practice in their home-based countries.
Highlights
According to a recent analysis of global neurosurgery academic groups, more than two-thirds of the world’s population has gaps in the provision of appropriate surgical and anesthetic care [1]
The objective of this paper is to present the results of a recently established model for a neurotrauma fellowship program, created for low- and middle-income countries (LMIC) neurosurgeons within the framework of global neurosurgery collaborations
One fellow created a program of sponsored rotations in neurotrauma and critical care for Venezuelan residents who return to their country to improve neurotrauma care practices in different regions throughout the country (Figure 2)
Summary
According to a recent analysis of global neurosurgery academic groups, more than two-thirds of the world’s population has gaps in the provision of appropriate surgical and anesthetic care [1]. There are an estimated 13,8 million potential neurosurgical cases every year worldwide, with more than 80% occurring in low- and middle-income countries (LMIC) [1]. It has been calculated that nearly 45% of the total neurosurgical cases are related to traumatic brain injury (TBI) care, including burr holes, craniotomies, and craniectomies [1, 2]. Neurosurgical care availability is limited in the most needed regions of the world. Even if neurosurgical care is available, sub-specialized care is often lacking according to global neurosurgery research audits [3,4,5,6]. Neurotrauma surgical procedures are considered first-line macroneurosurgical interventions according to the World Federation of Neurosurgical Societies (WFNS) classification for the level of provided neurosurgical care in different cities of the world [4]
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