Neurosurgical Training Programs Research Articles

Neurological Surgery Manpower Training and Density in Islamic Republic of Iran: A Population Study

BACKGROUND AND OBJECTIVES: Significant disparities in worldwide neurosurgical training and workforce distribution are prominent primarily in low-income and middle-income countries. Although Iran is considered a lower middle–income country, neurosurgical density and distribution in Iran has surpassed the recommended ratio of 1 neurosurgeon for every 100 000 population. The objective was to determine neurological surgery density and distribution in Iran and the factors significant in the relative success in training and allocation of neurosurgeons in Iran. METHODS: Review of PubMed and administration of site surveys of multiple data sources including Neurosurgical Society of Iran, Iranian Board of Neurological Surgery, Medical Council of Islamic Republic of Iran, Universities of Medical Sciences in Iran, and Ministry of Health and Higher Education of Iran. RESULTS: Over the 72-year period from 1952 to 2024, 1200 neurosurgeons have been trained and distributed in 31 provinces in Iran, attaining a ratio of 1.4/100 000 population. All but 40 neurosurgeons were trained after 1981, which coincided with the Iran-Iraq War. Decentralization of medical and neurosurgical residency training programs, resolving the immediate need for neurosurgeons managing penetrating traumatic brain and spinal cord injuries during the 1980 to 1988 Iran-Iraq War, and active participation of legislative and executive branches of government in solving health care disparities were major factors in meeting the needs of the country. At the present time, more than 555 neurosurgeons are practicing in Tehran Province, a proportion of 3.8 neurosurgeons for every 100 000 population, which indicates an element of disparity in density distribution across Iranian land. CONCLUSION: Legislative initiatives and government support of public health care delivery and decentralization of medical and residency training programs after the Iran-Iraq War and introduction of the Ministry of Health and Medical Education are considered the main reasons for the relative success in meeting the neurosurgical demand and manpower density. Still, further adjustment of distribution of manpower is needed.

Evaluating the efficacy of a cost-effective, fully three-dimensional-printed vertebra model for endoscopic spine surgery training for neurosurgical residents.

A fused deposition modeling three-dimensional (3D)-printed model of the L4-5 vertebra for lumbar discectomy was designed. The model included separately printed dura mater, spinal cord, ligamentum flavum, intervertebral disc (from thermoplastic polyurethane), and bony structures (from polylactic acid), and the material cost approximately US$ 1 per model. A simple plumbing endoscope was used for visualization. Dura mater injury was assessed by painting two layers on the dura mater, which peeled off with trauma. Endoscopic spine surgery is a subject of high interest in neurosurgery given its minimally invasive nature; however, it has a steep learning curve. This study evaluated the effectiveness of a cost-efficient 3D-printed model when teaching this technique to neurosurgery residents. Only a few studies have investigated the efficacy of such a model. Eight residents with >2 years of training participated. Residents performed the procedure bilaterally and twice at 1-week intervals. From the 32 surgeries, four were excluded because of facet removal (as it widened the surgical corridor), leaving 28 surgeries for analysis. Initial surgeries demonstrated a mean operation time of 21 minutes 18 seconds (standard deviation [SD], 2 minutes 32 seconds), which improved to a mean of 6 minutes 45 seconds (SD, 37 seconds) in the fourth surgery (F(3, 17)=19.18, p <0.0001), demonstrating a significant reduction in surgical time over successive surgeries. The median area with the paint removed decreased, from 161.80 (85.55-217.83) to 95.13 mm2 (12.62-160.54), (F(2.072, Inf)=2.04, p =0.128); however, this was not significant. Resident feedback indicated high satisfaction with the educational value of the model. The developed fully 3D-printed model provides a viable and scalable option for neurosurgical training programs, enhancing the learning experience while maintaining low costs. This model may be an excellent stepping stone for learning lumbar spine endoscopy, acclimating to the two-dimensional view, progressing to cadaver models, and, eventually, independent surgery.

Neurosurgical Residency Training at Veterans Affairs Medical Centers, the Resident Perspective.

Department of Veteran's Affairs (VA) Medical Centers play a crucial role in training neurosurgery residents. Although previous studies have examined the impact of VA rotations from the attending perspective, the resident experience remains unexplored. We present a national survey of neurosurgery residents to assess their perceptions of VA rotations, focusing on operative experience, call burden, longitudinal patient care experiences, and overall strengths and limitations. A 33-question survey was distributed by email to all neurosurgery residents who had previously completed a VA rotation within the past 7 years. Responses were received from 77 residents, representing 36 out of 40 neurosurgical residency programs with an active VA rotation. Most residents (79.2%) found their VA rotations adequate in length, having spent a median of 5 months at the VA. Residents completed an average of 11.7 (SD 7.2) cases per month while at the VA, including 8.9 (SD 5.5) spine, 1.7 (SD 2.0) cranial, and 1.4 (SD 1.6) peripheral nerve cases. Many residents reported completing a greater proportion of spine and peripheral nerve cases at the VA compared with their primary clinical sites. Across all postgraduate years, residents felt that the VA offered increased operative autonomy (79.0% agreement) at the expense of total operative volume (98.7% agreement) and complexity (81.9% agreement). Importantly, 94.8% of residents participated in longitudinal patient care experiences, and 59.7% followed all patients longitudinally. The resident experience at the VA varies, presenting both strengths and limitations. Addressing these factors could enhance the overall effectiveness of VA rotations in neurosurgical training programs in the future.

Resident Opinions on Image Guidance for External Ventricular Drain Placement: A National Survey

BACKGROUND AND OBJECTIVES: Low-quality data on image-guided external ventricular drain (EVD) accuracy are in large part due to a lack of widespread usage of this system for EVD placement. The potential disconnect between user preferences and existing technologies should be explored to guide future developments. The goal of this study was to survey neurosurgical residents regarding their EVD practices and determine the acceptable amount of setup time for an ideal neuronavigation system. METHODS: A 4-question survey was sent to approximately 1512 residents at 108 Acreditation Council for Graduate Medical Education–approved medical doctor neurosurgical training programs in the United States. The responses were received electronically, tabulated, and analyzed using descriptive statistics. RESULTS: A total of 130 respondents (9%) completed the survey, reflecting the highest number of neurosurgical resident respondents in an electronic qualitative survey of EVD practices thus far. Residents were willing to accept 6.39 min (SD = 3.73 min) on average for the setup of a bedside EVD image guidance system. The majority chose to use image guidance during EVD placement for cases of narrow slit-like ventricles (86.92%) over intraventricular hemorrhage (13.08%) and hydrocephalus (0%). A total of 90% of all resident respondents misplaced at least 1 EVD with 74% of post-graduate year–7 respondents misplacing more than 3 EVDs in their career. A total of 88.46% of respondents deemed more than a single pass as acceptable. CONCLUSION: Future EVD neuronavigation technologies should focus on achieving rapid registration times. These systems may be prioritized for patients with anatomic distortions. Current resident attitudes are accepting multiple EVD passes, likely because of the inherent limitations of the traditional freehand approach. Efforts should be made to encourage the best course for the patient.

African Women in Neurosurgery: An Exploration of Historical Perspectives, Current Realities, and Future Prospects

Gender disparities remain a significant issue, particularly impacting African women in the field of neurosurgery. Databases, articles, and perspectives were reviewed to identify challenges faced by African Women in Neurosurgery (AWIN), and explore solutions for recruitment, retention, and career advancement of AWIN. In 1982, Africa saw its first female neurosurgeon, with the first female president of the World Federation of Neurosurgical Societies appointed 4 null decades later. Presently, the continent hosts 245 female neurosurgeons, with North Africa comprising the majority at 76.3%, with Algeria notably contributing 72.2% of this total. Southern Africa contributes 7.8%, while West Africa, East Africa, and Central Africa contribute 6.5%, 6.1%, and 3.3%, respectively. Thirteen countries lack neurosurgeons entirely and 30 out of the 54 African nations face shortages of female neurosurgeons, with distributions as follows: North Africa (1-country), Southern Africa (6-countries), West Africa (8-countries), East Africa (9-countries), and Central Africa (6-countries). Our analysis mapped the distribution of 245 AWIN across the African regions and examined the professional trajectories and achievements of 17 pioneering AWIN. Additionally, we compiled registries for: 1) 76 neurosurgical training programs across 26 African countries, 2) organizations tackling gender disparities in neurosurgery, and 3) recommendations to promote AWIN across governmental, community, and academic spheres. To boost AWIN representation in neurosurgery, concerted and comprehensive efforts are vital. Collaboration among medical schools, training programs, and governments is key to fostering diversity and inclusivity in African neurosurgical settings.

Challenging assumptions: "unveiling meritocracy's reality in neurosurgery".

Meritocracy, a concept revered as the cornerstone of fairness and equal opportunity, is critically examined in the context of neurosurgery. This article challenges the notion that success in this demanding field is solely determined by individual abilities and effort. It reveals that factors such as background, gender, and socioeconomic status significantly influence one's career trajectory. By investigating how these systemic barriers impact admissions to neurosurgical training programs and professional advancement, the paper underscores the complexity of meritocracy in neurosurgery, suggesting that the meritocratic ideal is more nuanced and influenced by external variables than commonly believed. Certain universities deemed elite offer a curriculum divergent from that of their counterparts in low and middle-income countries. Students at these "elite" institutions gain exposure to new technologies and research incentives, which brings us to the realm of research. Remarkably, 75% of articles originating from developed nations account for just 25% of traumatic brain injury cases. This disparity highlights a significant research imbalance, and the common refrain underscores the need to bolster research capabilities in low-income countries. For neurosurgeons in the developing world, engaging in research often becomes a luxury due to multifaceted challenges. Financial barriers, including publication costs and paywalls for accessing articles, pose significant hurdles. Comparing salaries between countries underscores the glaring divide according to "Neurosurgeon Salary" in 2024. Neurosurgeons in the United States receive a median salary of $412,000 dollars per year, compared to $13,200 dollars in Latin America, as of June 2023. Given such incongruities, the prospect of even attending conferences or workshops abroad remains difficult for neurosurgeons from developing nations. Research isn't cast aside due to a lack of interest but due to resource limitations. The present landscape demands reconsideration. We underscore the journey towards a more inclusive and equitable future in neurosurgery as not just a goal, but a dynamic process fuelled by resilience, collaboration, and a commitment to diversity. The narrative promotes a collective endeavour to dismantle barriers and embrace innovation, emphasizing the importance of mentorship, cross-institutional collaboration, and the amplification of underrepresented voices.

Urgent Call for International Support and Research Focus on Neurosurgery in Conflict-Affected Sudan

Neurosurgical services and educational processes in Sudan have been severely disrupted by the ongoing armed conflict. The destruction of neurosurgical infrastructure and the continuous exodus of trained neurosurgeons from an already strained system have intensified the humanitarian crisis. The situation is further compounded by several factors, including attacks on medical professionals, partial suspension of neurosurgical training program, loss of communication tools, shortages of essential instruments, and disruptions in partnerships with regional and international neurosurgical associations. The re-establishment of international partnerships and the reconstruction of damaged neurosurgical infrastructure are advocated, coupled with the utilization of advanced research to address these critical issues. A staged recovery strategy is called for, and support from the global neurosurgical community is urged, highlighting the crucial role of academic platforms like "World Neurosurgery" in fostering global collaboration and disseminating research from conflict-affected regions.

Strengthening neurosurgical training programs in Sub-saharan Africa: a medical student's perspective.

This article provides a nuanced exploration of the state and exigencies of neurosurgical training in sub-Saharan Africa (SSA), viewed through the discerning lens of a medical student. The region has a pronounced scarcity of neurosurgical services, further compounded by sociocultural intricacies and infrastructural inadequacies, resulting in elevated mortality and morbidity rates. The insufficiency of neurosurgeons, facilities, and training centers, particularly in remote areas, exacerbates this predicament. The imperative to fortify neurosurgical training programs is underscored, necessitating a multifaceted approach inclusive of international collaborations and innovative strategies. The challenges impeding neurosurgical training program implementation range from constrained infrastructure to faculty shortages and financial constraints. Recommendations encompass infrastructural investments, faculty development initiatives, and augmented community engagement. An exploration of neurosurgical training programs across diverse African regions reveals commendable strides and imminent deficits, warranting heightened international collaboration. Furthermore, technological innovations, including virtual reality, robotics, and artificial intelligence, are posited as transformative conduits for augmenting neurosurgical training in SSA. The article concludes with a sagacious compendium of recommendations, encompassing standardized curricula, mentorship paradigms, and stringent evaluation mechanisms, all combining efficaciously fortifying neurosurgical insight in SSA and producing transformative improvements in healthcare outcomes.

Global Neurosurgical Challenges: A Focus on Central Asia

Neurosurgical care in Central Asia is marked by significant variation across the region's five countries—Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. This variation is influenced by factors such as limited modern technology, a shortage of neurosurgeons, and inadequate healthcare infrastructure. Despite these obstacles, there have been notable advancements in the field, particularly in Kazakhstan, where the number of neurosurgeons has increased, and specialized fields such as vascular neurosurgery and brain tumor management have seen significant progress. Other countries in the region, such as Uzbekistan, Tajikistan, and Kyrgyzstan, have also made strides in improving neurosurgical care. However, these advancements in neurosurgical care are insignificant to those seen globally which make standard neurosurgical care inaccessible to many patients in Central Asian countries due to shortages of neurosurgeons and limited facilities. The dearth of research data in some CA countries further emphasize the need for urgent intervention. Therefore, we recommend a multipronged approach involving targeted investments, policy reforms, international collaborations, and knowledge sharing is recommended to bolster neurosurgical care capabilities and expand access to essential care across Central Asia. This approach include establishing specialized neurosurgical training programs and fellowships, investing in infrastructure and technology for neurosurgical facilities, and fostering collaborations with international centers for training and research. Additionally, early introduction of neurosurgery education in medical schools, enhancing access to online education resources for neurosurgeons, and promoting the use of telemedicine for neurosurgical consultations and follow-up care are recommended

427 Optimization of Morbidity and Mortality Conference: Results of a Multi-center Pilot at Neurosurgical Training Programs

INTRODUCTION: Neurosurgical morbidity and mortality (M&amp;M) conference is essential to resident education and to quality control. Training programs use different methods for executing the conference, with variability in presentation format, case inclusion criteria, adjudication of findings, and follow-up strategy. Optimal format for this conference is debated. METHODS: Ten ACGME-accredited neurosurgical training programs participated in a 3-month pilot to optimize M&amp;M conference. A standardized format was implemented, using a broadly inclusive strategy for case selection, with morbidities selected by residents. Each neurosurgical complication was defined, in group discussion, according to type of error: indication; technique; procedure; judgment; nature of disease. Follow-up intervention was drafted for each case. Surveys were distributed to trainees and attending neurosurgeons before and after the pilot to assess the new format compared to historical standard. RESULTS: A total of 302 surveys were returned from attending and resident physicians. Seventy-four % of respondents found the new format to be an improvement (“slightly improved” or “much improved”) and Eight-five % expressed preference for the new standardized format. Fifty-two % of resident respondents believed engagement at the conference was increased. Twenty-six % responded that significant process improvements resulted from the standardized format. CONCLUSIONS: This 3-month pilot to optimize neurosurgical M&amp;M conference, undertaken at ten neurosurgery training programs, received favorable reviews by survey. Respondents endorsed high levels of faculty &amp; resident engagement. Case categorization by error was favorably reviewed. Significant process improvements were only noted by a minority of respondents, however, perhaps related to the short duration of the pilot. Overall these results suggest that future amplification of a standardized M&amp;M format across neurosurgical training programs could yield high satisfaction and enhanced resident engagement. Additional attention focused on process improvement will be critical.

114 Compliance with Federal Price Transparency Rules at US Hospitals With Neurosurgical Training Programs

INTRODUCTION: The Centers for Medicare &amp; Medicaid Services implemented federal requirements on January 1st, 2021 that require hospitals to provide a list of payer-negotiated prices in a machine-readable file. METHODS: We performed a cross-sectional analysis in March of 2023 of 116 US hospitals associated with a neurosurgical training program to assess compliance with the new federal requirements by searching “price transparency” or “standard charges” with associated hospital on the internet to download machine readable files. The payer-negotiated price for 11 common neurosurgical procedures based on CPT codes for 4 insurance companies were collected (Aetna,Anthem/BCBS,United,Medicare). Pricing using DRG codes were excluded given the range of neurosurgical procedures that are encompassed by a specific DRG code. RESULTS: 92/116 (79.3%) hospitals were compliant with the requirement for machine-readable file with payer-negotiated prices. 45/92 (48.9%) used DRG codes. For the common neurosurgical procedures, hospitals had negotiated price available for at least one insurance company with average private insurance cost and average Medicare costs as follows: ventriculoperitoneal shunt (21/92;$10,698;$1,919), lumbar laminectomy (20/92;$10,343;$4,460), lumbar microdiscectomy (31/92;$9,374;$5,026), anterior cervical discectomy and fusion (28/92;$11,544;$9,859), deep brain stimulator with microelectrode recording (15/92;$10,510;$3,616), craniotomy for tumor (14/92;$6,951;$2,361), stereotactic radiosurgery for brain (18/92;$22,409;$7,362) and spine (14/92;$14,242;$3,306), intrathecal pump placement (31/92;$7,139;$5,064), intracranial aneurysm endovascular treatment (14/92;$9,452;$3352), and diagnostic angiogram (46/92;$11,295;$5,867). CONCLUSIONS: While hospital compliance with federal requirement for machine readable files with payer-negotiated prices was high, availability of payer-negotiated prices for 4 major insurance types across 11 common neurosurgical procedures based on CPT code was sparce. Overall, meaningful conclusions on procedural related cost for elective procedures will be difficult for patients to make due to the unintelligible format of data and a lack of reporting of cost per CPT code in a comprehensive manner.

817 Promoting Durable Well-Being Among Neurosurgical Professionals via an Interactive, Online, Wellness Educational Initiative

INTRODUCTION: Burnout is increasingly recognized as a source of worse job satisfaction and well-being within neurosurgery. We initiated a 10-week department-wide wellness course (Peace Education Program, PEP) with the goal of improving well-being. METHODS: We utilized PEP, a free, interactive, online wellness course focusing on 10 domains (hope, appreciation, inner strength, self-awareness, clarity, understanding, dignity, choice, peace, and contentment). Two weeks before and 6 months after the course, we distributed de-identified surveys based upon the validated Schwartz Outcome Scale-10 (SOS) with Likert scale scores 0-6 to assess participant wellness. Completion of the course was defined as attending &gt;7 of 10 sessions. Mann-Whitney U testing analyzed statistical differences between post-and pre-course data. p-values &lt;0.05 were considered statistically significant. RESULTS: Sixty-nine faculty, trainees, and staff registered to participate, 41 joined &gt;1 session, and 15 completed the course. Twenty-one and ten participants completed the pre- and post-course survey, respectively. Pre-course mean(+SD) SOS-10 score was 4.32 ± 1.23, which improved to 5.10 ± 0.75 post-course (p &lt; 0.001). Pre-course, the lowest domain score related to “appreciation” (3.95 ± 1.46); post-course the highest domain score related to “hope” (5.30 ± 0.48). Overall, all 10 domains demonstrated improved mean scores over time, with 5 domains [“inner strength” (p = 0.008), “understanding” (p = 0.030), “hope” (p = 0.020), “choice” (p = 0.026), and “peace” (p = 0.048)] demonstrating statistically significant score improvements six months after course completion. Focusing on participants who completed &gt;7 sessions, we additionally found statistically significant score improvements in the domains of “clarity” (p = 0.019), “contentment” (p = 0.030), and “appreciation” (p = 0.029) six months after course completion. CONCLUSIONS: Our findings demonstrate improved wellness in participants up to 6 months after wellness course completion. Participants attending &gt;7 sessions benefited more than counterparts. This free, interactive, online course can be utilized at other neurosurgical training programs to combat burnout and improve wellness.

"Home Field Advantage": The Presence of a "Home" Neurosurgical Residency Training Program is Associated With Improved Match Outcomes.

Competition for neurosurgical residency training positions remains fierce. The support provided by applicants' home neurosurgery residency training programs (NRTP) is suspected to play a key role in the National Resident Matching Program (NRMP) process. We sought to evaluate the impact of the presence of an Accreditation Council for Graduate Medical Education-accredited NRTP at medical students' home institutions has on NRMP match outcomes. Our cross-sectional observational study examined all US allopathic senior student Electronic Residency Application Service applications to a single NRTP from 2016 to 2022. We analyzed a total of 1650 Electronic Residency Application Service applications to a single NRTP, of which 1432 (86.8%) were from schools with an Accreditation Council for Graduate Medical Education-accredited NRTP (NRTP+) and 218 (13.2%) were from schools without a residency (NRTP-). NRTP+ applicants matched a higher rate on both pooled analysis (80.8% vs 71.6%, P = .002) and paired analysis ( P = .02) over the seven-cycle study period. This difference was present before (82.4% vs 73.9%, P = .01) and after (77.2% vs 65.6%, P = .046) the COVID-19 pandemic. Cohorts were overall similar; however, NRTP+ applicants had more publication experiences (19.6 ± 19.0 vs 13.1 ± 10.2, P < .001) and were more likely to complete a research gap year (RGY) (25.8% vs 17.0%, P = .004). Completing a RGY was associated with an increased likelihood of matching for NRTP+ applicants but not for NRTP- applicants: NRTP+: 84.9% vs 78.1% ( P = .0056); NRTP-: 70.3% vs 70.9% ( P = .94). The presence of a NRTP at a medical student's home institution is associated with improved NRMP match outcomes. This held true both before and after the COVID-19 pandemic. Applicants from schools with a NRTP had more publication experiences and were more likely to complete a RGY. Completion of a RGY is associated with an increased likelihood of matching only for students with an affiliated NRTP.

Compliance With Federal Price Transparency Rules and Cost Estimation at United States Hospitals With Neurosurgical Training Programs.

The Centers for Medicare & Medicaid Services implemented federal requirements on January 1, 2021, under the Public Health Service Act that require hospitals to provide a list of payer-negotiated prices or "standard charges" in a machine-readable file and in a patient-friendly online estimator for standard services. We sought to assess compliance by United States hospitals associated with neurosurgical training programs with these federal requirements for 11 common neurosurgical procedures. We performed a cross-sectional analysis in March 2023 of 116 United States hospitals associated with a neurosurgical training program to assess compliance with the new federal requirements to have a machine-readable, downloadable file with standard charges and a patient-friendly online estimator for two spinal procedures. A total of 110/114 (96.5%) hospitals were compliant with the requirement for a machine-readable file with payer-negotiated prices. A total of 47/110 hospitals (42.7%) were compliant with downloadable machine-readable files and reported at least one payer-negotiated price for 1 of the 11 common neurosurgical procedures. A total of 45/110 (40.9%) used bundled Diagnosis-Related Group codes, and 18/110 (16.4%) did not contain any price information for neurosurgical procedures. For neurosurgical procedures, the percent difference between the average negotiated private insurance and Medicare price per procedure ranged from 17.5% to 77.6%. Medicare and private insurance data for each procedure were available on average for 10.3 states (SD = 3.8) and 15.6 states (SD = 4.8), respectively. While hospital compliance with federal requirements for machine-readable files with payer-negotiated prices was high, availability of payer-negotiated prices for 4 major insurance types across 11 common neurosurgical procedures based on Current Procedural Terminology codes was sparce. Consequently, meaningful conclusions on procedure-related charges for elective procedures are difficult for patients to make because of the unintelligible format of data and a lack of reporting of charges per Current Procedural Terminology code in a comprehensive manner.

Neurosurgery as a Top-Drawer Choice for Residency in India: Reality or Myth?

IntroductionThis survey was conducted to explore the perceptions of undergraduate (UG) medical students regarding enrolling in a neurosurgical training program. The purpose was to understand' expectations, reasons, apprehensions, and variables influencing students’ decisions to pursue a career in neurosurgery. The results shed light on students’ perceptions and can help educational institutions and training programs draw in and encourage aspiring neurosurgeons. MethodsA 35-point online questionnaire was created using Google Forms (Google LLC) after content and face validation and circulated using social media platforms amongst various public medical colleges across India. Responses were collected over a period of 3 months, from February 2023 to April 2023. A 5-point Likert scale was used to collect the responses wherever applicable. ResultsA total of 1042 respondents from 47 medical colleges completed the survey. The majority of the students were not exposed to neurosurgery during their UG program, but despite this, 60.1% (n = 627) were willing to consider it as their career option. Around 91.4% of the respondents perceived neurosurgery to be a challenging but prestigious specialty that has a long learning curve and the worst work-life balance when compared with other specialties. The majority of the respondents (strongly disagree = 24.3%, n = 253; disagree = 31.7%, n = 330) did not view neurosurgery as a male-dominated specialty. Most students preferred a 6-year training program over a 3-year program (p= 0.001) if their medical college had such a course. ConclusionsOur study reveals that although a majority of the UG students would like to join neurosurgery residency, there are significant barriers in the form of less exposure, negative perceptions and apprehensions towards the branch. Enhancing medical students' awareness about neurosurgery necessitates the integration of hands-on workshops, simulation-based training, didactic lectures, and neurosurgery rotations into the UG curriculum.

Peculiarities of training neurosurgeons in modern conditions using the example of a number of foreign countries

The possibility of unifying the training of neurosurgeons using the experience of different countries seems to be the most promising. At the same time, the uniqueness of the countries, the historical facts of the development of the neurosurgical specialty, scientific and technical achievements in them determined the diversity and specificity of individual neurosurgical schools. As a result, there is no unified model for a neurosurgical training program. In order to study the peculiarities of training neurosurgeons in foreign countries for the subsequent development of optimal models for training and advanced training of neurosurgery specialists in the Russian Federation, a search for foreign information was conducted in the databases Scopus, Web of Science, MedLine, Cochrane Library, EMBASE, Global Health, CyberLeninka, eLibrary.ru, RSCI for 2015–2022 to study the peculiarities of training neurosurgeons in the USA, England, Germany, Italy, Turkey. The analysis undertaken showed that the scope and training programs for neurosurgeons have their own characteristics in a number of countries. Thus, the duration of residency training in neurosurgery varies from 2 years in Russia to 6 years in Italy, Germany and 8 years in the UK. In the USA, postgraduate education for training a neurosurgeon includes 7 years of residency. Training programs also differ: in Italy they focus on primarily mastering practical skills; in Germany, during a 6-year training program, the student must master a wide range of theoretical and practical surgical skills. In the UK, training takes place in several stages: at the initial stage, mastering basic surgical skills common to all surgical specialties, skills and competencies in the field of basic neurosurgical care and emergency medicine. Competencies are further developed in relation to traumatic brain injury, degenerative spinal diseases, neuro-oncology and many other conditions. The final stage of training in the UK is in-depth neurosurgical training with the student spending a large amount of time in the operating room. In the USA, the “red thread” is the interdisciplinary integration of competencies and technologies. International cooperation within the framework of global neurosurgery is considered as the main vector for the development of the neurosurgical industry. The possibility of unifying the training of neurosurgeons using the experience of different countries and creating a global platform for the exchange of knowledge in the field of neurosurgery seem to be the most promising and useful in revising the training programs for neurosurgeons in our country.

The Status of Specialist Neurosurgical Training in Nigeria: A Survey of Practitioners, Trainers, and Trainees

Despite the well-known neurosurgical workforce deficit in Sub-Saharan Africa, there remains a low number of neurosurgical training programs in Nigeria. This study sought to reassess the current status of specialist neurosurgical training in the country. An electronic survey was distributed to all consultant neurosurgeons and neurosurgery residents in Nigeria. Demographic information and questions relating to the content, process, strengths, and challenges of neurosurgical training were explored as part of a broader survey assessing neurosurgical capacity. Descriptive statistics were used for analysis. Respondents identified 15 neurosurgical training centers in Nigeria. All 15 are accredited by the West African College of Surgeons, and 6 by the National Postgraduate Medical College of Nigeria. The average duration of core neurosurgical training was 5years. Some identified strengths of Nigerian neurosurgical training included learning opportunities provided to residents, recent growth in the neurosurgical training capacity, and satisfaction with training. Challenges included a continued low number of training programs compared to the population density, lack of subspecialty training programs, and inadequate training infrastructure. Despite the high number of neurosurgery training centers in Nigeria, compared to other West African countries, the programs are still limited in number and capacity. Although this study shows apparent trainee satisfaction with the training process and contents, multiple challenges exist. Efforts at improving training capacity should focus on continuing the development and expansion of current programs, commencing subspecialty training, driving health insurance to improve funding, and increasing available infrastructure for training.

Gender diversity in neurosurgical training: an analysis of trends and resident program characteristics

OBJECTIVE Recent trends have shown more women entering neurosurgery, but large gender gaps in the number of female trainees continue to persist. A previous study on the gender diversity of residents and faculty in neurosurgery training programs found that only 18.2% of residents and 8.7% of faculty at neurosurgical training programs were female. The goal of this study was to better understand program characteristics that may affect the recruitment of female residents and the gender composition of neurosurgery residency programs. METHODS The authors assessed publicly available information on websites and social media from 116 Accreditation Council for Graduate Medical Education (ACGME)–accredited neurosurgery residency programs from the 2022–2023 academic year. Data collected on residents included gender and postgraduate year (PGY), geographic region, accreditation year, and complement size for programs. The authors analyzed the distribution of female residents at each program and compared accreditation year, program size, program geographics, PGY, and acceptance rates. RESULTS There were 1602 residents across the 116 programs included in this study: 1223 (76.3%) male and 379 (23.7%) female residents. The gender distribution of female residents showed 29 programs had 30% or more female residents, 50 programs had between 16% and 30%, and 37 had fewer than 16%, including 8 with none. There were significantly more PGY-1 than PGY-7 female residents (28.9% vs 16.4%, p &lt; 0.01). Programs with ACGME accreditation before 1970 had significantly higher percentages of female residents (26.0%) compared with those accredited after 1970 (18.2%, p &lt; 0.01). Program size was associated with a higher percentage of female residents (large = 25.2%, medium = 24.9%, and small = 19.6%), although the results were not significant. The distribution of female trainees across five geographic regions of the United States was fairly even: Northeast (24.5%), West (25.2%), South Atlantic (23.1%), South Central (21.8%), and North Central (21.2%). Residency acceptance rates were similar between genders. CONCLUSIONS The underrepresentation of women in neurosurgery residency programs remains a significant issue. While some programs have achieved higher female representation than the overall average proportion of female neurosurgery residents, many still fall short. There are twice as many female PGY-1 compared with PGY-7 residents, suggesting increased recruitment over the past few years. Programs with longer accreditation histories have significantly higher proportions of female residents. Larger program size can also play a role in attracting more female residents, but geographic location did not impact gender composition of resident cohorts in this study.

Cross-Sectional Analysis of Neurosurgical Residency Websites During the Virtual Interview Cycle

The loss of in-person interviews during the COVID-19 pandemic warrants an investigation into what information is provided to applicants through neurosurgery residency program websites (NRPWs). This study examines NRPWs across the United States and Canada to determine what details are provided to applicants through their respective websites. Accreditation Council for Graduate Medical Education accredited neurologic surgery residency programs were identified through the American Association of Neurological Surgeons (AANS) website. NRPWs were searched for 48 criteria, including program overview, application requirements, and curriculum information. Small programs were defined as 1-2 residents per class, while large programs were classified as those with 3-4 residents per year. Content differences were analyzed between the top 20 and remaining programs per the Doximity Residency Navigator Rankings. The most prevalent information among 122 NRPWs was the neurosurgery residency overview (95%), names of faculty members (95%), and names of current residents (94%). Top-20 NRPWs were more likely to include post PGY-7 fellowships (90% vs. 61% P= 0.0108), operating room virtual reality experience (35% vs. 12% P= 0.0160), and faculty research (90% vs. 62% P= 0.0182) than the remainder of the programs. This study investigates NRPW content after the COVID-19 pandemic. We report broad variability in content provided by various neurosurgical training programs. Higher-ranked neurosurgery programs are more likely to include fellowship information, operating room virtual reality experience, and faculty research than lower-ranked programs.

The Neurosurgical Workforce of the Philippines.

No study has comprehensively examined the delivery of neurosurgical care in the Philippines, a lower-middle-income country in Southeast Asia with a total population of 109 million. We aimed to quantify the workforce, map the distribution, and characterize the clinical practice of neurosurgeons across the 17 regions and 81 provinces of the Philippines. An online survey was sent to all fellows of the Academy of Filipino Neurosurgeons and all graduates of neurosurgical training programs in the country. Neurosurgeons who have been in active clinical practice for at least 1 year were eligible to participate. A database of Filipino neurosurgeons was generated through personal communications, correspondence with neurosurgery departments, and accessing publicly available information. The top neurosurgical procedures were identified to estimate the overall volume of neurosurgical disease. There are 174 neurosurgeons practicing in the Philippines or approximately one neurosurgeon for every 600 000 people. In 9 provinces, neurosurgeons were only available part-time, and 35 provinces had no neurosurgeons at all, equivalent to an underserved population of 24 million people. Among 99 survey respondents, the median numbers of neurosurgical consults and operations every month were 30 (IQR:35) and 8 (IQR:8), respectively. The top neurosurgical procedures were burr holes/craniotomy for traumatic brain injury, craniotomy for stroke, and biopsy/resection of brain tumors. There are an estimated 93 498 cases requiring essential neurosurgery every year. Although positive trends have been observed in the number, distribution, and composition of neurosurgeons in the Philippines, there remains a large workforce deficit that needs to be addressed to provide timely, quality, and affordable neurosurgical care to the entire population.