The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part II): Barriers to Professional Development and Service Delivery in Neurosurgery

Faith C Robertson; Sujit Gnanakumar; Claire Karekezi; Kerry Vaughan; Roxanna M Garcia; Bilal Abou El Ela Bourquin; Fahd Derkaoui Hassani; Alexander Alamri; Nesrine Mentri; Julius Höhne; Tsegazeab Laeke; Hosam Al-Jehani; Luis Rafael Moscote-Salazar; Ahmed Nasser Al-Ahmari; Nicolás Samprón; Martin N Stienen; Federico Nicolosi; Davi J Fontoura Solla; P David Adelson; Franco Servadei; Amro Al-Habib; Ignatius Esene; Angelos G Kolias; WFNS Young Neurosurgeons Committee

doi:10.1016/j.wnsx.2020.100084

The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part II): Barriers to Professional Development and Service Delivery in Neurosurgery

World Neurosurg X. 2020 May 11:8:100084. doi: 10.1016/j.wnsx.2020.100084. eCollection 2020 Oct.

Authors

Faith C Robertson¹, Sujit Gnanakumar^{2

3}, Claire Karekezi⁴, Kerry Vaughan⁵, Roxanna M Garcia⁶, Bilal Abou El Ela Bourquin^{2

3}, Fahd Derkaoui Hassani⁷, Alexander Alamri⁸, Nesrine Mentri⁹, Julius Höhne¹⁰, Tsegazeab Laeke^{3

11}, Hosam Al-Jehani^{12

13}, Luis Rafael Moscote-Salazar¹⁴, Ahmed Nasser Al-Ahmari¹⁵, Nicolás Samprón¹⁶, Martin N Stienen¹⁷, Federico Nicolosi¹⁸, Davi J Fontoura Solla¹⁹, P David Adelson²⁰, Franco Servadei¹⁸, Amro Al-Habib²¹, Ignatius Esene²², Angelos G Kolias^{3

23}; WFNS Young Neurosurgeons Committee

Affiliations

¹ Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
² School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.
³ National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
⁴ Department of Neurosurgery, Rwanda Military Hospital, Kigali, Rwanda.
⁵ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁶ Department of Neurosurgery, Northwestern University, Chicago, Illinois, USA.
⁷ Department of Neurosurgery, Cheikh Zaid International Hospital, Abulcasis International University of Health Sciences, Rabat, Morocco.
⁸ Department of Neurosurgery, The Royal London Hospital, London, United Kingdom.
⁹ Department of Neurosurgery, Bejaia University Hospital, Bejaia, Algeria.
¹⁰ Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
¹¹ Department of Surgery, Neurosurgery Unit, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia.
¹² Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University, Al-Khobar, Saudi Arabia.
¹³ Neuroscience Center, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
¹⁴ Department of Neurosurgery, University of Cartagena, Cartagena de Indias, Colombia.
¹⁵ Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
¹⁶ Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, Spain.
¹⁷ Department of Neurosurgery, University Hospital Zurich & Clinical Neuroscience Center, University of Zurich, Switzerland.
¹⁸ Department of Neurosurgery, Humanitas University and Research Hospital, Rozzano, Milan, Italy.
¹⁹ Department of Neurosurgery, University of São Paulo, São Paulo, Brazil.
²⁰ Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona, USA.
²¹ Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Saudi Arabia.
²² Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon.
²³ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom.

Abstract

Background: Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training.

Methods: An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April-November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed.

Results: In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively (P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues (P < 0.001), neurosurgical journals (P < 0.0001), and textbooks (P = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests (n = 953; 1673 requests) were research (n = 384), education (n = 296), and subspecialty/fellowship training (n = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested.

Conclusions: Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training.

Keywords: 3D, Three-dimensional; Barriers; CT, Computed tomography; Capacity; Global health; Global neurosurgery; HICs, High-income countries; LICs, Low-income countries; LMICs, Low-middle-income countries; MRI, Magnetic resonance imaging; Neurosurgery; QALYs, Quality-adjusted life years; Service delivery; Training; UMICs, Upper-middle-income countries; WFNS, World Federation of Neurosurgical Societies.

Grants and funding

D43 TW010543/TW/FIC NIH HHS/United States