Adjunct Training for Low- and Middle-income Country Neurosurgeons: A Scoping Review and Survey

Introduction: The Lancet Commission on Global Surgery was founded in 2014 to address the lack of essential surgical and anesthetic care for individuals in low- and middle-income countries (LMICs). The deficit in surgical care is especially prominent in the field of neurosurgery. Annually, 5 million essential neurosurgical cases in LMICs go unperformed, necessitating an estimated additional 23,000 neurosurgeons globally. Despite this massive global demand, trainees in LMICs face significant obstacles, including lack of funding, resources, educational opportunities, and clinical exposure. For these reasons, supplemental education in the form of international fellowships, observerships, exchange programs, mission trips, and online courses can mitigate the gaps in neurosurgical training in LMICs.

Methods: This scoping review explores existing global opportunities for supplemental neurosurgery training. We compiled the structured observership programs, international fellowships, international rotations, and online training modalities available to neurosurgical trainees in LMICs. Additionally, we surveyed international observers at the Barrow Neurological Institute to assess the impact of observership experiences on their clinical training.

Results: Supplemental education for neurosurgeons in LMICs is available through observerships, fellowships, online training, and exchange programs. Furthermore, mission trips, bidirectional exchange programs, and international rotations for U.S. residents are additional opportunities to enhance training for host LMIC neurosurgeons. We have created a comprehensive list of these global opportunities for reference. Survey results from the BNI observership program showed that 65.1% of participants found the experience “added a lot of value” to their clinical training, while 31.5% deemed the experience as “indispensable”. Additionally, 71.3% reported increased comfort with complex cases. Finally, participants cited increased clinical experience, mentorship, leadership, networking, research, and more.

Conclusion : Supplemental training for LMICs offer substantial benefit to neurosurgeons globally by mitigating gaps in clinical training and improving skills and confidence. Sustainable, long-term collaborations are essential to support neurosurgical trainees in LMICs to address the lack of neurosurgical care globally.