1
|
Ahmed H, Furqan M, Okon II, Oduoye MO, Mitchell UO, Akpan U, Umutoni F, Bandyopadhyay S, Akilimali A, Nkeshimana M. The availability, access, challenges and advancements in neurosurgical care in Africa: a mini review. Ann Med Surg (Lond) 2024; 86:2011-2015. [PMID: 38576995 PMCID: PMC10990298 DOI: 10.1097/ms9.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 04/06/2024] Open
Abstract
The availability and accessibility of neurosurgical care across Africa remains limited despite recent advancements. Overall, Africa accounts for 15% of the global neurosurgical disease burden but has access to less than 1% of neurosurgeons globally. While the number of neurosurgeons has increased in recent decades, huge workforce shortages remain, with the region facing the second-largest neurosurgical deficit. Access to adequate facilities and equipment is also lacking. Barriers like poverty, conflicts, and distance from care centres negatively impact patients' ability to access services. However, training programs like the World Federation of Neurosurgical Societies Rabat Training Center have contributed to building local capacity. Use of technologies like neuro-endoscopy is expanding access to more cost-effective interventions for conditions such as hydrocephalus. Undergraduate medical education is also seeing a rise in African students interested in neurosurgery. Despite these advancements, workforce shortfalls, inadequate infrastructure, and challenges posed by geopolitical instability continue to hinder the provision of comprehensive neurosurgical care. Limited research and funding discourage experienced surgeons from practicing in their home countries. Increased international collaboration, support for education, and tackling of structural issues are needed to continue strengthening Africa's neurosurgical capacity and reducing the disease burden. This narrative review aims to provide an overview of the current state of neurosurgery on the continent, highlight achievements, and identify persisting challenges.
Collapse
Affiliation(s)
- Hassan Ahmed
- Faculty of medicine, University of Kordofan, Elobeid, Sudan
| | - Muhammad Furqan
- Faculty of medicine, King Edward Medical University, Lahore, Pakistan
| | - Inibehe Ime Okon
- Department of Research, Medical Research Circle (MedReC), Bukavu
| | | | | | - Usoro Akpan
- Faculty of medicine, University of Warwick, Coventry
| | - Florence Umutoni
- Department of Research, Medical Research Circle (MedReC), Bukavu
- Faculty of Medicine, University of Rwanda
| | - Soham Bandyopadhyay
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire
- Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Aymar Akilimali
- Department of Research, Medical Research Circle (MedReC), Bukavu
| | - Menelas Nkeshimana
- Department of Health Workforce Development, Ministry of Health, Kigali, Rwanda
| |
Collapse
|
2
|
Gupta S, Aukrust CG, Bhebhe A, Winkler AS, Park KB. Neurosurgery and the World Health Organization Intersectoral Global Action Plan for Epilepsy and Other Neurological Disorders 2022-2031. Neurosurgery 2024:00006123-990000000-01020. [PMID: 38224233 DOI: 10.1227/neu.0000000000002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/27/2023] [Indexed: 01/16/2024] Open
Abstract
The World Health Organization's Intersectoral Global Action Plan (IGAP) on Epilepsy and Other Neurological Diseases 2022-2031 is a holistic, interdisciplinary, and intersectoral plan with a strong focus on equity and human rights. The IGAP was unanimously approved by all World Health Organization Member States at the 75th World Health Assembly in May 2022 and provides a framework for researchers and clinicians to study and address national and global inadequacies in the evaluation and management of people suffering from neurological disorders and their prevention. While IGAP has applied epilepsy as an entry point for other neurological disorders, advocacy by neurologists and neurosurgeons has broadened it to include diseases with a large and growing global health footprint such as stroke, hydrocephalus, traumatic brain injury, and brain and spine cancers. The IGAP is important to neurosurgeons globally because it provides the first ever roadmap for comprehensively addressing unmet neurological and neurosurgical care in low- and middle-income countries. Furthermore, it creates an opportunity for neurologists and neurosurgeons to scale up services for neurological diseases in tandem. As such, it provides a structure for the neurosurgery community to become involved in global health initiatives at all levels.
Collapse
Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Camilla G Aukrust
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Arnold Bhebhe
- Department of Neurosurgery, University Teaching Hospital, Lusaka, Zambia
| | - Andrea S Winkler
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany
| | - Kee B Park
- Department of Global Health and Social Medicine, Program for Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Farooq M. Neurosurgery abroad? Medical Graduate's perspective from LMIC. BRAIN & SPINE 2023; 3:102710. [PMID: 38020993 PMCID: PMC10668102 DOI: 10.1016/j.bas.2023.102710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Minaam Farooq
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
4
|
Carter A, Findlay MC, Earl ER, Khan M, Bauer S, Farsi K, Lucke-Wold B, Karsy M. Systematic Review of Research, Mentorship, and Career Resources for Medical Students Pursuing Neurosurgical Training. World Neurosurg 2023; 179:28-36. [PMID: 37544605 DOI: 10.1016/j.wneu.2023.07.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Medical students are important team members and future healthcare providers in neurosurgery or other medical fields. We performed a systematic review evaluating studies assessing medical student guidance, mentorship, and career development in neurosurgery. The study aimed to identify the best practices and acknowledge gaps requiring improvement. METHODS A systematic review of 586 research studies evaluating important aspects of medical student career development in neurosurgery was performed. The studies were analyzed for evidence supporting specific strategies to foster career development. RESULTS A total of 45 studies were identified and categorized into 8 categories: 1) medical student interest groups; 2) student fellowships and institutional programs; 3) research and observership funding; 4) medical student research and scholarship; 5) student-led interest groups; 6) student mentorship; 7) educational resources; and 8) diversity, equity, and inclusion for medical students. Studies supported the significant positive effects of career resources for medical students, which often resulted in higher publication quantities, increased interest in the field, and greater ease of matriculation into a neurosurgical residency. One central gap included limited formal opportunities at many institutions, including medical schools without neurosurgery programs. Additional gaps were an absent structure for many forms of mentorship and delayed engagement of medical students in neurosurgical training, which significantly affects career interests. The currently available resources for these aspects of career development are listed. CONCLUSIONS These studies highlight the current endeavors to encourage medical student careers. However, ample gaps and missed opportunities were also identified. Further work at both institutional and national levels is needed to improve the current environment.
Collapse
Affiliation(s)
- Ashley Carter
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Matthew C Findlay
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA; School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Emma Rose Earl
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA; School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Majid Khan
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Sawyer Bauer
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Koorosh Farsi
- Global Neurosciences Institute, Philadelphia, Pennsylvania, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Michael Karsy
- Global Neurosciences Institute, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
5
|
Takoutsing BD, Wunde UN, Zolo Y, Endalle G, Djaowé DAM, Tatsadjieu LSN, Zourmba IM, Dadda A, Nchufor RN, Nkouonlack CD, Bikono ERA, Magadji JPO, Fankem C, Jibia ABT, Esene I. Assessing the impact of neurosurgery and neuroanatomy simulation using 3D non-cadaveric models amongst selected African medical students. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1190096. [PMID: 37215067 PMCID: PMC10192731 DOI: 10.3389/fmedt.2023.1190096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
Background Laboratory dissections are essential to acquire practical skills to perform neurosurgical procedures. Despite being traditionally done on cadavers, they are often unavailable and suffer from cultural barriers in the African context. Non-cadaveric UpSurgeOn neurosurgery models have been developed to bridge this barrier, providing an almost similar experience with the human body. This study aimed to assess the impact of the UpSurgeOn hands-on-touch non-cadaver model training amongst selected Cameroon medical students. Methods An anonymous 35-item questionnaire was distributed online using Google drive systems to medical students who attended UpSurgeOn's hands-on-touch non-cadaver model training course. These questions aimed to capture data on previous experience with neuroanatomy and neurosurgery practicals and the perception, attitudes, and impact of the UpSurgeOn neurosurgery tool. Results Eighty-six students completed the survey. The mean age was 21.2 ± 1.868 years, 61.6% were males with 62.8% of respondents being medical students in preclinical years. Before the training, 29.4% had a fair knowledge of neuroanatomy. Textbooks and Youtube videos were the main sources of neuroanatomy and neurosurgery knowledge for more than half of the respondents. Up to 91.5% had no prior exposure to a neuroanatomy/neurosurgery cadaver laboratory dissection, and 22.6% and 17.6% had witnessed and performed at least one craniotomy before, respectively. There were 11.1%, 15.5%, and 31.3% of our respondents who had used a surgical microscope, a neurosurgical instrument, and the UpSurgeOn Neurosurgery tool before, respectively. The majority perceived the UpSurgeOn tool easy to use and felt they needed to learn just a few things before getting going with the box. Most thought of increasing the use of the UpSurgeOn Box and saw the need to be part of the training curriculum. Finally, the majority felt this tool helped to increase familiarity and acquire neurosurgical skills, and to develop the orientation skills needed during neurosurgical approaches. Conclusion Undergraduate exposure to traditional neurosurgery/neuroanatomy labs is limited in Cameroon. Neurosurgery/neuroanatomy practical skills are gained essentially using non-practical means. Most students found the UpSurgeOn tool user-friendly, saw the need to incorporate it as part of their training, and perceived it to be essential in getting acquainted with neurosurgical skills.
Collapse
Affiliation(s)
- Berjo Dongmo Takoutsing
- Research Division, Winners Foundation, Yaounde, Cameroon
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Ubraine Njineck Wunde
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Global Surgery Division, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Geneviève Endalle
- Research Division, Winners Foundation, Yaounde, Cameroon
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Dieunedort Arnold Menga Djaowé
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Garoua, Garoua, Cameroon
| | | | - Ines Miste Zourmba
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Garoua, Garoua, Cameroon
| | - Aminatou Dadda
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, University of Garoua, Garoua, Cameroon
| | | | | | | | | | | | | | - Ignatius Esene
- Research Division, Winners Foundation, Yaounde, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| |
Collapse
|
6
|
El-Hajj VG, Gharios M. Letter to the Editor Regarding "The Perceived Utility of 3 Online Resources for Medical Student Neurosurgery Education". World Neurosurg 2023; 170:254-255. [PMID: 36782413 DOI: 10.1016/j.wneu.2022.10.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 02/10/2023]
Affiliation(s)
| | - Maria Gharios
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
7
|
Rallo MS, Strong MJ, Teton ZE, Murazsko K, Nanda A, Liau L, Rosseau G. Targeted Public Health Training for Neurosurgeons: An Essential Task for the Prioritization of Neurosurgery in the Evolving Global Health Landscape. Neurosurgery 2023; 92:10-17. [PMID: 36519856 DOI: 10.1227/neu.0000000000002169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
The gap between the tremendous burden of neurological disease requiring surgical management and the limited capacity for neurosurgical care has fueled the growth of the global neurosurgical movement. It is estimated that an additional 23 300 neurosurgeons are needed to meet the burden posed by essential cases across the globe. Initiatives to increase neurosurgical capacity through systems strengthening and workforce development are key elements in correcting this deficit. Building on the growing interest in global health among neurosurgical trainees, we propose the integration of targeted public health education into neurosurgical training, in both high-income countries and low- and middle-income countries. This effort will ensure that graduates possess the fundamental skillsets and experience necessary to participate in and lead capacity-building efforts in the developing countries. This additional public health training can also help neurosurgical residents to achieve the core competencies outlined by accreditation boards, such as the Accreditation Committee on Graduate Medical Education in the United States. In this narrative review, we describe the global burden of neurosurgical disease, establish the need and role for the global neurosurgeon, and discuss pathways for implementing targeted global public health education in the field of neurosurgery.
Collapse
Affiliation(s)
- Michael S Rallo
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michael J Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Zoe E Teton
- Department of Neurosurgery, University of California - Los Angeles, Los Angeles, California, USA
| | - Karin Murazsko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anil Nanda
- Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Linda Liau
- Department of Neurosurgery, University of California - Los Angeles, Los Angeles, California, USA
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
8
|
Nguembu S, Kenfack YJ, Sadler S, Zolo Y, Figuim B, Sebopelo LA, Tétinou F, Kanmounye US. Factors Associated with Adverse Outcomes in Cameroonian Patients with Traumatic Brain Injury: A Cross-Sectional Study. World Neurosurg 2022; 172:e62-e67. [PMID: 36481439 DOI: 10.1016/j.wneu.2022.11.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The burden of traumatic brain injury (TBI) disproportionately affects low- and middle-income countries. In Cameroon, the estimated annual incidence rate is 572 cases per 100,000 people. This study investigated factors associated with adverse outcomes in the management of Cameroonian patients with TBI. METHODS This cross-sectional study included all patients with TBI treated between January 1 and December 31, 2018, at 2 Cameroonian referral hospitals. Sociodemographic and clinical data were extracted from patient charts and admission registries and analyzed with SPSS v.26. Independent t tests, odds ratios, and cumulative mortality hazard rates were computed. A P-value <0.05 was considered statistically significant. Also, binomial regression analyses were calculated. RESULTS One hundred seventy-one patients aged 38.63 ± 20.46 years old received treatment for TBI. Most patients were male (78.9%), Cameroonian (98.2%), from urban areas (75.4%), and uninsured (88.8%). The average admission length was 11.23 ± 10.71 days, during which 27.5% of patients received surgical treatment while 72.5% received non-surgical (conservative) management. From postdischarge day 12 onwards, surgically-treated patients had a greater cumulative mortality hazard rate than conservatively-treated patients. By 28 days postdischarge, 66.1% of patients had recovered completely [Glasgow Outcome Scale (GOS) = 5], 23.4% had a disability (GOS = 2-4), and 10.5% expired (GOS = 1). Complete recovery was associated with the absence of severe TBI (B = -1.42, standard error [SE] = 0.52, P = 0.006), disability was associated with increased injury-to-admission delay (B = -1.27, SE = 0.48, P = 0.009), and death was associated with severe TBI (B = 3.16, SE = 0.73, P < 0.001). CONCLUSIONS We identified factors associated with unfavorable outcomes among Cameroonian patients with TBI. These results can inform triage and referral practices and aid policymakers in developing context-specific prehospital guidelines.
Collapse
Affiliation(s)
- Stéphane Nguembu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Yves Jordan Kenfack
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Bello Figuim
- Department of Surgery, Neurosurgery Unit, Yaounde Central Hospital, Yaounde, Cameroon
| | | | - Francklin Tétinou
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | |
Collapse
|
9
|
Dada OE, Bukenya GW, Konan L, Mbangtang CB, Ooi SZY, Makambo PDDN, Adrien TDE, Kenfack YJ, Senyuy WP, Abu-Bonsrah N, Karekezi C, Jokonya L, Alalade AF, Esene I, Kanmounye US. State of African Neurosurgical Education: An Analysis of Publicly Available Curricula. World Neurosurg 2022; 166:e808-e814. [PMID: 35926702 DOI: 10.1016/j.wneu.2022.07.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Africa bears more than 15% of the global burden of neurosurgical disease; however, it has the lowest neurosurgical workforce density worldwide. The past decade has seen an increase in neurosurgery residency programs on the continent. It is unclear how these residency programs are similar or viable. This study highlights the current status and interdepartmental and regional differences, with the main objective of offering a template for improving the provision of neurosurgical education on the continent. METHODS PubMed and Google Scholar were searched using keywords related to "neurosurgery," "training," and "Africa" from database inception to October 13, 2021. The residency curricula were analyzed using a standardized and validated medical education curriculum viability tool. RESULTS Curricula from 14 African countries were identified. The curricula differed in resident recruitment, evaluation mode and frequency, curriculum content, and length of training. The length of training varied from 4 to 8 years, with a mean of 6 years. The Eastern African region had the highest number of examinations, with a mean of 8.5. Few curricula had correlates of viability: ensuring that the instructors are competent (64.3%), prioritization of faculty development (64.3%), faculty participation in decision making (64.3%), prioritization of resident support services (50%), creating a conducive environment for quality education (42.9%), and addressing student complaints (28.6%). CONCLUSIONS There are significant differences in the African postgraduate neurosurgical education curriculum warranting standardization. This study identifies areas of improvement for neurosurgical education in Africa.
Collapse
Affiliation(s)
- Olaoluwa Ezekiel Dada
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
| | - George William Bukenya
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Landry Konan
- Neurosurgery Department, University Felix Houphouet Boigny, Abidjan, Côte d'Ivoire
| | | | - Setthasorn Zhi Yang Ooi
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | | | - Yves Jordan Kenfack
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Wah Praise Senyuy
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Nancy Abu-Bonsrah
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Luxwell Jokonya
- Neurosurgery Unit, Department of Surgery, University of Zimbabwe, Harare, Zimbabwe
| | - Andrew F Alalade
- Department of Neurosurgery, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, United Kingdom
| | - Ignatius Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | | |
Collapse
|
10
|
Ooi SZY, Dada OE, Bukenya GW, Kenfack YJ, Le C, Ohonba E, Adeyemo E, Narain K, Awad AK, Barrie U, Sichimba D, Ogunfolaji O, Kitonga LM, Oriaku AJ, Bamimore MA, Okor DE, Rominiyi O. Evaluating the impact of neurosurgical rotation experience in Africa on the interest and perception of medical students towards a career in neurosurgery: a protocol for a continental, cross-sectional study. JOURNAL OF SURGICAL PROTOCOLS AND RESEARCH METHODOLOGIES 2022; 2022:snac006. [PMID: 35480394 PMCID: PMC9027747 DOI: 10.1093/jsprm/snac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Africa has the second highest neurosurgical workforce deficit globally. Despite the many recent advancements in increasing neurosurgical access in Africa, published reports have shown that the vast majority of undergraduate students have little or no exposure to neurosurgery. The lack of exposure may pose a challenge in reducing the neurosurgical workforce deficit, which is one of the long-term strategies of tackling the unmet burden of disease. Students may also miss the opportunity to appreciate the specialty and its demands as well as nurture their interest in the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery.
Methods
The cross-sectional study will be conducted through the dissemination of a self-administered e-survey hosted on Google Forms from 21st February 2021 to 20th March 2021. The survey will contain five-point Likert scale, multiple-choice and free-text questions. The structured questionnaire will have four sections with 27 items: (i) socio-demographic background, (ii) neurosurgical experience, (iii) perception towards a neurosurgical career and (iv) interest in a neurosurgical career. All consenting medical students in African medical schools who are in their clinical years (defined as fourth to sixth years or higher years of study) will be eligible. Odds ratios and their 95% confidence intervals, Wilcoxon rank-sum test, Welch t-test and adjusted logistic regression models will be used to test for associations between independent and dependent variables. Statistical significance will be accepted at P < 0.05.
Collapse
Affiliation(s)
| | | | | | - Yves Jordan Kenfack
- School of Medicine, University of Texas Southwestern Medical Center, TX, USA
| | - Chi Le
- School of Medicine, Vanderbilt University, Tennessee, USA
| | - Efosa Ohonba
- Department of Health, North West Province, Mahikeng, South Africa
| | - Emmanuel Adeyemo
- School of Medicine, University of Texas Southwestern Medical Center, TX, USA
| | - Kapil Narain
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Berea, South Africa
| | | | - Umaru Barrie
- School of Medicine, University of Texas Southwestern Medical Center, TX, USA
| | - Dawin Sichimba
- Michael Chilufya Sata School of Medicine, Copperbelt University, Kitwe, Zambia
| | | | - Lilian Mwende Kitonga
- College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya
| | | | | | | | - Ola Rominiyi
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| |
Collapse
|
11
|
Dada OE, Ooi SZY, Bukenya GW, Kenfack YJ, Le C, Ohonba E, Adeyemo E, Narain K, Awad AK, Barrie U, Sichimba D, Ogunfolaji O, Kitonga LM, Oriaku AJ, Bamimore MA, Okor DE, Rominiyi O. Evaluating the Impact of Neurosurgical Rotation Experience in Africa on the Interest and Perception of Medical Students Towards a Career in Neurosurgery: A Continental, Multi-Centre, Cross-Sectional Study. Front Surg 2022; 9:766325. [PMID: 35223975 PMCID: PMC8866575 DOI: 10.3389/fsurg.2022.766325] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Africa has the second highest neurosurgical workforce deficit globally and many medical students in Africa lack exposure to the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students toward a career in neurosurgery. Study Design Cross-sectional study. Methods A Google form e-survey was disseminated to African clinical medical students between February 21st and March 20th, 2021. Data on exposure and length of neurosurgical rotation and perception of, and interest in, neurosurgery were collected. Data was analyzed using descriptive statistics and adjusted logistic regression modeling. Results Data was received from 539 students in 30 African countries (30/54, 55.6%). The majority of participants were male and were from Kenya, Nigeria and South Africa. Most students had undertaken a formal neurosurgery rotation, of which the majority reported a rotation length of 4 weeks or less. Students who had more than 4 weeks of neurosurgical exposure were more likely to express a career interest in neurosurgery than those without [odds ratio (OR) = 1.75, p < 0.04] and men were more likely to express interest in a neurosurgical career compared to women (OR = 3.22, p < 0.001), after adjusting for other factors. Conclusion Neurosurgical exposure is a key determinant in shaping the perception and interest of medical students toward a career in neurosurgery. Our findings support the need: i) for a continent-wide, standardized curriculum guide to neurosurgical rotations and ii) to advocate for gender inclusivity in education and policy-making efforts across the African continent.
Collapse
Affiliation(s)
- Olaoluwa Ezekiel Dada
- College of Medicine, University of Ibadan, Ibadan, Nigeria
- *Correspondence: Olaoluwa Ezekiel Dada
| | | | | | | | - Chi Le
- Vanderbilt School of Medicine, Nashville, TN, United States
| | - Efosa Ohonba
- Department of Neurosurgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Emmanuel Adeyemo
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kapil Narain
- Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ahmed K. Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Umaru Barrie
- University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Dawin Sichimba
- Michael Chilufya Sata School of Medicine, Copperbelt University, Kitwe, Zambia
| | | | - Lilian Mwende Kitonga
- College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya
| | | | - Michael A. Bamimore
- School of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, United States
| | | | - Ola Rominiyi
- Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
12
|
Kanmounye US, Zolo Y, Nguembu S, Tétinou F, Sebopelo LA, Endalle G, Sichimba D, Takoukam R, Ghomsi N, Jumbam DT. Training the Next Generation of Academic Global Neurosurgeons: Experience of the Association of Future African Neurosurgeons. Front Surg 2021; 8:631912. [PMID: 34124130 PMCID: PMC8193051 DOI: 10.3389/fsurg.2021.631912] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Although the past decade has seen a substantial increase in African neurosurgeons' academic productivity, productivity remains low compared to their colleagues from other regions. Aspiring neurosurgeons can contribute to the academic neurosurgery workforce by taking care of less technical and time-consuming research tasks. Fortunately, global neurosurgery institutions have also made efforts to increase research exposure and scholarly output in academic global neurosurgery. The Association of Future African Neurosurgeons (AFAN) created a research incubator for aspiring academic global neurosurgeons in Africa to provide enrollees with mentorship, skills, and experience. This study assesses and reports the activities and results of the research incubator. Methods: Aspiring academic global neurosurgeons were enrolled in the AFAN Research Incubator Program (ARIP), whose primary objective was to provide enrollees with foundational skills in all aspects of the research cycle. ARIP enrollees participated in didactic and practical activities with the aim of publishing ≥1 article and presenting ≥1 abstracts at international conferences in one year. Results: Fifteen AFAN members aged 25.0 ± 3.0 years enrolled in ARIP: 7 (46.7%) medical students, 4 (26.7%) general practitioners, and 4 (26.7%) residents. Eleven (73.3%) were male, 6 (40.0%) were from Cameroon and 6 (40.0%) had no previous research experience. Two (13.3%) enrollees dropped out. ARIP enrollees published a total of 28 articles, and enrollees published a median of 1.0 (IQR = 2) first-author articles on neurosurgical system strengthening. Additionally, ARIP enrollees presented 20 abstracts with a median of one abstract (IQR = 3.0). Conclusion: South-South research collaborations like ARIP can contribute to improving global neurosurgery research capacity and output. These collaborations can set up the foundations for robust research in low- and middle-income countries.
Collapse
Affiliation(s)
| | - Yvan Zolo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Stéphane Nguembu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Faculty of Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
| | - Francklin Tétinou
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Faculty of Medicine, Higher Institute of Health Sciences, Université des Montagnes, Bangangté, Cameroon
| | - Lorraine Arabang Sebopelo
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Geneviève Endalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Dawin Sichimba
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,School of Medicine, Copperbelt University, Ndola, Zambia
| | - Régis Takoukam
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Department of Neurosurgery, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire
| | - Nathalie Ghomsi
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Department of Neurosurgery, Felix-Houphouet Boigny University, Abidjan, Côte d'Ivoire
| | - Desmond T Jumbam
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon.,Operation Smile Ghana, Accra, Ghana
| |
Collapse
|
13
|
State of Neurosurgical Education in Africa: A Narrative Review. World Neurosurg 2021; 151:172-181. [PMID: 34058355 DOI: 10.1016/j.wneu.2021.05.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is no comprehensive report of neurosurgery postgraduate education in Africa. This narrative review aimed to map out the landscape of neurosurgery training in Africa and highlight similarities and differences in training. METHODS The keywords "neurosurgery," "education," and "Africa" were searched on PubMed and Google Scholar from inception to January 17, 2021. Next, a complementary hand search was conducted on Google using the keywords "neurosurgery," "residency," and the individual African countries in English and official languages. The relevant data were extracted and compiled into a narrative review. RESULTS A total of 76 African training programs that recruit more than 168 trainees each year were identified. Less than half (40.7%, n = 22) of African countries have at least 1 neurosurgery training program. Egypt (n = 15), Algeria (n = 14), and Nigeria (n = 10) have the highest number of training programs, whereas Algeria (0.33), Egypt (0.15), and Libya (0.15) have the highest number of training programs per 1 million inhabitants. The College of Surgeons of East, Central, and Southern Africa has 16 programs in 8 countries, whereas the West African College of Surgeons has 17 accredited programs in 3 countries. The duration of training varies between 4 and 8 years. There is limited information available in the public domain and academic literature about subspecialty fellowships in Africa. CONCLUSIONS This review provides prospective applicants and African and global neurosurgery stakeholders with information to advocate for increased investment in African neurosurgery training programs.
Collapse
|