Journal – Brain and Spine
Article type – Journal research article – Clinical research
Publication date – Aug – 2022
Authors – Deen L. Garba, Tarig Fadalla, Kwadwo Sarpong, Mazin Suliman, Myron Rolle, Adam Ammar, Haytham Hussein, Kee B. Park
Keywords – high-income countries (HICs), low- and middle-income countries (LMICs), Neurosurgery
Open access – Yes
Speciality – Neurosurgery, Surgical education
World region Global

Language – English
Submitted to the One Surgery Index on September 2, 2022 at 9:58 pm
Abstract:

Introduction
Opportunities for in-country neurosurgical training are severely limited in LMICs, particularly due to rigorous educational requirements and prohibitive upfront costs.

Research question
This study aims to evaluate financial barriers aspiring neurosurgeons face in accessing and completing neurosurgical training, specifically in LMICs, in order to determine the barriers to equitable access to training.

Material and methods
In order to assess the financial costs of accessing and completing neurosurgery residency, an electronic survey was administered to those with the most recent experience with the process: aspiring neurosurgeons, neurosurgical trainees, and recent neurosurgery graduates. We attempted to include a broad representation of World Health Organization (WHO) geographic regions and World Bank income classifications in order to determine differences among regions and countries of different income levels.

Results
Our survey resulted in 198 unique responses (response rate 31.3%), of which 83% (n ​= ​165) were from LMICs. Cost data were reported for 48 individual countries, of which 26.2% were reported to require trainees to pay for their neurosurgical training. Payment amounts varied amongst countries, with multiple countries having costs that surpassed their annual gross national income as defined by the World Bank.

Discussion and conclusions
Opportunities for formal neurosurgical training are severely limited, especially in LMICs. Cost is an important barrier that can not only limit the capacity to train neurosurgeons but can also perpetuate inequitable access to training. Additional investment by governments and other stakeholders can help develop a sufficient workforce and reduce inequality for the next generation of neurosurgeons worldwide.

OSI Number – 21750

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