The Need for Improved Recruitment to Neurosurgery Training: A Systematic Review of Enrollment Strategies

Abstract

Neurosurgery is one of the cornerstones corresponding to a large scope of clinical pathologies and is a highly-regarded surgical specialty. However, there has been a decline in recruits into the neurosurgical residency due to many factors derailing the interest of medical students with an ambition to become neurosurgeons. Some of these issues encompass little or lack of early exposure to neurosurgery, lack of quality mentorship programs, and institutional curriculum entailing prolonged periods of training and study in neurosurgery. Therefore, this systematic review and meta-analysis aim to establish some strategic methodologies for increasing the recruitment to neurological surgery. Neurosurgery is an interestingly exciting specialty that integrates cutting-edge technology allowing for diversified subspecialization with an exceptional degree of variety. Nevertheless, several factors such as the duration of the required training, the kind of lifestyle, lack of early exposure to neurosurgery, and lack of mentors to a vast of medical students across the globe have curtailed the recruitment to neurological surgery. Despite an increased number of female representations in medical surgery, there has been a reported increase in students matching into neurosurgery, although the number is relatively below the expectation due to the factors highlighted earlier. As a result, many studies and surveys have been conducted to identify ways of improving neurosurgical recruitment. Five electronic databases, including PubMed, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, MEDLINE, and Cochrane Library, were searched to provide pertinent information to the topic of study in strict compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. Meta-analysis was then conducted on the included studies to determine their correlations based on the individual outcomes of each study. A total of 2,134 search results were obtained, screened, and reviewed against the exclusion and inclusion criteria to remain with 12 included studies detailing improving the recruitment to neurosurgical residency. The 12 studies were retrieved for their study characteristics based on the PICO (predetermined patient, intervention, control, and outcome) standards. Most of the studies were surveys (n = 8), retrospective and prospective studies (n = 2), and pilot and multifocal studies making up for the rest (n = 2). Several neurosurgery aspects need consideration to improve the recruitment of medical students to neurosurgical fields. Medical institutions, specialists, and other stakeholders should consider reconstructing the neurosurgical curriculum to ease the prolonged study time as well as to create and encourage structural programs aimed at acquainting medical students in neurosurgery and involving the students in conducting other research projects. In addition, mentorship programs and early exposure of medical students to neurological surgery play a key role in influencing the medical students' interest in choosing neurosurgical career paths.

Keywords: education; enrollment; neurology; neurosurgery; surgery.

Figure 1. PRISMA table showing the flowchart diagram on the literature search and the process employed in search of information

This figure summarizes the search strategy; the electronic databases explore the number of studies obtained from each one of them in search of pertinent information for this systematic review and meta-analysis. Additionally, the flowchart provides a procedural screening of articles based on inclusion and exclusion criteria.

Figure 2. Risk of bias graph detailing the selection, performance, detection, attrition, reporting, and other bias of the 12 included studies on the improvement of the recruitment process into neurosurgery

The red section implies that the outcomes of the studies can seriously implicate the confidence of the results, which led to ignoring articles of this nature. The green parts indicate low-risk studies, which are less likely to alter the outcomes. Thus, the 12 studies considered were of low risk. The unclear bias provides some doubts about the information that was ignored and excluded from the inclusion in the article.

Figure 3. The summarized risk of bias of the various judgments made on the included studies and the overall interdependence of risks related to individual articles

Figure 4. The forest plot showing the total number of students matching into neurological surgery residency after various interventional strategies of improving recruitment to neurosurgery

Figure 5. The funnel plot for the improvement of recruitment neurosurgery

Figure 6. The forest plot of students who were interested and matched into surgical specialties including neurosurgery after going through various institutional programs

Figure 7. The funnel plot of students who were matched into surgical specialties including neurological surgery after undergoing various institutional programs