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. 2024 Feb 24:22:100346.
doi: 10.1016/j.wnsx.2024.100346. eCollection 2024 Apr.

Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings

Muhammad Shakir  1 , Hammad Atif Irshad  2 , Aly Hamza Khowaja  2 , Ahmed Altaf  1 , Syed Ather Enam  1
Affiliations

Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings

Muhammad Shakir et al. World Neurosurg X. .

Abstract

Background: Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan.

Methods: A nationwide survey was conducted, covering 22 CPSP-accredited neurosurgery training programs in Pakistan. Convenience sampling was utilized with a pilot tested questionnaire and responses were analyzed using STATA 15.

Results: The response rate was 98% (120/122) with 70.8% male and mean age of 30.4 ± 4.1 years. Training programs included teaching courses (79%) and journal club (66%); however, there was a lack of cadaver workshops (14%) and cranial model-based stimulation (22%). 67% of trainees lacked publications in indexed journals. 69% worked 50-100 h weekly, with 62% experiencing burnout due to workload and hours and a third reporting poor work-life balance. Trainees dedicated more to operating rooms (37%, 10-24 h/week) and clinics (34%, 24-48 h/week) compared to study (42%, <5 h/week) and research (64%, <5 h/week). Gender equality was rated poorly by 50%. Disparities emerged in subspecialty exposure, with over half of trainees lacking exposure to deep brain stimulation (67%), and epilepsy (75%). 52.5% of the training institutes did not offer fellowships and 64.1% of trainees planned to pursue fellowships abroad.

Conclusions: Steps need to be taken to improve working hours, gender equity, and increase simulation courses, diversify subspecialty exposure, and promote research initiatives.

Keywords: Developing Country; Neurosurgery; Residency; Surgical training.

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Conflict of interest statement

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Figures

Fig. 1
Fig. 1
A) Distribution of responses by gender as a percentage. B) Regional distribution of responses across Pakistan (%). C) Distribution of responses based on institutional sector (%). D) Responses categorized by year of training. Postgraduate year (PGY).
Fig. 2
Fig. 2
Surgical exposure of trainees (A) Based on number of cases divided between supervised and unsupervised and (B) Based on subspeciality.
Fig. 3
Fig. 3
Research publications of respondents divided between indexing.
Fig. 4
Fig. 4
Graphs showing time allotment to various activities during training.
Fig. 5
Fig. 5
Top- Likert Scale responses to barriers in training. Bottom- Suggested improvements by trainees.
See this image and copyright information in PMC

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References

    1. James C.D. Sir William Macewen. Proc R Soc Med. 1974;67(4):237–242. - PMC - PubMed
    1. Wang X. [History of world neurosurgery] Zhonghua Yi Shi Za Zhi. 2017;47(3):160–164. doi: 10.3760/cma.j.issn.0255-7053.2017.03.006. - DOI - PubMed
    1. Current health expenditure (% of GDP) - Pakistan | Data. Accessed September 8, 2023. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?locations=PK.
    1. Kato Y., Liew B.S., Sufianov A.A., et al. Review of global neurosurgery education: horizon of neurosurgery in the developing countries. Chinese neurosurgical journal. 2020;6(3):178–190. - PMC - PubMed
    1. Mukhopadhyay S., Punchak M., Rattani A., et al. The global neurosurgical workforce: a mixed-methods assessment of density and growth. J Neurosurg. 2019;130(4):1142–1148. doi: 10.3171/2018.10.JNS171723. - DOI - PubMed

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