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Shlobin NA, Ellenbogen Y, Hodaie M, Rosseau G. Education and Training in Global Neurosurgery: Current State and Path Toward a Uniform Curriculum. Neurosurg Clin N Am 2024; 35:429-437. [PMID: 39244315 DOI: 10.1016/j.nec.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Education is a sustainable long-term measure to address the global burden of neurosurgical disease. Neurosurgery residencies in high-income countries are accredited by a regional governing body and incorporate various educational activities. Few opportunities for training may be present in low-income and middle-income countries due to a lack of neurosurgery residency programs, tuition, and health care workforce reductions. Core components of a neurosurgical training curriculum include operative room experience, clinical rounds, managing inpatients, and educational conferences. A gold standard for neurosurgical education is essential for creating comprehensive training experience, though training must be contextually appropriate.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurosurgery, Neurological Institute of New York, New York Presbyterian Hospital - Columbia University Irving Medical Center, 710 West 168th Street, 4th Floor, New York, NY 10032, USA.
| | - Yosef Ellenbogen
- Division of Neurosurgery, Department of Surgery, University of Toronto, Stewart Building 149 College Street, 5th Floor, Toronto, ON M5T 1P5, Canada. https://twitter.com/YosefEllenbogen
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University of Toronto, Stewart Building 149 College Street, 5th Floor, Toronto, ON M5T 1P5, Canada; Division of Brain, Imaging & Behaviour, Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON M5T 0S8, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Cir, Toronto, ON M5S 1A8, Canada. https://twitter.com/mhodaie
| | - Gail Rosseau
- Department of Neurological Surgery, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Avenue, NW, Suite 7-420, Washington, DC 20037, USA; Barrow Global, Barrow Neurological Institute, 2910 N 3rd Avenue, Phoenix, AZ 85013, USA. https://twitter.com/grosseaumd
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Jelmoni AJ, Cannizzaro D, Uralov D, Totis F, Safa A, Zaed I, Fauzi AA, Khan T, Esene IN, Kolias A, Karekezi C, Hutchinson P, Servadei F. Collaborative Initiatives in Neurosurgery Research and Publications Between High-Income and Low/Middle-Income Countries: A Bibliometric Analysis. Neurosurgery 2024; 95:e121-e131. [PMID: 39283118 PMCID: PMC11377094 DOI: 10.1227/neu.0000000000002935] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/01/2024] [Indexed: 09/22/2024] Open
Abstract
Despite the globalization of health information, collaborations between high-income countries (HICs) and low/middle-income countries (LMICs), while present, could still increase. This study builds on previous research highlighting LMIC underrepresentation in neurosurgery literature. We conducted a comprehensive bibliometric analysis using the Scopus database to investigate collaborative neurosurgical research between HIC institutions and those in low-income country (LIC)/LMICs. Articles published between 2018 and 2020 were examined. Articles were categorized into 3 groups: guidelines, conferences, and consensus statements; articles related to training and collaborations; and other articles. We categorized articles and authors by country, role, and specific subtopic. We included 238 reports from 34 neurosurgical journals for analysis. Geographic distribution indicated that India led LIC/LMIC contributions (25.21%). Among HICs, the United States had the highest contribution (47.76%). In collaborative studies, Uganda, Cameroon, Tanzania, Indonesia, and Nigeria made significant contributions. LICs and LMICs accounted for 446 authors, while HICs contributed with 592. India has presented the highest number of authors in significant positions. In HICs, significant positions are recognized in USA articles. When scoring authors' position in collaborative papers, still HICs had a clear prevalence. The highest number of collaborations between HICs and LICs/LMICs has been observed in articles related to training and collaborations. Kenya matched India's contributions in training and collaborations. Global guidelines and consensus papers can enhance patient care, but LMICs' involvement remains limited. Further attention to training and collaboration initiatives is needed. This study emphasizes the importance of promoting collaboration and training between countries with varying resources to advance neurosurgical care globally.
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Affiliation(s)
| | - Delia Cannizzaro
- Neurosurgical Unit, Department of Neurosciences, ASST Ovest Milanese - Legnano Hospital, Legnano, Italy
| | - Daniel Uralov
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesca Totis
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Adrian Safa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of South Switzerland, EOC, Lugano, Switzerland
| | - Asra Al Fauzi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Tariq Khan
- Department of Neurosurgery, North Western General and Research Hospital, Peshawar, Pakistan
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Angelos Kolias
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, University of Rwanda, Kigali, Rwanda
| | - Peter Hutchinson
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
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Lippa L, Cadieux M, Barthélemy EJ, Baticulon RE, Ghotme KA, Shlobin NA, Piquer J, Härtl R, Lafuente J, Uche E, Young PH, Copeland WR, Henderson F, Sims-Williams HP, Garcia RM, Rosseau G, Qureshi MM. Clinical Capacity Building Through Partnerships: Boots on the Ground in Global Neurosurgery. Neurosurgery 2024; 95:728-739. [PMID: 39185894 DOI: 10.1227/neu.0000000000003129] [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: 11/04/2023] [Accepted: 06/29/2024] [Indexed: 08/27/2024] Open
Abstract
Global neurosurgery seeks to provide quality neurosurgical health care worldwide and faces challenges because of historical, socioeconomic, and political factors. To address the shortfall of essential neurosurgical procedures worldwide, dyads between established neurosurgical and developing centers have been established. Concerns have been raised about their effectiveness and ability to sustain capacity development. Successful partnerships involve multiple stakeholders, extended timelines, and twinning programs. This article outlines current initiatives and challenges within the neurosurgical community. This narrative review aims to provide a practical tool for colleagues embarking on clinical partnerships, the Engagements and assets, Capacity, Operative autonomy, Sustainability, and scalability (ECOSystem) of care. To create the ECOSystem of care in global neurosurgery, the authors had multiple online discussions regarding important points in the practical tool. All developed tiers were expanded based on logistics, clinical, and educational aspects. An online search was performed from August to November 2023 to highlight global neurosurgery partnerships and link them to tiers of the ECOSystem. The ECOSystem of care involves 5 tiers: Tiers 0 (foundation), 1 (essential), 2 (complexity), 3 (autonomy), and 4 (final). A nonexhaustive list of 16 neurosurgical partnerships was created and serves as a reference for using the ECOSystem. Personal experiences from the authors through their partnerships were also captured. We propose a tiered approach for capacity building that provides structured guidance for establishing neurosurgical partnerships with the ECOSystem of care. Clinical partnerships in global neurosurgery aim to build autonomy, enabling independent provision of quality healthcare services.
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Affiliation(s)
- Laura Lippa
- Neurosurgery Unit, Department of Neurosciences, ASST Grande Ospedale Metropolitano Niguarda, Milan , Italy
- Sezione di Traumatologia Cranica, Società Italiana di Neurochirurgia (SINCh), Padua , Italy
| | - Magalie Cadieux
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis , Missouri , USA
- Division of Neurosurgery, Muhimbili Orthopaedic Hospital, Dar Es Salaam , Tanzania
- Och Spine at NewYork-Presbyterian/Weill Cornell Medical Center, New York , New York , USA
| | - Ernest J Barthélemy
- Global Neurosurgery Laboratory, Division of Neurosurgery, SUNY Downstate Health Sciences University, Brooklyn , New York , USA
| | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, University of the Philippines Manila, Manila , Philippines
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, School of Medicine, Universidad de La Sabana, Chia , Colombia
- Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota , Colombia
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - José Piquer
- Chair VIU-NED Foundation, Hospital de la Ribera, Alzira , Valencia , Spain
| | - Roger Härtl
- Division of Neurosurgery, Muhimbili Orthopaedic Hospital, Dar Es Salaam , Tanzania
- Och Spine at NewYork-Presbyterian/Weill Cornell Medical Center, New York , New York , USA
| | | | - Enoch Uche
- Division of Neurosurgery, University of Nigeria Teaching Hospital, Enugu , Nigeria
- Division of Neurosurgery, College of Medicine, University of Nigeria Nsukka, Ituku/Ozalla Campus, Enugu , Nigeria
| | - Paul H Young
- Section of Neurosurgery, Department of Surgery, St. Louis University, St. Louis , Missouri , USA
| | | | - Fraser Henderson
- Division of Neurosurgery, Tenwek Hospital, Bomet , Kenya
- Department of Neurosurgery, Loma Linda University, Loma Linda , California , USA
| | | | - Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
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Gupta S, Gomez MG, Johnston JM, Park KB. Global Partnerships in Neurosurgery: Mapping the Need. Neurosurg Clin N Am 2024; 35:489-498. [PMID: 39244321 DOI: 10.1016/j.nec.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
The field of global neurosurgery seeks to improve access to neurosurgery and reduce health disparities worldwide. This process depends on intensive collaboration between partners in high-income and low-to-middle income country (LMIC) settings. Several such collaborations have propelled global neurosurgery forward, and long-standing partnerships in particular have brought subspecialty care and training to new locations. Recently, there have been more reports of collaborations between LMICs themselves. In this narrative study, we summarize the state of collaboration in global neurosurgery and discuss how the field is likely to change moving forward.
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Affiliation(s)
- Saksham Gupta
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Martina Gonzalez Gomez
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James M Johnston
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kee B Park
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Hamzah R, Bunch K, Qureshi M, Park KB, Haglund MM, Dempsey RJ. Partnering with Foundations, Philanthropy, and Universities with Programs Supported by Local Physicians and Eventually Local Physicians Taking Ownership. Neurosurg Clin N Am 2024; 35:465-474. [PMID: 39244318 DOI: 10.1016/j.nec.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
This article provides a thorough analysis of the evolution and current state of global neurosurgery, emphasizing the transformative power of partnerships between various stakeholders to address the stark inequities in neurosurgical care, especially in LMICs. It discusses the transition from reliance on short-term medical missions to the development of sustainable, locally led neurosurgical programs through education, training, and infrastructure development. The article highlights the importance of long-term educational exchanges, innovative digital learning platforms, and strategic collaborations with foundations, philanthropic organizations, and academic institutions to build local capacities, enhance global neurosurgical competency, and promote self-sufficiency in neurosurgical care across different regions.
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Affiliation(s)
- Radzi Hamzah
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA.
| | - Kate Bunch
- Department of Neurological Surgery, University of Wisconsin-Madison, 600 Highland Avenue, K4/8 CSC, Box 8660, Madison, WI 53792, USA
| | - Moody Qureshi
- Department of Neurosurgery, 1st Floor, Aga Khan Hospital, P.O. Box 76553 3rd Parklands Avenue, Nairobi, Kenya
| | - Kee B Park
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Michael M Haglund
- Department of Neurological Surgery, Duke University, 40 Duke Medicine Cir, Durham, NC 27710, USA
| | - Robert J Dempsey
- Department of Neurological Surgery, University of Wisconsin-Madison, 600 Highland Avenue, K4/8 CSC, Box 8660, Madison, WI 53792, USA
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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.
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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
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