Shadows and Lights: Perspectives of Training and Education in Neurosurgery for Undergraduate Students

In-State Retention Rates of Female Neurosurgery Graduates

OBJECTIVE

We sought to determine the rate of retaining female neurosurgery graduates in the same states as their medical education and identify medical school and state characteristics associated with high retention rates.

METHODS

Database from the Centers for Medicare & Medicaid Services was used to extract female physicians indicating "neurosurgery" as their specialty. The top 25 medical schools with the highest number of female neurosurgery graduates were selected. Descriptive analysis was used to determine the retention rate of female neurosurgery graduates. Univariable and multivariable analyses were used to identify medical school and state characteristics associated with high retention rates.

RESULTS

Medical schools with the highest retention rate included the University of California, San Francisco (60%), the University of Alabama (60%), and the University of Pennsylvania (60%). Univariable and multivariable analysis showed the number of female neurosurgery attendings (β = 0.036, 95% confidence interval [CI] = 0.003 to 0.070, P = 0.04 and β = 0.036, CI = 0.001 to 0.071, P = 0.04.) and the healthcare employment rate (β = 0.098, CI = 0.011 to 0.186, P = 0.03 and β = 0.117, CI = 0.021 to 0.212, P = 0.02) to be positively associated with the retention rate of female neurosurgery graduates.

CONCLUSIONS

Retaining female neurosurgery graduates within a state is essential for addressing the physician shortage and gender inequality. To encourage female medical students to practice in the same state, medical schools and states should work collectively to improve the visibility of female neurosurgeons and increase employment opportunities.

Factors Affecting Turkish Medical Students' Pursuit of a Career in Neurosurgery: A Single Center Survey Study

BACKGROUND

Statistics show that over the past 2 decades, even in high-income countries, fewer and fewer students have listed neurosurgery as their top career option. Literature on medical students' pursuit of neurosurgical careers in middle- and low-income countries are scarce. The aim of this research, conducted in Turkey with a middle-income economy, was to contribute insights relevant to medical education and neurosurgery across the world.

METHODS

A survey was conducted with a target sample of fourth-year (167 students), fifth-year (169 students), and sixth-year (140 students) medical students (476 in total) from the Medical School at Istanbul Medeniyet University in Turkey. The response rates of the fourth-, fifth-, and sixth-year students were 62% (104/167), 53% (90/169), and 50% (70/140), respectively (in total, 266, including 147 female and 119 male).

RESULTS

In terms of the genuine intention, only 2.5% of men and 2.7% of women were committed to specializing in neurosurgery. This study further revealed that possible reasons for these students' low motivation to specialize in neurosurgery were their beliefs that in neurosurgery, the physical and psychological demands were high, and the night shifts were intense, meaning they would not have a social life or spare time for their hobbies; that morbidity/mortality were high; and that financial incentives were insufficient, especially in public institutions.

CONCLUSION

Turkish medical students did not rank neurosurgery at the top of their career choices. Possible reasons for this are socioeconomic factors and the inadequate introduction of neurosurgery to medical students.

Impact of medical school experiences on the career choice of neurosurgery: a cross- sectional study from Pakistan

BACKGROUND

Pakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on career choice, but no study has delved into the impact of medical school exposure among Pakistani medical students, especially for the field of neurosurgery. This study aims to evaluate the impact of neurosurgery exposure, mentorship, and interest groups on medical students' decision to pursue neurosurgery.

METHODS

A national cross-sectional survey was conducted in Pakistan, collecting data from medical students, interns, and medical officers over a one-month period. Ethical approval was obtained from the Ethical Review Committee at Aga Khan University, Pakistan. The data was analyzed using SPSS version 26.

RESULTS

Out of 2618 participants, 38.0% were male and 62.0% were female, with an average age of 21.82 years (± 2.65). Among them, only 358 (13.6%) were interested in pursuing neurosurgery as a career, while the remaining 2,260 (86.3%) were not. More females (58.9%) than males (41.1%) expressed interest in pursuing neurosurgery as their intended career. Most medical students interested in pursuing neurosurgery were in the early years of their medical school (1st Year: 19.6%, 2nd Year: 26.0%, 3rd Year: 20.9%). In our study, students from public sector institutions (52.2%) showed more interest in neurosurgery as a career choice compared to those from private sector institutions (44.1%). The main deterrents for choosing neurosurgery were intense training (42.2%), work-life balance (39.9%), limited residency slots (56.7%), medical knowledge (34.1%), and surgical skills (36.6%).

CONCLUSION

This study highlights the need for increased student engagement to inculcate the decision to pursue neurosurgery among medical students in Pakistan. A significant gap is highlighted, with the majority of interested students in early years. Public sector students show higher interest than their private sector counterparts. However, barriers like intense training, limited residency slots, and work-life balance concerns influence career choice. Targeted interventions like mentorship programs are crucial for fostering future neurosurgeons and advancing patient care and research. By addressing the identified disparities in experiences and promoting a supportive educational environment, it is possible to cultivate a future generation of skilled and dedicated neurosurgeons who can contribute to advancements in patient care and research in the field.

Perception of Neurosurgery as a Career Choice Among Early Career Doctors in Pakistan: A Nationwide Cross-Sectional Survey

BACKGROUND

A low neurosurgeon-to-patient ratio persists in many developing nations including Pakistan. We aimed to investigate the perceptions of medical students regarding neurosurgery as a first step toward recognizing this problem and potentially suggesting ways to solve it.

METHODS

A questionnaire was designed comprising 3 sections: 1) demographics, 2) possible challenges and perceptions regarding neurosurgery as a profession, and 3) general perceptions about neurosurgery. Statistical analysis was conducted, and a P value < 0.05 was considered significant.

RESULTS

Of 387 responses received, 44.4% of male respondents and 50.6% of female respondents revealed intent to consider opting for neurosurgery as a profession. Regression analysis revealed inadequate dexterity (P = 0.001) and inability to carry out private practice (P = 0.002) were responsible for increased likelihood of opting out of neurosurgery by medical students.

CONCLUSIONS

This study identified the perceptions that may influence the decision to pursue neurosurgical training among physicians early in their careers. Interventions including availability of day care facilities for children and introduction of curricula to promote neurosurgical knowledge in clinical training are expected to encourage the decision to pursue neurosurgery among medical students in Pakistan.

Factors Affecting the Choice of Neurosurgery as a Future Career: A Cross-Sectional Study

Introduction Selecting a specialty is a very important and stressful decision that students must make, as it will have a lasting impact on their professional lives. Medical students could gain insight into a variety of specialties during their clinical years, especially the work environment in different specialties. Numerous factors can influence this decision, such as work-life balance, lifestyle, and gender differences. The goal of our study is to demonstrate the different factors, both attractive and deterrent, that influence neurosurgery selection as a future specialty among students. Also, we will consider the exposure-related geographical distribution of the neurosurgery field regarding conferences and workshops, as well as the availability of university professors and their impact on the interest of students in the specialty. Methods A cross-sectional study spanning from June 2023 to September 2023 was conducted among students at medical colleges across the Kingdom of Saudi Arabia. All medical students from the second medical year up to the internship were invited to take part in the study. Non-medical students, first-year medical students, and incomplete questionnaires were excluded. Employing a stratified random sampling technique, we ensured diverse representation, eventually gathering data from 1141 participants. Results The study involved a diverse group of 1141 medical students and interns, with an average age of 21.7 years. Among them, 683 (59.9%) were female. Approximately half of the participants, 572 (50.1%), express an interest in pursuing a career in neurosurgery, and a significant portion of respondents find neurosurgery appealing due to its challenging nature (50.9%). On the other hand, stress emerged as the most significant deterrent factor (50.3%). Among educational levels, interns, 39 (28.3%), showed the least interest, while second-year students, 193 (64.8%), exhibited the highest interest (p < 0.001*). The analysis revealed statistically significant gender differences in factors. Specifically, a higher percentage of females found "interested in neuroscience" to be the most attractive factor compared to males (18.2% vs. 15.5%, p < 0.001*). Regarding deterring factors, a greater percentage of males found "risk" as the most deterring factor compared to females (19.2% vs. 17.1%, p = 0.001*). Conclusion We found no significant age variation in the most attractive factors; however, significant gender differences in attractive and deterrent factors were observed. The "risk" associated with neurosurgery was the most deterring factor for students across different cumulative grade point average (CGPA) ranges and for students from the eastern and central areas. Our findings suggest that most factors are consistently attractive or deterring across different educational and clinical levels, emphasizing the stability of these perceptions throughout medical education. We propose innovative educational initiatives with increased faculty participation to implement the curricula with early exposure of students to neurosurgery.

Hands-on neuroendovascular practice for nonselective undergraduate medical students increases interest and aspirations in pursuing neurosurgery as a specialization

Background

The number of medical students aspiring to become neurosurgeons has decreased worldwide, mainly due to poor work-life balance among neurosurgeons; therefore, recruiting students for neurosurgery is essential to ensure the availability and appropriate quality of neurosurgical treatment. This study aimed to evaluate the efficacy of hands-on neuroendovascular practice for nonselective undergraduate medical students to determine whether this increases their interest in neurosurgery and contributes to their aspirations of becoming neurosurgeons.

Methods

Hands-on neuroendovascular practice for mechanical thrombectomy was performed by undergraduate 5th-year medical students during their 2-week clinical rotation in the Department of neurosurgery at our university hospital between April 2021 and March 2023. After the neurosurgery practice, a questionnaire about their understanding of neurosurgery and aspirations for this specialization before and after the practice was anonymously completed by all students.

Results

Overall, 153 students completed the questionnaire. Of these, 140 (91.5 %) showed increased interest in neurosurgery after participating in the hands-on practice. Through this practice, the number of students who considered neurosurgery as their first choice or one of their specialty choices increased from 8 (5.2%) to 12 (7.8%) (P = 0.3534) and from 19 (12.4%) to 52 (34.0%) (P < 0.0001), respectively. Furthermore, the number of students with no aspiration to become neurosurgeons decreased from 95 (62.1%) to 43 (28.1%) (P < 0.0001).

Conclusion

Hands-on neuroendovascular practice for nonselective undergraduate medical students effectively increased their interest in neurosurgery specialization and their desire to become neurosurgeons. Therefore, this practice can help recruit medical students for neurosurgery specialization.

Assessment of the Adequacy of Neurosurgery Teaching Methods among Medical Students in Enugu State, Nigeria

Background

Various educational neurosurgery teaching methods are employed across few Nigerian universities, especially Enugu state.

Aims

To determine the adequacy of current neurosurgery teaching methods, factors influencing eventual choice of neurosurgery amongst final year medical students in Enugu state, Nigeria and suggest improvement methods towards best global standards.

Materials and Methods

This was an online cross-sectional study conducted among final year medical students currently on Neurosurgery rotation in Enugu state, Nigeria using a validated questionnaire. Data was analyzed (inferential and deferential) using SPSS; chi-squares values were calculated. Significance was set at p value <0.05 and measures were put in place to limit bias.

Results

106 students filled and submitted the form with a response rate of 72.60%. Most respondents revealed that their universities had mandatory neurosurgery rotations. Majority affirmed that a general poor learning environment (75%) was the major obstacle to standard teaching. About 49% had interest in specializing in surgery but only 18% have interest in neurosurgery as a future sub-specialty choice. Positively, majority (90.6%) alluded to having qualified teachers, with 43.4% of them advocating for improved training of the teachers. There was a significant correlation between choice of specialty and the students' monthly income (less than N10, 000 had a p: 0.003). Other factors that were positively correlated in eventual choice as their future desired subspecialty include poor exposure to clinical neurosurgery cases (p: 0.020) and little or no exposure of students to neurosurgery research opportunities (p: 0.024).

Conclusion/Recommendations

The current neurosurgical teaching methods in Enugu state are not fully optimal yet. There is a need for some improvement in current learning environment and teaching methods to improve the students' understanding of neurosurgery and eventual increased interest in final choice of neurosurgery as their desired subspecialty.