title: Barriers to Neurosurgical Training in Sub-Saharan Africa: The Need for a Phased Approach to Global Surgery Efforts to Improve Neurosurgical Care.
abstract: BACKGROUND
  Neurosurgery in low-income countries is faced with multiple challenges. Although the most common challenges include infrastructure and physical resource deficits, an underemphasized barrier relates to the methods and components of surgical training. The role of important aspects, including didactic surgical training, surgical decision-making, workshops, conferences, and assessment methods, has not been duly studied. Knowledge of these issues is a crucial step to move closer to strengthening surgical capacity in low-income countries.
  
  
  METHODS
  We designed an online survey to assess self-perceived and objectively measured barriers to neurosurgical training in various Sub-Saharan African countries. Key outcomes included perception toward adequacy of neurosurgery training and barriers to neurosurgical training at each individual site.
  
  
  RESULTS
  Only 37% of responders felt that their training program adequately prepared them for handling incoming neurosurgical cases. Top perceived limitations of neurosurgery training included lack of physical resources (25% of all responses), lack of practical workshops (22%), lack of program structure (18%), and lack of topic-specific lectures (10%).
  
  
  CONCLUSIONS
  Our results show that most responders believe their training program is inadequate and are interested in improving it through international collaborations. This implies that activities directed at strengthening surgical capacity must address this important necessity. One important strategy is the use of online educational tools. In consideration of the observed limitations in care, resources, and training, we recommend a phased approach to neurosurgical growth in low-income settings.
authors: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Elie
authors: E
authors: Sader
authors: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Philip
authors: P
authors: Yee
authors: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada. Electronic address: mojgan.hodaie@uhn.ca.
authors: Mojgan
authors: M
authors: Hodaie
mesh_terms: D017954:Africa South of the Sahara; D014943:Global Health / Q000592:standards / Q000639:trends*; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000639:trends*; D000069471:Neurosurgeons / Q000592:standards / Q000639:trends*; D009493:Neurosurgery / Q000193:education / Q000592:standards / Q000639:trends*; D019635:Neurosurgical Procedures / Q000193:education / Q000592:standards / Q000639:trends; D005791:Patient Care / Q000592:standards* / Q000639:trends; D011795:Surveys and Questionnaires
keywords: Africa; International education; Neurosurgical education; Online education; Survey