On June 11, 2020, the World Federation of Neurosurgical Societies (WFNS)’ Global Neurosurgery
Committee (GNC) and Young Neurosurgeons Forum (YNF) discussed the effects of coronavirus
disease 2019 (COVID-19) on training in low- and middle-income countries (LMICs). During
this event, the leadership of the WFNS and stakeholders of global neurosurgery identified
challenges and proposed solutions to the issues faced by trainees during the pandemic.
We recount the problems and action items that were identified during the meeting.
Each year, 23 million patients develop neurosurgical conditions, and 78% of them live
in LMICs.
1
LMICs have <56% of the specialist neurosurgical workforce and require an additional
23,300 neurosurgeons to meet local neurosurgical demands.
1
,
2
Few LMICs have sufficient capacity to make up for the local workforce deficit; thus,
neurosurgeons from all over the world are working to find sustainable solutions.
3
This movement has given birth to the field of global neurosurgery—"an area for study,
research, practice, and advocacy that places a priority on improving health outcomes
and achieving health equity for all people worldwide who are affected by neurosurgical
conditions or need neurosurgical care."
4
To coordinate the efforts of global neurosurgeons, the WFNS has created an ad-hoc
committee: the WFNS GNC.
5
In addition to the difficulties already faced in providing neurosurgical care in LMICs,
the current COVID-19 pandemic has further strained healthcare resources, especially
for those in low-resource settings.
6
To understand the effects of the pandemic on training and propose solutions to the
issues identified, the WFNS GNC and the WFNS YNF co-hosted a webinar. The webinar
was held on June 11, 2020, and titled “COVID-19 & Neurosurgical Training in Low- and
Middle-Income Countries: The Global Neurosurgery Perspective."
The Webinar
The webinar featured: Franco Servadei (WFNS President), Miguel Arraez (WFNS Foundation
Chair), Isabelle Germano (WFNS Education Committee Chair), Robert Dempsey (Foundation
for International Education in Neurological Surgery Chair), Mahmood Qureshi (Continental
Association of African Neurosurgical Societies President), Abdessamad El Ouahabi (WFNS
GNC Co-Chair), William Harkness (Intersurgeon Co-Founder), Ronnie Baticulon (WFNS
YNF), and Jeff Ntalaja (Continental Association of African Neurosurgical Societies
Vice-President). The co-hosts were Kee Park (WFNS GNC Co-Chair) and Ignatius Esene
(WFNS YNF Co-Chair).
The following are key messages from the presentations:
1.
COVID-19 has had a significant effect on medical education and surgical training and
is likely to do so for the foreseeable future owing to restrictions on gatherings,
restrictions to local movement, and the reduction in overseas travel.
2.
We must ensure that our graduates in LMICs are supported with equipment and continuing
education to allow them to establish successful practice within their healthcare system.
3.
Education in neurosurgery is a bidirectional exchange of knowledge, which is essential
for success.
4.
Digital technology is playing an increasing role in education and continuing professional
development, which has been accelerated by the pandemic.
5.
Collaboration is the key to successfully improving education in global neurosurgery.
6.
It is the responsibility of neurosurgeons to lead the process to ensure an adequate
neurosurgical workforce in their respective countries.
More than 500 attendees registered on Zoom, and an additional 200 followed the live
streams on Facebook and YouTube. Additionally, the audience followed and commented
about the webinar on Twitter with the hashtag #GlobalNeuroAndCovid (378,520 impressions
and 120,701 reaches; Figure 1
). Notably, 32.1% of participants were women, from Southeast Asia and Africa (87.5%),
and either neurosurgeons or residents (87.5%; Figure 2
).
Figure 1
Social media analytics of hashtag #GlobalNeuroAndCovid.
Figure 2
Demographic characteristics of webinar attendees regarding coronavirus disease 2019
and neurosurgical training in low- and middle-income countries. WHO, World Health
Organization.
Most (63.2%) had reported a significant change in their training as a result of the
pandemic. The participants reported that the WFNS could help them train better in
the post–COVID-19 era if it sponsored online courses (62%), virtual dissection laboratories
(51.9%), and research collaborations with high-income country institutions (50.9%;
Figure 3
).
Figure 3
Responses to the question “What would be most helpful for neurosurgery training post-COVID
[coronavirus] in low- and middle-income countries for the WFNS [World Federation of
Neurosurgical Societies] to consider? HIC, high-income country; lab, laboratory; LMIC,
low- and middle-income country.
Action Items
Three recommendations surfaced from the discussions:
1.
Harmonization of the present “several randomly organized webinars by various WFNS
committees” to create a coherent and essential curriculum suitable for LMIC trainees
and accepted by national accreditation authorities. In that regard, the WFNS might
consider issuing certificates that could be recognized by local authorities.
2.
Reinforcement of twinning programs with more organized collaborations between high-income
countries and LMICs,
3.
The development and validation of novel educational and training tools such as virtual
meetings, virtual laboratories, and surgical simulation using augmented reality.
Conclusions
Although the current COVID-19 pandemic has had a sudden and negative effect on the
ability to train neurosurgeons, especially in LMICs, the increased use of social media
and virtual platforms (in our case, Zoom) is markedly improving the interactions between
the leadership of the WFNS and neurosurgeons around the globe. The feedback from the
audience will serve as a reliable driver of how the WFNS will respond to the pandemic
vis-a-vis training. The WFNS leadership has been quick to adapt to the pandemic and
has proactively encouraged the use of virtual platforms for its activities. We clearly
see untapped potential in these platforms and look forward to maximizing the potential
for the benefit of all who need neurosurgical care.