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| CORRESPONDENCE |
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| Year : 2015 | Volume
: 63
| Issue : 6 | Page : 1003-1004 |
Neurosurgical teaching in the present context
Vengalathur Ganesan Ramesh
Department of Neurosurgery, Chettinad Hospital and Research Institute, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu, India
| Date of Web Publication | 20-Nov-2015 |
Correspondence Address:
Vengalathur Ganesan Ramesh
Department of Neurosurgery, Chettinad Hospital and Research Institute, Chettinad Health City, Kelambakkam, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.170115
How to cite this article:
Ramesh VG. Neurosurgical teaching in the present context. Neurol India 2015;63:1003-4 |
Sir,
Neurosurgical teaching and training in the present day requires some streamlining to maintain quality. This article deals with the present challenges and possible solutions, with a brief insight into the past and the future. Training and teaching in Neurosurgery, which was akin to Gurukula, wherein the trainee almost lived with the mentor and worked with him closely to learn the art and the science of Neurosurgery, has undergone change. The change in the perceptions and the attitude of both the trainees and the trainers is responsible for this. The advances in diagnosis and surgical techniques with more emphasis on minimal-access surgery require some changes in the teaching and training methodology.[1] The following are a few thoughts on challenges in the present-day neurosurgical teaching, with a few insights into the past and the future.
| » Neurosurgical Training in the Past | |  |
The teaching and training in the past was tough, as the specialty of Neurosurgery was in its infancy and was just evolving. The centers for neurosurgical training were also few and far from each other. The tough training and high morbidity and mortality in Neurosurgery discouraged many from taking up this field. The training included developing a strong grounding in Clinical Neurology for establishing the diagnosis and learning difficult diagnostic procedures such as cerebral angiography, myelography, air and contrast ventriculography, etc., which by themselves led to morbidity and mortality. Surgical training included large and tedious exposures; dealing with the bulging brain in many situations; and hemostasis, which was difficult in those days (with monopolar cautery and gelatin sponge). The postoperative care was also difficult, which required close clinical monitoring and manual vital sign monitoring. Hence, the focus of training was more on clinical and radiological aspects that focused on the diagnosis and on planning surgical exposures for access to different parts the brain and the spinal cord. The examination and evaluation systems were also along similar lines—with a lot of emphasis on Clinical Neurology and Neuroradiology. The candidates who were successful in the first attempt at the exit examination were also very few. However, the tough training and examination systems developed the mental and physical stamina necessary for a neurosurgeon. Owing to the close proximity of the teacher and the trainees in the teaching departments, there was a close bonding between them.
| » Neurosurgical Training in the Present | | |
The present day neurosurgical training is in a flux. The problems have been highlighted in previous articles by the author.[2],[3] The numbers of neurosurgical training centers have multiplied manifolds; the numbers of neurosurgical trainees have also increased exponentially. This has been due to the increasing popularity of the specialty of Neurosurgery. The diagnosis of intracranial and spinal cord lesions has become easy and precise. The surgical techniques have also improved owing to the operating microscope, minimal-access surgical techniques, improved hemostatic techniques, and improved neuroanesthesia and monitoring devices. Hence, the emphasis seems to be shifting from clinical and radiological diagnostic skills to the development of surgical skills, especially microsurgical and minimal-access surgical techniques. These have added problems to neurosurgical training: (1) The number of neurosurgical trainees is in unmanageable proportions in many teaching centers, which has led to reduced personal attention to the training of individual trainees; (2) the facilities available in various centers and the quality of training are also variable, which has lead to a lot of disparity in the quality of trainees emerging from various centers; (3) the teaching curriculum and academic programs are also variable in different centers in their frequency, quality, as well as content; (4) the examination and evaluation systems are also variable in different places; (5) the flair for teaching and training neurosurgeons is also on the wane among the teachers, owing to various reasons; and, (6) the close bonding between the trainers and the trainees seems to be deficient in the present day.
But what are the remedies? Although there are no simple or short-cut solutions, a few suggestions may be considered: (1) Have a cap on the number of trainees at a center. The maximum number should be six, irrespective of the caseload or the number of faculty members working at the center. (2) There should be a strict quality control over the training centers, with established criteria for minimum facilities required for training, caseload, faculty, and practical surgical exposure under supervision. (3) There should be minimum mandatory teaching activities at the centers, including clinical teaching sessions, preoperative discussions, radiology and pathology sessions, journal clubs, basic science lectures, symposia, etc. (4) The examination and evaluation system should be uniform, strict, unbiased, and objective. Clinical, radiological, and surgical aspects should be given equal importance in the examination and evaluation. (5) The field of neurosurgical teaching should be encouraged: Creation of a specialty of "Academic Neurosurgery" with dedicated teachers; suitable increase in the remuneration of teachers; a structured training program for aspiring young teachers ("training the trainers") —all these may go a long way in improving things. (6) There should be a close interaction between the trainees and the trainers—each of the trainees may be allotted a mentor who will closely interact and monitor the activities of the trainee during the entire training period. This may be especially needed in centers with a large number of trainees.
| » Future Directions in Neurosurgical Training | | |
In future, neuroendoscopic training, endovascular neurosurgical training, and training in other minimal-access techniques will form an integral part of the basic neurosurgical training curriculum. The use of computer-based simulation (virtual reality surgery) will be required for training in basic and complex neurosurgical procedures. Telemedicine is also likely to play an important role in training. As the emphasis is likely to be more on surgical skills, the examination and evaluation systems will also include detailed examination in practical neurosurgical procedures. The present neurosurgical training centers shall anticipate these and gear up suitably for the future. There must be a central monitoring body, to closely monitor the requirement of neurosurgical manpower and neurosurgical centers in the country and to periodically offer advise regarding the intake of neurosurgical trainees, so that the problem of unemployment and underemployment among the neurosurgeons is mitigated.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | | |
| 1. | Tandon PN. Neurosurgical Education: Some thoughts. Neurol India 2015;63:464-7.  [ PUBMED]  |
| 2. | Ramesh VG. Neurosurgical training in India at the crossroads? Neurol India 2004;52:271-2. [ PUBMED] |
| 3. | Ramesh VG. Whither neurosurgical teaching? Neurol India 2006;54:317-8. [ PUBMED] |
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