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Table of Contents    
REPLY TO LETTER TO EDITOR
Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 950-951

Quality of Neurosurgery Training in India when Compared to UK- Are We There Yet?


1 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
3 Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication26-Aug-2020

Correspondence Address:
Dr. Shashwat Mishra
Assistant Professor, Department of Neurosurgery, Neurosurgery Office, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.293439

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How to cite this article:
Garg K, Deora H, Mishra S, Tripathi M, Sadashiva N, Chandra SP, Kale SS. Quality of Neurosurgery Training in India when Compared to UK- Are We There Yet?. Neurol India 2020;68:950-1

How to cite this URL:
Garg K, Deora H, Mishra S, Tripathi M, Sadashiva N, Chandra SP, Kale SS. Quality of Neurosurgery Training in India when Compared to UK- Are We There Yet?. Neurol India [serial online] 2020 [cited 2020 Oct 25];68:950-1. Available from: https://www.neurologyindia.com/text.asp?2020/68/4/950/293439




Sir,

We are grateful to Hegdeet al.[1] for their critical reading of our article and the insights they have provided based upon their comparative experiences of neurosurgical training in India and the United Kingdom. We acknowledge that ours[2] might be the first of its kind article in interrogating the neurosurgical training in India from a trainee's perspective and sincerely hope that it may provide valid inputs for improving the neurosurgical training in India. As mentioned by the authors, neurosurgery in India is relatively new but has been making rapid strides. The history of neurosurgery in United Kingdom is substantially longer than India and peppered with some brilliant and path-breaking achievements.[3],[4] While India was battling famines and colonial exploitation, Sir William Macewen had performed the first surgery for removal of brain tumour in 1879.[4] It cannot be denied that the considerably longer experience of UK in training residents can be instructive for India. However, local conditions, geographical expanse of India and economic limitations impose restrictions on the degree to which we can emulate the UK model, though it will be well worth striving for. Important similarities between Indian and UK pattern of training include availability of dual opportunities for entry into neurosurgical residency.

Some conspicuous differences need to be mentioned. The Graduate Medical Council of UK rigorously monitors the quality of residency training based on pre-determined metrics to ensure uniformity of training experience across the country. The number of residency spots available per program is tightly controlled and linked to the available training opportunities. Periodic evaluation of training programs is implemented to maintain standards. These measures can be readily implemented in India but would require scrupulous record maintenance, transparency, commitment and co-operation from various institutions offering residency training.

The authors have highlighted the importance of surgical expertise, which one acquires during residency period. They have raised concerns about the fact that only 55% of the respondents felt that operative training was good or excellent, while only 42% felt that they were with adequate hands-on exposure to neurosurgical cases. They further stated that this data belongs to the best neurosurgical training centers in India and the condition might be worse in other training programs. We agree with the authors concern and have highlighted the same in our article.[2] Here we would like to emphasize that these figures are regarding the surgical expertise in all areas of the neurosurgery. The exposure in areas like trauma and spine surgery is better as compared to other sub-specialties, especially in centers that consider trauma a part of neurosurgery. These two sub-specialties account for about 80% of the neurosurgical practice in most of the neurosurgery centers.

The authors have suggested simulation workshops, better surgical exposure, logbook maintenance, and better surgical oversight to ensure acquisition of surgical skills to a satisfactory degree. It is encouraging to note that cadaveric workshops and simulation labs are becoming popular in India, but there is a need to mandatorily include them in training programs. We agree with the author that “50 index cases” where surgical proficiency is expected towards the completion of the training program need to be identified in Indian context. Traditionally, the Indian system of exit examinations have emphasized clinical approach and tested a candidate's operative skills perfunctorily. This probably needs to change, and a method needs to be evolved for more objective and focussed examination of surgical skills. The E-log book[1] is an eminently implementable suggestion from the authors, which would go a long way in permitting a comparative evaluation of surgical training across institutions.

It must also be stated that the organization of training and work schedule of a typical UK neurosurgical resident is starkly different from his/her Indian counterpart.[5] The residency working hours in UK are being steadily revised downwards with 48-56hrs of work per week becoming the norm. Comparatively, more than 50% of our residents reported working in excess of 80hr/week.[5] Due to the scarcity of trained ancillary staff, a significant portion of the resident's time in India may be spent on logistical tasks of poor educative value. This along with other factors like lack of funds, infrastructure, proper training programs and brain drain of quality neurosurgeons, as the author mentions, are important areas of improvement. The neurosurgical community in India should certainly draw inspiration from the training programs of developed countries.[6] However, the future direction of neurosurgical training in India must take into account our own strengths and limitations.

In the words of the author's quoted neurosurgeon:

“If we recognize our talents and use them appropriately, and choose a field that uses those talents, we will rise to the top of our field.”— Benjamin Carson

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hegde A, Bhattathiri P. Post graduate Training in Neurosurgery UK Perspective. Neurol India 2020;68:947-9.  Back to cited text no. 1
  [Full text]  
2.
Garg K, Deora H, Mishra S, Tripathi M, Sadashiva N, Chandra PS, et al. How is neurosurgical residency in India? Results of an anonymized national survey of residents. Neurol India 2019;67:777-82.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Preul MC. History of brain tumor surgery. Neurosurg Focus 2005;18:1-1.  Back to cited text no. 3
    
4.
Kirkpatrick, Douglas B. The first primary brain-tumor operation. J Neurosurg 1984;61:809-13.  Back to cited text no. 4
    
5.
What is the European Working time directive? Available on: https://www.bma.org.uk/advice/employment/working-hours/ewtd. [Last accessed on 2019 Oct 02].  Back to cited text no. 5
    
6.
Xu T, Evins AI, Lin N, Chang J, Hu G, Hou L, et al. Neurosurgical Postgraduate Training in China: Moving Toward A National Training Standard. World Neurosurgery 2016;96:410-416.  Back to cited text no. 6
    




 

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