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Table of Contents    
EDITORIAL
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1279-1280

The Need for Uniform Residency Training Programs and the challenges during COVID Pandemic for India


Editor, Neurology India, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication19-Dec-2020

Correspondence Address:
Prof. P Sarat Chandra
Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.304084

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How to cite this article:
Chandra P S. The Need for Uniform Residency Training Programs and the challenges during COVID Pandemic for India. Neurol India 2020;68:1279-80

How to cite this URL:
Chandra P S. The Need for Uniform Residency Training Programs and the challenges during COVID Pandemic for India. Neurol India [serial online] 2020 [cited 2021 Jan 24];68:1279-80. Available from: https://www.neurologyindia.com/text.asp?2020/68/6/1279/304084




The year 2020 is now coming to an end. And What a year it has been!

Neurosurgical training programs have never been easy. Not on faculty, neither on residents. Unlike other branches of medicine or even other non-medical fields, one of the greatest challenges have been to provide proper training without compromising the patient care. Training in medicine traditionally has been based on an apprentice model. The onset of COVID pandemic has thrown greater challenges for residency programs.[1],[2]

Creating uniform training for neurosurgery has been a significant challenge for India for both MCh and DNB (diploma) courses. And the reasons are many. Some of them include absence of good facilities, absence of lack of standard operating protocols, lack of proper direction from the central regulatory authorities (e.g., Medical council of India and/or National Medical Council), inability of several small centres to perform all the required procedures are just to mention a few.

The Neurological Society of India also feeling a need for creating such uniform guidelines held a meeting at the All India Institute of Medical Sciences (AIIMS), New Delhi on 15th March, 2014. The meeting was organized by myself along with Prof BS Sharma (as Chairman) and the starting point of discussion was a preliminary document prepared by Prof VG Ramesh in 2013. Several well-known faculties from all over the country attended the meeting which included Prof's VG Ramesh (MMC, Chennei), V Rajshekar (CMC, Vellore), RC Mishra (then secretary of NSI), CS Deopujari (Bombay hospital, Mumbai), Deepak Agarwal (AIIMS, Delhi), Manmohan Singh (AIIMS, Delhi), Sanjay Behari (SGPGI, Lucknow), Daljit Singh (GB Pant, Delhi), Sanjiv Sinha (GB Pant, Delhi), SN Ghosh (Bangur, Kolkata), SN Mathuriya ( PGIMER, Chandigarh), Satnam Chhabra (Ganga Ram, Delhi), and Vivek Tandon (AIIMS, New Delhi). During deliberations, a white paper was created which was published on the website of Neurological Society of India and a period of 4 months was provided for various members of the society to respond. Following incorporations of suggestions, it was then placed on the NSI website [Annexure 1][Additional file 1]. Various aspects of training and residency programs were debated.

Some of the topics included

  1. 3 years vs 6 years program: The committee members felt that both three- and six-year training programs were important. However, since the neurosurgical training program was likely to take more than three years, more centres were recommended to take up the 6-year courses. It was also felt that centres should have an opportunity for the candidates to spend one additional optional year, which would provide the candidate with a better perspective in neurosurgery and also provide the candidate the time before he/she finds a job.
  2. Countries like the US have a residency training program for 84 months with 54 months dedicated to clinical neurosurgery and 12 months as chief resident. It was felt that our system should also aim for an equivalent or a better system.
  3. Some additional recommendations were made on existing regulations [Annexure 1].
  4. Guidelines were also created to provide mandatory and desirable requirements for providing optimal operative exposure for the candidates [Annexure 1].


Among other things discussed included work distribution over various years of residency programs, work hours for residents, rotation to other departments and institutes, academic sessions, examination pattern, training on medico-legal aspects of neurosurgical practice and counselling sessions for residents.

There is also a challenge to introduce affordable programs especially for developing countries without compromising the quality of education.[3] The onset of COVID has placed tremendous challenges. Elective surgeries have been significantly reduced or even stopped in several centers.[4] Now that it is becoming clear that COVID is here to stay at least till we get an effective vaccine, it is important to create strategies to improvise residency programs during this pandemic.[5] Since, most of the protocols are well laid down to be followed during COVID pandemic[6],[7],[8],[9],[10],[11],[12],[13],[14], strategies must be now undertaken to create “COVID” and “COVID free” spaces to allow proper restarting of elective neurosurgery. Telemedicine has played a very important role in closing gap for academics and combined rounds.[15],[16],[17] The main advantages of performing academics online has been of course convenience and the absence of need to have physical spaces. But a major shortcoming is lack of physical interaction, which may have an impact on long term e.g., ins inter personal relationships. I personally feel that while a majority of curricula can be made online, some areas still will require physical interaction (e.g. patient examination). However, telemedicine is a powerful medium and has the potential to create uniform training programs by unifying academic curricula between various centres.

I will conclude this editorial by saying that though we expect this 'change' to normalize again[18], the actual turn of events may be very different. While the vaccine may be expected to reduce the incidence of COVID remarkably, the way we live and interact with each other may change forever. Hence, rather than waiting for things to come back to “status quo”, we should adapt to the circumstances, and create strategies to allow our return to normal functioning as early as possible.



 
  References Top

1.
Aljuboori ZS, Young CC, Srinivasan VM, et al. Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs. World Neurosurg 2020.  Back to cited text no. 1
    
2.
Burks JD, Luther EM, Govindarajan V, Shah AH, Levi AD, Komotar RJ. Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large U.S. Academic Medical Center. World Neurosurg 2020;144:e926-e933.  Back to cited text no. 2
    
3.
Krishna Narayanan MD, Balasubramanian D. An Affordable Neurosurgical Training System for Neurosurgical Residents; The Indian Perspective. Neurol India 2020;68:1418-22.  Back to cited text no. 3
    
4.
Misra BK. Neurosurgery in India during COVID Times. Neurol India 2020;68:972-974.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Deora H, Sadashiva N, Tripathi M, et al. The Aftermath of COVID-19 Lockdown- Why and How Should We Be Ready? Neurol India 2020;68:774-791.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Moorthy RK, Rajshekhar V. Impact of COVID-19 Pandemic on Neurosurgical Practice in India: A Survey on Personal Protective Equipment Usage, Testing, and Perceptions on Disease Transmission. Neurol India 2020;68:1133-1138.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Tripathi M, Deora H, Sadashiva N, Batish A, Mohindra S, Gupta SK. Adaptations in Radiosurgery Practice during COVID Crisis. Neurol India 2020;68:1008-1011.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Verma SK, Dharanipathy S, Suri A, Chandra PS, Kale SS. Video Section-Operative Nuances: Step by Step-Donning and Doffing in Neurosurgical Operating Room. Neurol India 2020;68:796-799.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Gupta T, Singh VP, Balasubramian A, et al. ISNO Position Statement on Treatment Guidance in Neuro-oncology During Pandemics. Neurol India 2020;68:769-773.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Guleria R. The Need to Change and the Necessity to Evolve During the COVID-19 Pandemic. Neurol India 2020;68:726-727.  Back to cited text no. 10
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11.
Panigrahi M, Kakani N, Vooturi S. Impact of SARS-Cov2 on Endoscopic Trans-Nasal Skull Base Surgeries. Neurol India 2020;68:S141-S145.  Back to cited text no. 11
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12.
Quillin JW, Oyesiku NM. Status of Pituitary Surgery During the COVID-19 Pandemic. Neurol India 2020;68:S134-S136.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Gupta P, Muthukumar N, Rajshekhar V, et al. Neurosurgery and Neurology Practices during the Novel COVID-19 Pandemic: A Consensus Statement from India. Neurol India 2020;68:246-254.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Khilnani GC. The COVID-19 Pandemic: Challenges for the Neurosurgeons and Neurologists. Neurol India 2020;68:244-245.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Lahiri D, Mitra S. COVID-19 is accelerating the acceptance of telemedicine in India. J Family Med Prim Care 2020;9:3785-3786.  Back to cited text no. 15
  [Full text]  
16.
Ganapathy K. Telemedicine and Neurological Practice in the COVID-19 Era. Neurol India 2020;68:555-559.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Chandra PS. Telemedicine: The Next Important Health Vertical for Neurosciences In India. Neurol India 2020;68:532-533.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Hegde T. COVID-19: And this shall also pass. Neurol India 2020;68:276-277.  Back to cited text no. 18
[PUBMED]  [Full text]  




 

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