Simulation training for neurosurgical residents: Need versus reality in Indian Scenario

Sir,

Neurosurgical training is provided at 156 training centers across India[[1]],[[2]] and most of the neurosurgical training programs are based on the traditional apprenticeship model. Changing health-care scenarios, for example, high patient satisfaction demands, cost constraints, ethical issues of practicing on patients, and intolerant and hostile attitude of our society toward surgical mis-happenings in the past two decades have reduced learning opportunities of neurosurgical residents.[[3]],[[4]] Some centers have started to follow outcome-based reimbursements and reporting surgeon specific outcome data. In many instances, these factors practically lead to qualified faculty members performing the larger part of procedures themselves and thus reducing the required hands-on experience for resident trainees. To add to this list, there has been a disproportionate increase in the number of neurosurgical seats, without regard to actual training opportunities.[[5]] As most of the neurosurgery training programs in India follow the traditional apprenticeship model only, an unplanned increase in the number of residents is decreasing their surgical exposure. Thus, the need of better training is obvious for producing competent neurosurgeons. Laboratory training/simulation is an avenue that can augment the training prospects of neurosurgical trainees and has the capability to shorten the arduous learning curve of neurosurgery. It can provide uniformity in neurosurgical education and is a good tool of assessment also.[[6]],[[7]],[[8]] We made telephonic inquiries to faculty members/alumni of major neurosurgical training centers across various Indian states about the availability of simulation facilities and whether they are being utilized for resident training or not. Institute websites were also searched for these details. We have discussed the present status of simulation facilities for neurosurgical postgraduate students in India and shared our views on the challenges as well as possible solutions for the inclusion of laboratory training into the training curriculum. We have also mentioned our experience of starting simulation training in the form of cadaver dissection.

Current Situation in India

In India, there are two types of programs for a medicine graduate who aspires to be a neurosurgeon, namely Magister Chirurgiae/Master of Chirurgiae (Mch) and Diplomate of National Board (DNB). The course duration is 3 years for a candidate who joins the program after completing general surgery residency and 6 years for those who join directly after finishing graduation (MBBS). Currently, there are about 156 centers in India where there is a neurosurgical residency program (88 providing Mch training + 68 providing DNB training).[[1]],[[2]] Mch training centers are largely in government-funded medical colleges, while most of the DNB programs are run by private hospitals. As compared to a large number of training centers, only a few utilize simulation regularly for their neurosurgical trainees. [[Table 1]] mentions a list of neurosurgical training centers with availability of simulation facilities in India. {Table 1}

Table 1: Neurosurgical training centers with the availability of simulation facilities in India

The Neurosurgery Education and Training School (NETS) at All India Institute of Medical Sciences (AIIMS), New Delhi, is a nonprofit-based education and skills training platform established with Indo-German and medico-technological collaboration with the Indian Institute of Technology, Delhi, India. This is probably the only one of a kind facility dedicated to neurosurgery in India, which offers well-structured modules for both trainee as well as practicing neurosurgeons through its multiple cadaveric as well as computer and noncomputer based simulation programs.[[9]]

Neta Ji Subhash Chander Bose (NSCB) Medical College, Jabalpur, utilizes an anatomy dissection hall for their neuroendoscopy-training program organized twice a year and they have a small departmental laboratory also. Himalayan Institute, Dehradun, Ramaiah Institute, Bengaluru, and DY Patil Institute, Kolhapur, have good simulation (cadaveric dissection) labs. Although these laboratories use well-structured dissection programs as a part of training workshops, most of the participants are practicing neurosurgeons and information about regular use of dedicated resident training modules for their own postgraduates of neurosurgery is lacking.

[[Table 2]] provides a list of simulation workshops organized on a regular basis. Although these meetings are open to residents and offer discounted course fees for them, the majority of participants are qualified neurosurgeons in their early career.{Table 2}

Table 2: List of regular simulation workshops related to neurosurgery in India

The 1st day of annual conferences of two professional neurosurgical societies of India, namely neurological Society of India (NSI) in collaboration with Congress of Neurological Surgeons, USA, and Neurological Surgeons Society of India (NSSI), is dedicated to various simulation workshops for residents as a fixed event. However, these two events are usually held only once a year and the number of residents that can take part is limited. CEMAST, Mumbai, is a nonprofit organization run by surgeons with grants from Karl Stroz, Germany, which caters to minimal access surgical training of 17 specialties including neurosurgery and skull base surgery. It also runs multiple workshops over year.[[10]]

Hence, it is obvious that simulation facilities that are dedicated for residents during their training period and available round the year at their disposal are very few as compared to large number of neurosurgical trainees trained every year.

Financial support and sponsorship

Prof Radhey Shyam Mittal is currently serving as president of Neurological Surgeons Society of India.

Dr Chandershker E. Deopujari is co- chairman WFNS neuroendoscopy committee, memeber educational committee, Neurological Society of India and is associated with CEMAST.

However, there are no financial disclosures to be made.

Publikationsverlauf

Eingereicht: 09. Oktober 2020

Angenommen: 17. Dezember 2020

Artikel online veröffentlicht:
16. August 2022

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