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Table of Contents    
LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 505-506

Postgraduate Training in Neurosurgery in India: The Problems and the Possible Remedies


Department of Neurosurgery, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai, Tamil Nadu, India

Date of Submission08-Sep-2020
Date of Decision14-Jan-2021
Date of Acceptance29-Jan-2021
Date of Web Publication24-Apr-2021

Correspondence Address:
Vengalathur G Ramesh
Department of Neurosurgery, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chennai - 603 103, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.314526

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How to cite this article:
Ramesh VG. Postgraduate Training in Neurosurgery in India: The Problems and the Possible Remedies. Neurol India 2021;69:505-6

How to cite this URL:
Ramesh VG. Postgraduate Training in Neurosurgery in India: The Problems and the Possible Remedies. Neurol India [serial online] 2021 [cited 2021 May 16];69:505-6. Available from: https://www.neurologyindia.com/text.asp?2021/69/2/505/314526




Sir,

I read with interest the letter by Hegde and Bhattathiri, on the Postgraduate training in Neurosurgery.[1] They have very nicely highlighted the neurosurgery training in the UK and have made some welcome suggestions for neurosurgery training in India. It is very difficult to compare the training programs in countries like UK, US, and India. The problems with the neurosurgery training in India are manifold[2]:

  1. The Neurosurgery training in India is only for three years after three years in General Surgery as compared to seven to eight years of Neurosurgery in the US and UK, where general surgery exposure is only for a short period or has been done away with. No other country in the world except India has only three years for Neurosurgery training. Only a couple of centers offer the 6-year training program after MBBS
  2. There is no structured graded training program in India, barring a few centers. There is gross variation in the “syllabus” in various Universities, different exit examination patterns, and evaluation systems
  3. The training facilities in various teaching institutions are grossly different, and exposure to subspecialities is not available in majority of the institutions. The surgical skill training labs are available only in a few centers
  4. There is no proper objective assessment of surgical skill of the trainees either during training or at the end of training in most centers. The logbooks do not have the same importance or weightage as in the other countries and most of the time only a casual perusal of the logbook is done at the time of final viva examination
  5. There is also uncontrolled, unregulated mushrooming of neurosurgery training posts in both teaching hospitals and private hospitals without paying attention to the volume of neurosurgery work for each trainee and the quality of training the trainee will get. Some centers have 50 to 60 neurosurgical trainees at any given time, which is not conducive to graded closely supervised personalized training that is required for neurosurgery
  6. The regular clinical discussions, preoperative discussion, neuroradiology discussions, journal clubs, symposia and seminars, basic science lectures are not uniformly available in all centers
  7. There is no periodic internal assessment (formative assessment) of the trainees in most centers
  8. There is no uniformity in both the structure and standard of exit examination in various centers.


Everyone of us, especially those in charge of neurosurgery training programs, need to think over these. As a neurosurgeon involved in postgraduate neurosurgical training for over 3 decades, I would like to share some of the possible remedies for the various maladies affecting the neurosurgery training in India:

  1. There is a need to promote direct 6-year training program after MBBS.[3] As Prof. Banerji has pointed out, there is no special advantage of having a three year General Surgery training before Neurosurgery training.[3] The post-MS (General Surgery) candidate has to unlearn many things learned during the General Surgery training and relearn things like Basic Neurosciences, Clinical Neurology, in addition to acquiring Neurosurgical skills which have no relation to general surgical techniques, which consume a significant period of the three years. Though it may not be possible to take away the post-MS General Surgery three year training immediately, more centers may be allowed to start the 6-year program with gradual withdrawal of the 3-year program. This process has to be started soon; otherwise, our training programs will get outdated
  2. There needs to be national-level uniform structured graded training throughout India, with the established level of standard minimum facilities in various centers. Some time ago a proposal for uniform training and examination in Neurosurgery has been formulated, but it is yet to make any headway with the authorities.[4],[5] This needs to be pursued further with the Medical Council of India (MCI)/National Medical Commission (NMC)
  3. The training should concentrate on graded training in various neurosurgical skills over the training period, with exposure to at least one or two subspecialitites[6]
  4. The logbook should be given utmost importance. This has to be scrutinized closely by the chairman/head of the training program, so that any lacunae in training can be rectified then and there. Fully certified logbook showing the number of surgeries performed by the trainee under various categories should be evaluated by the examiners at the time of final viva examination. It should be ensured that the candidate has performed the stipulated minimum number of surgeries before taking the final exit examination
  5. More surgical skill training labs need to be developed at the National level with mandatory training of the trainees in the basic skills during their training period.
  6. The conduct of regular clinical discussions, preoperative discussion, neuroradiology discussions, journal clubs, symposia and seminars, basic science lectures should be ensured in various training centers[5]
  7. The number of trainees in each center should be regulated by the case load, faculty, and the availability of closely supervised personalized training of each trainee. The maximum intake should be six per year in a high volume center with adequate faculty ensuring one to one attention
  8. There should be periodic internal assessment of the trainee (formative assessment) in clinical and surgical skills, so that any shortcoming can be rectified then and there
  9. There should be a single national-level common exit examination, which is ideal, but may not be possible immediately. Till such time, at least there can be a common pattern of examination - both theory, practical, and viva to be followed by all the Institutes and Universities. There can also be a common pool of examiners at the National level every year, who will examine the candidates each year.


Through this letter, I appeal to all the neurosurgery teachers and the Neurological Society of India (NSI) office bearers to consider the above points and take necessary action to ensure that our Neurosurgery training program and exit examination get strengthened and updated with a high uniform national level standard.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hegde A, Bhattathiri P. Postgraduate training in neurosurgery—a UK perspective. Neurol India 2020;68:947-9.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Ramesh VG. Neurosurgical training in India at the crossroads? Neurol India. 2004;52:271-2.  Back to cited text no. 2
    
3.
Banerji AK. Neurosurgical training and evaluation – Need for a paradigm shift. Neurol India 2016;64:1119-24.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
UNIFORM CURRICULUM FOR MCh AND DNB NEUROSURGERY. Internet. NSI; Available from: http://www.neurosocietyindia.com/NewLaunch/Download/NSI%20teaching%20curicullum.pdf.  Back to cited text no. 4
    
5.
Chandra PS. The Need for Uniform Residency Training Programs and the challenges during COVID Pandemic for India. Neurol India 2020;68:1279-80.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
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. 6
[PUBMED]  [Full text]  




 

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