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Year : 2017  |  Volume : 65  |  Issue : 2  |  Page : 438-

Author's Reply: Neurosurgical training and evaluation – Need for a paradigm shift

Ajit K Banerji 
 Department of Neurosurgery, Indraprastha Apollo Hospital, New Delhi, India

Correspondence Address:
Dr. Ajit K Banerji
Senior Consultant Neurosurgeon, Indraprastha Apollo Hospital, New Delhi

How to cite this article:
Banerji AK. Author's Reply: Neurosurgical training and evaluation – Need for a paradigm shift.Neurol India 2017;65:438-438

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Banerji AK. Author's Reply: Neurosurgical training and evaluation – Need for a paradigm shift. Neurol India [serial online] 2017 [cited 2023 Feb 5 ];65:438-438
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I have read with great interest both the letters to the editor entitled: “The “reverse' evaluation!”[1] and “Magister Neurochirurgiae”: A 3-year 'Crash Course' or a 5-year 'Punctilious Pedagogy' ?[2]

The following is my brief response:

The aim of training is to produce an average neurosurgeon, who is able to do 90% of the neurosurgical work, with a potential to improve.[3]Having two training streams in the country, the 3- and 6- year residency programs, leads to a lot of confusion in the process of establishing a cogent training program. It is also confusing for the new trainee, as often the academic programs are weighted in favor of the seniors. Having simultaneous running programs for the three and six year residents compounds the confusion. There should be one stream preferably of 6 years in conformity with global trends.[4]General surgeons spend time and energy to acquire appropriate attitudes and craftsmanship related to a wide variety of diseases they deal with. It is a pity to put to waste all these efforts, both from the personal as well as the national point of view. Further, unlearning of attitudes of a general surgeon is the most difficult part, as clinical Neurosurgery is more aligned to clinical Neurology. This adjustment period varies, but often takes months, and is quite frustrating. I speak with personal experience both as a post MS candidate myself, as well as what I have learnt over the years. In any institution, where a neurosurgeon would be working, certainly there would also be a general, an orthopedic or an otorhinolaryngological surgeon. It would be wise to take their help on the few occasions deemed necessary, during exposure of anatomically less familiar areas while performing Neurosurgery.[2]The argument that a degree like M.S. (Surgery) would allow a person to fall back on general surgery if neurosurgical practice is not feasible, is fallacious.[2] There is a huge demand for neurosurgeons all over the country with a plethora of new hospitals coming up even in small cities.Each aspect of training is equally important. Clinical evaluation is a weak area in the training of most residents. Each department has to introspect and discuss with trainees, both present and past, to find the weak spots, which need strengthening. Emphasis on structured exercises for counselling, consent taking, and legal implications of the practice of Neurosurgery is desirable.Hands-on training has suffered mainly because of the disproportionate number of teachers. Ideally, there should be one teacher for 7 beds. Each unit should be of about 20 beds having its own academic programme.Rating and periodic assessment of training institutions are required.[5] Unless a body like the Medical Council of India or the National Board of Examinations initiates this practice, the rating will not have credibility. The Neurological Society of India (NSI) could certainly suggest guidelines after due deliberation.Rating a teacher is also important. I wish the NSI takes a lead in formulating a questionnaire for the residents-in-training to anonymously assess their teachers.[1]

The essence of training is to ensure that the weakest trainee has risen to the state of acceptability to join the club of neurosurgeons. Maintaining a status quo in the training program is a noncontroversial option. However, it is only because our founding fathers 'dared to innovate' that the present training system came into being. We have decades of experience behind us and it is time that we 'dare' again to make appropriate choices for a better future for our speciality.


1Mishra S. The 'reverse' evaluation! Neurol India 2017;65:433.
2George C. Vilanilam GC, Easwer HV, Menon GR, Karmarkar V: Magister Neurochirurgiae: A 3-year 'Crash Course' or a 5-year 'Punctilious Pedagogy'? Neurol India 2017;65:434-7.
3Lipsman N, Khan O, Kulkarni AV. 'The Actualized Neurosurgeon': A proposed model of surgical resident development. World Neurosurg. 2016 Dec 21. pii: S1878-8750(16) 31351-1. doi: 10.1016/j.wneu.2016.12.039. [Last accessed on 2017 Jan 24].
4Banerji AK. Neurosurgical training and evaluation– Need for a paradigm shift. Neurol India 2016;64:1119-24.
5Lee RP, Venable GT, Roberts ML, Parikh KA, Taylor DR, Khan NR, et al. Five-year institutional bibliometric profiles for 119 North American neurosurgical residency programs: An update. World Neurosurg. 2016;95:565-75.