Letter to the Editor Regarding “Neurosurgery Residency Education in the Post−Coronavirus Disease 2019 (COVID-19) Era: Planning for the Future”

Letter:

We read the article by Zuckerman et al.¹ with great interest. They provided 6 recommendations embraced by their department at the Vanderbilt University Medical Center that may set a fruitful path forward in the postpandemic world of neurosurgery department educational activities. Their recommendations include returning to in-person events when possible, global alliances to mitigate disparities, embracing local education, maximizing virtual clinic attendance, making interinstitutional visiting lectureships routine, and acknowledging what has happened and move on.¹

Within academic neurosurgery, much has been written regarding the mid-pandemic response in New York City,² and elsewhere,³ to both care for patients with coronavirus disease 2019 (COVID-19) and treat neurosurgical emergencies without compromising resident teaching. However, less attention has been given to the postpandemic dynamics of neurosurgery education.⁴ Whether departments will return to previous standard operating procedures or integrate novel virtual education techniques remains to be seen.⁴

Sapkota et al.⁵ have published an article on the past, present, and future of neurosurgery in the context of Nepal. Neurosurgery in Nepal is now more than half a century old. Although Nepalese neurosurgical roots can be traced back to ancient times, modern services began in Nepal only after 1990, following the arrival of Dr. Upendra Devkota—the father of Nepalese neurosurgery.

Despite these advancements, neurosurgical care in Nepal is mostly limited to the capital city of Kathmandu, and there remains a deficit of qualified neurosurgeons. Geographic dissemination of neurosurgical care, reappraisal of residency training programs, and initiation of subspecialty-based neurosurgical practices are the next steps to further improve the field in Nepal.⁵

Several challenges in Nepal regarding neurosurgery have been mentioned in the literature.⁶ In addition to this pre-existing burden, the effects of COVID-19 pandemic were not excepted. Challenges including lack of resources, medicolegal risks, lack of trained staff owing to contraction of COVID-19, and lack of operating rooms and intensive care units were magnified. Research and other academic activities were profoundly impacted.⁷

The neurosurgical residency training program in Nepal is limited. Only a few institutions are accredited for this program. The concept of global neurosurgery has not been realized yet. Common people are denied the timely, safe, and affordable neurosurgical care that they should have been ensured. Medical students’ interest in neurosurgical career has not been addressed promptly. The practice of evidence-based medicine and academic research has not bloomed yet properly. In addition, poor governance, political instability, burnout of residents, and hectic duty hours have been other significant challenges. The COVID-19 pandemic further worsened the situation. Albeit these aforementioned concerns, praiseworthy achievement has been done by one of the institutes. Annapurna Institute and Allied Sciences (ANIAS) extended and upgraded its academic activity with an FCPS residency program in Neurosurgery, which has been accredited by the CPSP (Collage of Physician and Surgeons Pakistan) on September 2018. The inspection team from Pakistan and Nepal visited ANIAS on August 2018. ANIAS enrolled FCPS residents in neurosurgery from January 2019. This has helped significantly to meet the demands of neurosurgeons in Nepal, although this country awaits the drastic changes. For this, collaborations between medical institutions, government, and international universities/organizations are deemed necessary.