Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 52, Num. 2, 2004, pp. 271-272

Neurology India, Vol. 52, No. 2, April-June, 2004, pp. 271-272

Letter To Editor

Neurosurgical training in India at the crossroads?

Ramesh VG

Institute of Neurology, Madras Medical College, Chennai - 600003

Correspondence Address:Institute of Neurology, Madras Medical College, Chennai - 600003
drvgrur@vsnl.net

Code Number: ni04089

Sir,
The Neurosurgical Training in India at present seems to be in the crossroads. The problem seems to be many folds: 1) There does not seem to be any regulation of demand and supply, leading to underemployment and unemployment among qualified neurosurgeons! 2) There is a gross disparity between training imparted in various institutions, leading to gross difference in the quality of the Neurosurgeons produced. 3) There are the problems in training in non-teaching Private Hospitals offering neurosurgical training approved by the National Board of Examinations (NBE). These problems need to be addressed urgently by the Senior Neurosurgeons and Neurosurgical Teachers in the interest of the Profession and the Community at large.

On an average about 40 to 50 Neurosurgeons (both M.Ch. and D.N.B) are added every year in India. Though the number of neurosurgeons per population may still be low, compared to the developed countries, the non-availability of neurosurgical facilities precludes the migration of trained neurosurgeons to smaller centers. This leads to undue concentration of neurosurgeons in a few centers, where facilities are available, leading to less and less of neurosurgical work for individual neurosurgeons and frustration among the younger neurosurgeons. This has to be tackled in two ways: i) The National body like the Neurological Society of India (NSI) must take charge in identifying the likely vacancies in a year in the Neurosurgery Posts in various Hospitals, both Teaching and non-teaching and suggest to various teaching Hospitals on the intake of candidates in a particular year based on the likely vacancies. The number may be based on likely vacancies in existing institutions and new opportunities likely to arise in new institutions with Neurosurgical facilities. This may sound utopian, but can be implemented with some effort. ii) The Teaching Hospitals must provide for a mandatory period of after-qualification training for all Neurosurgical Postgraduates trained by them. This may mitigate the unemployment and under-employment to some extent and also allow young Neurosurgeons gain more experience and confidence.

As for the second point, the NSI and the Medical Council of India must coordinate and see that the minimum standards are kept up in the Teaching Hospitals approved for Neurosurgical Training. They must do periodic surprise inspections in such Institutions and withdraw recognition of the Institutions if there is a shortcoming. The training must include opportunities to familiarize with operating microscope, endoscope, stereotaxy and training in one or more subspecialities. The minimum standards must be based on the standards available at the Central Institutes like AIIMS, PGI, etc. Private institutions offering Neurosurgical training (for DNB program), must be supervised by NSI and NBE and minimum standards must be same as Teaching Hospitals as mentioned. For this NSI must have a subcommittee to coordinate with MCI and NBE.
Regarding the third point, it is a real truth that the majority of Neurosurgical trainees in non-teaching Private Hospitals approved by the NBE do not get adequate practical experience because of the natural limitations of Private Medical Care environment. The trainees in such Institutions must be rotated through Teaching Hospitals preferably in the same city for a good period of their training. It must also be insisted by NBE that the candidates perform minimum number of independent operations under each category of Neurosurgery during their training.

Finally NSI, in concurrence with the various Universities Neurosurgery Examinations throughout the country.
I think we must act before it is too late. Otherwise the future may not forgive us.

Copyright 2004 - Neurology India