Evaluating the Evolution of Neurosurgical Training in Sub-Saharan Africa: Trends and Insights From the Cosecsa Operative Logbook.

Abstract

Introduction: The College of Surgeons of East, Central, and Southern Africa (COSECSA) addresses the severe shortage of neurosurgeons in Sub-Saharan Africa through its fellowship programs. Neurosurgical trainees record their operative experiences in e-logbooks, aligning with COSECSA's procedural bundles, to ensure comprehensive surgical training. However, limited resources and access to specialized procedures continue to challenge the quality of neurosurgical care in the region. This study evaluates the operative exposure and procedural diversity of COSECSA neurosurgical trainees and assesses the effectiveness of the original COSECSA bundles compared to a newly proposed ICD-10-PCS-based system.

Methods: This retrospective analysis reviewed data from 15 neurosurgical trainees who completed their COSECSA training between 2015 and 2023, across 25 hospitals in 5 countries. Operative data were extracted from the COSECSA e-logbook, which was standardized using the ICD-10-PCS coding system. Procedures were categorized into both the original COSECSA bundles and the new ICD-10-PCS-based bundles. Descriptive statistics were used to evaluate the total number of operations performed, the diversity of procedures, and compliance with training requirements.

Results: Trainees logged a total of 12,352 operations, exceeding the minimum required 400 cases. The original COSECSA bundles had variable completion rates (26%-64%), while the ICD-10-PCS-based bundles demonstrated higher and more consistent completion (76%-100%). Hospital participation was broader under the new system, but specialized procedures, such as cranial nerve and vertebral vessel surgeries, were still underrepresented in certain hospitals.

Discussion: While COSECSA's volume-based requirements ensure adequate operative exposure, they fail to address the procedural diversity needed for comprehensive neurosurgical training. The ICD-10-PCS-based system better captures the full range of trainee experiences and offers a more adaptable framework for evaluating training quality, though regional disparities in procedural availability remain a challenge.

Conclusion: The ICD-10-PCS-based bundle system provides a more effective method for tracking neurosurgical training, enhancing its relevance in resource-limited settings. To further improve training, COSECSA should focus on increasing access to specialised procedures and refining training requirements to ensure a more diverse and comprehensive surgical education.