Formation of the NSI-Young Neurosurgeons Forum and the Fellowship Landscape in India: Wants vs Needs.

Background: Post-residency fellowship training is essential for neurosurgeons to gain expertise in specialized subspecialties. In India, where residency programs are not standardized, inadequate exposure to subspecialties, in many institutes, drives young neurosurgeons to seek fellowship training. The fellowship landscape remains fragmented, with formal programs accredited by bodies like CAST (USA) and RCS (UK), alongside informal observer ship. Understanding the expectations and barriers faced by fellowship aspirants can help tailor Indian fellowship programs to meet these needs effectively.

Objective: This study aims to evaluate the needs and preferences of young neurosurgeons in India regarding fellowship training. It also seeks to understand the perspectives of fellowship directors to align aspirants' expectations with available training opportunities.

Methods and materials: A cross-sectional survey was conducted among members of the Neurological Society of India (NSI) under 40 years of age. Eligible participants included neurosurgeons in residency or within 4 years of completion. The survey assessed demographic details, residency exposure, preferred fellowship duration, location, subspecialty interests, barriers to training, and directors' perspectives. Responses were collected electronically over 3 months.

Results: A total of 177 respondents participated, with 81.9% currently in or recently out of residency. Exposure to subspecialties varied significantly, with high exposure in trauma (61.5%) but low exposure in functional, epilepsy, and endovascular neurosurgery (46.3% and 43.5% reporting "less than adequate"). A majority (52%) pursued fellowships for skill enhancement, preferring domestic programs (65.5%) over international ones. The most cited barriers included financial constraints (37.9%) and relocation concerns (12.4%). Fellowship directors emphasized the need for structured training, technical proficiency, and accreditation to enhance career prospects.

Conclusion: This study highlights systemic gaps in Indian neurosurgical fellowship training, emphasizing the need for modular programs, improved financial aid, and standardized curricula. Strengthening domestic training infrastructure and fostering global collaborations can bridge these gaps, ensuring young neurosurgeons receive adequate subspecialty training.