Global Perspectives on Task Shifting and Task Sharing in Neurosurgery

Authors

Faith C. Robertson, Harvard Medical School, Boston, Massachusetts, USA.
Ignatius N. Esene, Neurosurgery Division, Department of Surgery, University of Bamenda, Bamenda, Cameroon.
Angelos G. Kolias, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom.
Tariq Khan, Department of Biotechnology, University of Malakand, Chakdara Dir Lower, Pakistan.
Gail Rosseau, Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
William B. Gormley, Harvard Medical School, Boston, Massachusetts, USA.
Kee B. Park, Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Marike L. Broekman, Leiden University Medical Center, Neurosurgery, Leiden, the Netherlands.

Document Type

Article

Abstract

BACKGROUND: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. METHODS: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018-January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. RESULTS: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). CONCLUSIONS: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs.

Publication Date

4-1-2020

Publication Title

World neurosurgery: X

E-ISSN

2590-1397

Volume

6

First Page

100060

PubMed ID

32309801

Digital Object Identifier (DOI)

10.1016/j.wnsx.2019.100060

Recommended Citation

Robertson, Faith C.; Esene, Ignatius N.; Kolias, Angelos G.; Khan, Tariq; Rosseau, Gail; Gormley, William B.; Park, Kee B.; and Broekman, Marike L., "Global Perspectives on Task Shifting and Task Sharing in Neurosurgery" (2020). Neurosurgery. 1740.
https://scholar.barrowneuro.org/neurosurgery/1740