• Zhuoyan Lu, Tshibambe N Tshimbombu, Nancy Abu-Bonsrah, Ulrick Sidney Kanmouyne, Donna Hesson, Anbrasi Edward, Michael C Dewan, Alvan-Emeka K Ukachukwu, Anthony T Fuller, Mari L Groves, and Daniel S Rhee.
• Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. Electronic address: Zhuoyan.Lu.MED@Dartmouth.edu.
• World Neurosurg. 2023 May 1; 173: 188198.e3188-198.e3.

BackgroundNeurosurgical capacity building efforts attempt to address the shortage of neurosurgeons and lack of neurosurgical capacity in low- and middle-income countries. This review sought to characterize neurosurgical capacity building efforts in low- and middle-income countries and the challenges they face, and identify factors that predict higher engagement, better training, and performance of high-impact activities.MethodsA scoping review using PubMed and Embase databases was performed and relevant articles were identified. Programs were classified into 6 categories and the activities they performed were classified as having a high-, medium-, or mild impact on capacity. Programs were also classified using the Olivieri engagement and training criteria.ResultsFifty-seven articles representing 42 unique efforts were included. The most important determinant of impact was a program's design and intent. Furthermore, 91% of training and twinning programs received high (class 2 or 3) engagement classifications compared to 17% of mission trips and training camps (P < 0.001); 91% of training and twinning programs received high training classifications compared to 64% of mission trips and training camps (P = 0.015); and 91% of training and twinning programs reported performing high-impact activities compared to 29% of mission trips and training camps (P < 0.001).ConclusionsTraining and twinning programs are more engaged, offer better training, and are more likely to perform high-impact activities compared to mission trips and training camps, suggesting that these types of programs offer the greatest chance of producing substantial and sustainable improvements to neurosurgical capacity.Copyright © 2023 Elsevier Inc. All rights reserved.

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