Global neurosurgery training. Part 1: Skills and challenges for equity

Neurosurgery requires rigorous training, yet access remains limited in low-resource countries, particularly in Africa, creating a crisis in specialised care. This paper, grounded in the principles of global neurosurgery, examines the essential competencies required in neurosurgical training, distinguishing between clinical skills-such as technical proficiency and decision-making-and non-clinical skills, including leadership, emotional management, and communication. Deliberate practice is emphasised as a key methodology for improving skill acquisition through structured repetition, continuous feedback, and expert supervision. Additionally, the main challenges of specialisation in East Africa are analysed: inadequate infrastructure, overburdened health systems, limited and heterogeneous residency programmes, and a shortage of qualified mentors. Finally, the development of innovative educational strategies is proposed to enhance training in resource-constrained settings and contribute to the sustainable advancement of the specialty.