Identifying pediatric neurosurgery training priorities in Paraguay: a novel quadrant analysis

The landscape of pediatric neurosurgical training in Paraguay is largely unknown, partly due to the absence of pediatric fellowship training in the country. Correspondingly, the aim of this study was to identify priorities for future training initiatives using a novel quadrant analysis based on current trainee perceptions.

Paraguayan neurosurgical trainees were surveyed regarding their familiarity with multiple pediatric neurosurgical diseases (n = 21), procedures (n = 24), and technologies (n = 10). Familiarity was scored on a discrete numerical scale. The mean and standard deviation of pooled values were then plotted in a quadrant analysis as importance and urgency, respectively, to identify priority groups for future training endeavors.

A total of 23 Paraguayan neurosurgical trainees, including 14 of the total 15 (93%) active Paraguayan neurosurgical residents, completed this survey. The majority of respondents believed there was insufficient time in residency to adequately train in pediatric neurosurgery (n = 19, 83%). The most common barriers reported were cost (n = 14, 61%) and availability (n = 9, 39%). Our quadrant analysis showed that in terms of pediatric neurosurgical disease understanding, the highest priority was spasticity, and the lower priorities included hydrocephalus and infection. In terms of pediatric cranial and spine procedures, the highest priorities were found to be non-peritoneal ventricular shunts, endoscopic lavage, vertebral body tethering (WBT), and selective dorsal rhizotomy (SDR). Finally, in terms of technology, the highest priorities were intraoperative electrocorticography (ECOG), laser ablation, and focused ultrasound (FUS). All respondents were open to more dedicated pediatric exposure as part of their residency training.

Our novel quadrant analysis identified multiple diseases, procedures, and technologies that are priorities for future pediatric neurosurgery training initiatives in Paraguay. Further, this approach can likely be used similarly in other middle- and low-income countries to continue to raise the bar of global pediatric neurosurgery training.