Neuroanatomy Education Access by Country Income Level: A Mixed-Methods Analysis.

Abstract

Neuroanatomy is complex and often perceived as challenging to students and residents. It is important to have an appreciation of neuroanatomy as it directs sound clinical reasoning and may provide inspiration to pursue higher training in a neuroscience-related medical specialty. We conduced a cross-sectional analysis of 519 pre-course questionnaire responses. The questionnaire collected basic demographic variables and opinions regarding the provision of neuroanatomy on a Likert scale. A mixed methods approach was undertaken comparing quantitative and free text responses between respondents from high-income countries (HICs) and low-middle income countries (LMICs). Participants from HICs (N = 383) formed the largest group compared to LMICs (N = 136) and most respondents reported being in medical school (N = 271, 52%). Multivariable proportional ordinal regression, highlighted greater dissatisfaction with neuroanatomy provision by LMIC trainees (odds ratio = 2.34, 95% confidence interval = 1.58-3.48, P < 0.001). Thematic analysis uncovered 4 key barriers to surgical neuroanatomy education including: the need for greater multimodal teaching, a lack of specialist led teaching, systematic barriers, and the complexity of neuroanatomy. LMIC trainees were more likely to report a lack of specialist teaching as a barrier (χ2 = 7.68, P = 0.006). HIC and LMIC neuroanatomy provision differs, with a lack of specialist teaching highlighted as a barrier in our survey. Greater focus is required to ensure equitable access to neuroanatomy teaching with international online courses providing a useful bridge between HIC and LMIC neuroanatomy provision.