Neurology training around the world

Abstract

Africa's history of neurology remains largely undiscovered and unwritten, except in countries like Egypt. The more modern history of neurology has been peppered with remarkable people such as Osuntokun in the latter part of the 20th century, followed by an unedifying gap in training and development in the specialty. Neurological morbidity, especially from human immunodeficiency virus (HIV) related neurological disease and stroke, is rising in much of the continent including Kenya. Kenya currently has six neurologists for a population of 30 million. (Contrast this with the demand to increase the number of neurologists in the UK, where over 300 consultant neurologists serve a population of 69 million, and it puts the situation neatly into perspective; figure.) 1 All of them work in Nairobi; four work at the Kenyatta National Hospital-the national referral and teaching hospital and the apex health institution of the public health service-but also in part-time private practice, and two work in private practice. Of the four public-health-service neurologists, three hold academic appointments with the University of Nairobi Medical School, and only one actually works for the hospital board (the equivalent of a UK National Health Service contract). I have been appointed by the hospital to develop my interest in clinical neurology and will become the seventh neurologist in the country when I return later this year. A Kenyan neurologist's long journey begins in medical school, with 5 years of undergraduate medical training, followed by a 1 year internship, leading to at least 2 years as a medical officer in a district general hospital. One can then apply for the formal internal medicine residency at the Kenyatta National Hospital, which takes a minimum of 3 years. This includes a research project-in addition to the clinical and academic workload-done over 2 years, which, in the case of the fledgling neurologist, is commonly on a topic of neurological interest (mine was on tuberculous meningitis, a problem of immense importance to the neurologist in an HIV and tuberculosis endemic region). At the end of this residency is an examination modelled on the Membership of the Royal College of Physicians (MRCP) assessment. My own initial training followed this pattern. There is no proper neurology training programme in Kenya. The trainee neurologist would thus seek a medical specialist or lecturer job at the Kenyatta National Hospital, which is the only institution with anything resembling

Job variation in Australian advanced training in neurology

“…By way of further background, there is considerable international variation in the length of neurological training from one country to another 3 . A recent European survey showed that the number of years required to become a trained neurologist ranged from two (Georgia) to seven (Denmark), with most of the countries requiring 4 or 5 years 4 .…”

The European Board of Neurology Examination - junior neurologists are eager to take the challenge

“…In addition, the UEMS/EBN might consider to open the examination to neurologists from outside the EU under special conditions. This might be a potential chance not only for examinees from countries with lower educational standards than Europe to assess their knowledge but also to strengthen and restore the position of European neurology [6,7].…”

Postgraduate training in infectious diseases: investigating the current status in the international community

“…No global reviews on postgraduate training in other specialties were identified. Again there were opinion papers and anecdotal pieces, 10 and national/European articles, but no truly international papers. The issues we discuss may indeed apply to other specialties.…”