International Observerships in Global Neurosurgery: Overview and Analysis of a 40-Year Experience at Barrow Neurological Institute.

This article provides an overview of the Barrow Neurological Institute international observership and visiting scholars program, one of the oldest and largest international neurosurgical observership programs in the world, and discusses its past, present, and future directions. Background information was collected from the program manager and through one-on-one interviews with the program's founders and current chairman. A survey was administered to past observers to capture feedback. Interviews were summarized, descriptive statistical analysis was performed on quantitative survey data, and a thematic analysis was completed for qualitative data. Since 2006, 686 neurosurgeons, residents, and medical students from more than 64 countries have traveled to Barrow Neurological Institute for an observership. Five hundred and seventy (86.2%) of 661 observers with historical data on country of origin came from high-income countries or upper middle-income countries, 91 (13.7%) from lower middle-income countries, and none from low-income countries (LICs). Of 94 observers who completed the feedback survey, 67 (71%) specialized in cerebrovascular and 21 (22%) in spine. Most observers (70%) were self-funded. Cost (38%) and time (25%) were considered the greatest barriers to observership. Despite the barriers, 93% would recommend the observership to a colleague. Future aspirations for the program include fully funded observerships geared toward neurosurgeons from lower middle-income countries and LICs. Next steps for the program are better inclusion of observers from lower middle-income countries and LICs and expanded research and mentorship opportunities. Future work should investigate the effect of observership programs on career path and "brain drain."