Neurosurgical resident education in Europe--results of a multinational survey

Education and Training in Global Neurosurgery: Current State and Path Toward a Uniform Curriculum

Education is a sustainable long-term measure to address the global burden of neurosurgical disease. Neurosurgery residencies in high-income countries are accredited by a regional governing body and incorporate various educational activities. Few opportunities for training may be present in low-income and middle-income countries due to a lack of neurosurgery residency programs, tuition, and health care workforce reductions. Core components of a neurosurgical training curriculum include operative room experience, clinical rounds, managing inpatients, and educational conferences. A gold standard for neurosurgical education is essential for creating comprehensive training experience, though training must be contextually appropriate.

Challenges and aspirations of neurosurgery residents in Germany: Insights from a questionnaire-based survey

OBJECTIVE

Neurosurgery residents in Germany face numerous challenges including receiving comprehensive surgical training with adequate learning opportunities, achieving balanced work life equilibrium, maintaining a positive work environment and navigating career prospects. The objectives of this study are to assess overall satisfaction with the training program, identify factors contributing to dissatisfaction, explore various dimensions of the training program, evaluate the psychological well-being of residents, and ascertain their preferences for future subspecialties.

METHODS

A questionnaire-based survey was conducted anonymously among neurosurgery residents from various training hospitals, nationwide. The survey utilized a quantitative questionnaire as data collection tool. The data collection took place from June 2021 to January 2023.

RESULTS

The survey encompassed 120 neurosurgery residents, with a gender distribution of 55 % male and 45 % female. The respondents were primarily from university hospitals (53 %), followed by community hospitals (38 %) and private hospitals (9 %). In terms of training program satisfaction, 37 % reported moderate satisfaction, 39 % indicated below-moderate satisfaction, and 28 % experienced above-moderate satisfaction. The predominant causes of dissatisfaction identified were insufficient surgical exposure (reported by 39 % of respondents), suboptimal educational content (38 %), and inadequate research opportunities (32 %). Additionally, 24 % of respondents highlighted psychological stress, and 36 % reported frequent experiences of burnout. A majority (63 %) indicated a workload of 60-80 h weekly. About half of the residents indicated a future specialization interest in neurosurgical oncology.

CONCLUSION

The results of the survey findings provide valuable insights into the challenges and aspirations of neurosurgery trainees in Germany. These results serve as a basis for improving the training system, enhancing the working environment, and guiding future planning in this field. To optimize the training of residents, it is important to address issues such as limited surgical and research opportunities and psychological well-being. The expressed interest in subspecializing offers guidance for shaping the training program's future direction.

Seniority of Surgeon in Chronic Subdural Hematoma Recurrence: A Systematic Review and Meta-analysis

Chronic subdural hematoma (CSDH) is increasingly common, particularly in the older and multimorbid population. Surgical proficiency in management is required in the early years of U.K. neurosurgical training with most cases performed by nonconsultant-grade surgeons. The aim of this systematic review was to examine the effect of surgeon seniority on recurrence for patients with CSDH. Full-text articles comparing surgical treatment for CSDH with a "senior" (consultant/attending level) or "junior" (resident/registrar or similar) lead surgeon were identified. MEDLine and EMBASE databases were searched. The primary outcome of this study was recurrence. Secondary outcomes included postoperative complications and mortality rate. A random effects meta-analysis was performed. The risk of bias was assessed using the National Institute of Health risk of bias toolkit. Five studies were included in the final analysis (n = 941 total patients). Individually, no study identified a significant difference in recurrence rate and postoperative complications between senior and junior neurosurgeons. On meta-analysis, junior-led evacuations had lower recurrence rates on pooled univariable analysis (12.0% vs. 17.9% [odds ratio 0.48, 95% confidence interval 0.29-0.78, I2 = 0%]) (3 studies). Seniority of surgeon was not associated with increased rates of recurrence patients undergoing CSDH surgery. Complexity of operation may be a confounding factor in observed lower recurrence rates with more junior operators.

Survey Research Among Neurosurgeons: A Bibliometric Review of the Characteristics, Quality, and Citation Predictors of the Top 50 Most-Influential Publications in the Neurosurgical Literature

Survey research enables the gathering of information on individual perspectives in a large cohort. It can be epidemiological, attitude or knowledge focussed. Assessment of survey studies sampling neurosurgeons is currently lacking in the literature. This study aimed to highlight the characteristics, quality, and citation predictors of the most influential survey research studies published in the neurosurgical literature. Using PubMed and Google Scholar, the 50 most cited survey research publications were identified and reviewed. Data relating to the characteristics of the articles, participants and questionnaires were retrieved. The studies' quality and citation patterns were assessed. The median articles' age and publishing journal impact factor (IF) were 15.5 years and 2.82, respectively. Thirty-two (64%) articles were first authored by researchers from the USA while 28(56%) studies were focussed on specific disease management. The median number of participants and response rates were 222 and 51%, respectively. A full version of the questionnaire was provided in 18 (36%) articles. Only four (8%) articles reported validation of the questionnaire. The overall quality of reporting of the surveys was considered fair (based on good grading in five parameters, fair grading in one parameter, and poor grading in four parameters). The median citation number was 111. The citation analysis showed that the participant number, article age (≥15.5 years), and questionnaire category (surgical complications) were significant predictors of citation numbers. The citation rates were not influenced by the response rates or the journal's IF. In conclusion, high-impact survey publications in the neurosurgical literature were moderately cited and of fair quality. Their citation numbers were not affected by response rates but were positively influenced by the publication age, number of participants, and by novel data or the questions raised in the survey category. Surveys are valuable forms of research that require extensive planning, time, and effort in order to produce meaningful results. Increasing awareness of the factors that could affect citations may be useful to those who wish to undertake survey research.

The Status of Specialist Neurosurgical Training in Nigeria: A Survey of Practitioners, Trainers, and Trainees

OBJECTIVE

Despite the well-known neurosurgical workforce deficit in Sub-Saharan Africa, there remains a low number of neurosurgical training programs in Nigeria. This study sought to reassess the current status of specialist neurosurgical training in the country.

METHODS

An electronic survey was distributed to all consultant neurosurgeons and neurosurgery residents in Nigeria. Demographic information and questions relating to the content, process, strengths, and challenges of neurosurgical training were explored as part of a broader survey assessing neurosurgical capacity. Descriptive statistics were used for analysis.

RESULTS

Respondents identified 15 neurosurgical training centers in Nigeria. All 15 are accredited by the West African College of Surgeons, and 6 by the National Postgraduate Medical College of Nigeria. The average duration of core neurosurgical training was 5 years. Some identified strengths of Nigerian neurosurgical training included learning opportunities provided to residents, recent growth in the neurosurgical training capacity, and satisfaction with training. Challenges included a continued low number of training programs compared to the population density, lack of subspecialty training programs, and inadequate training infrastructure.

CONCLUSIONS

Despite the high number of neurosurgery training centers in Nigeria, compared to other West African countries, the programs are still limited in number and capacity. Although this study shows apparent trainee satisfaction with the training process and contents, multiple challenges exist. Efforts at improving training capacity should focus on continuing the development and expansion of current programs, commencing subspecialty training, driving health insurance to improve funding, and increasing available infrastructure for training.

Survey on Training Satisfaction among German Neurosurgical Trainees

BACKGROUND

 There has been a fivefold increase of neurosurgeons over the last three decades in Germany, despite a lesser increase in operations. Currently, there are approximately 1,000 neurosurgical residents employed at training hospitals. Little is known about the overall training experience and career opportunities for these trainees.

METHODS

 In our role as resident representatives, we implemented a mailing list for interested German neurosurgical trainees. Thereafter, we created a survey including 25 items to assess the trainees' satisfaction with their training and their perceived career prospects, which we then distributed through the mailing list. The survey was open from April 1 until May 31 2021.

RESULTS

 Ninety trainees were enrolled in the mailing list and we received 81 completed responses to our survey. Overall, 47% of the trainees were very dissatisfied or dissatisfied with their training. Sixty-two percent of the trainees reported a lack of surgical training. Fifty-eight percent of trainees found it difficult to attend courses or classes and only 16% had consistent mentoring. There was an expressed desire for a more structured training program and mentoring projects. In addition, 88% of trainees were willing to relocate for fellowships outside their current hospitals.

CONCLUSIONS

 Half of the responders were dissatisfied with their neurosurgical training. There are various aspects that require improvement, such as the training curriculum, structured mentoring, and reduction of the amount of administrative work. We propose the implementation of a modernized structured curriculum, which addresses the mentioned aspects, in order to improve neurosurgical training and, consecutively, patient care.

Strategies to improve surgical technical competency: a systematic review

BACKGROUND

A cornerstone of surgical residency training is an educational program that produces highly skilled and effective surgeons. Training structures are constantly being revised due to evolving program structures, shifting workforces, and variability in the clinical environment. This has resulted in significant heterogeneity in all surgical resident education, training tools utilized, and measures of training efficacy.

METHODS

We systematically reviewed educational interventions for technical skills in neurosurgery published across PubMed, Embase, and Web of Science over four decades. We extracted general characteristics of each surgical training tool while categorizing educational interventions by modality and neurosurgical application.

RESULTS

We identified 626 studies which developed surgical training tools across eight different training modalities: textbooks and literature (11), online resources (53), didactic teaching and one-on-one instruction (7), laboratory courses (50), cadaveric models (63), animal models (47), mixed reality (166), and physical models (229). While publication volume has grown exponentially, a majority of studies were cited with relatively low frequency. Most training programs were published in the development and validation phase with only 2.1% of tools implemented long-term. Each training modality expressed unique strengths and limitations, with limited data reported on the educational impact connected to each training tool.

CONCLUSIONS

Numerous surgical training tools have been developed and implemented across residency training programs. Though many creative and cutting-edge tools have been devised, evidence supporting educational efficacy and long-term application is lacking. Increased utilization of novel surgical training tools will require validation of metrics used to assess the training outcomes and optimized integration with clinical practice.

Becoming a neurosurgeon in France: A qualitative study from the trainees' perspective

Introduction

The training of neurosurgeons is evolving in a world of socio-professional changes, including the technological revolution, administrative pressure on stakeholders, reduced working hours, geographical heterogeneity, generational changes, to name but a few.

Research question

This qualitative study aimed to explore experiences and feedback of French neurosurgical trainees concerning their training.

Material and methods

The grounded theory approach was used with 23 neurosurgical trainees' interviews. Inclusion was continued until data saturation. Six researchers (an anthropologist, a psychiatrist, and four neurosurgeons) thematically and independently analyzed data collected through anonymized interviews.

Results

Data analysis identified three superordinate themes: (1) The Trainee-Senior Dyad, where the respondents describe a similar bipolarity between trainees and faculty (trainees oscillating between those who fit into the system and those who are more reluctant to accept hierarchy, faculty using an ideal pedagogy while others refuse to help or invest in training); (2) The difficulty to learn (describing pressure exercised on trainees that can alter their motivation and degrade their training, including the impact of administrative tasks); (3) A pedagogy of empowerment (trainee' feelings about the pertinent pedagogy in the OR, ideal sequence to progress, progressive empowerment especially during the shifts, and stress of envisioning themselves as a senior neurosurgeon).

Discussion and conclusion

Respondents emphasize the heterogeneity of their training both intra- and inter-university-hospital. Their critical analysis, as well as the formalization of their stress to become autonomous seniors, can be an important link with the reforms and optimizations currently being carried out to improve and standardize the training of young French neurosurgeons.

Neurosurgical training and education - General European certification is supported: Results of an EANS survey

Introduction

Delivering high-quality Neurosurgical care is dependent on excellence in neurosurgical training. Across Europe requirements of these programs vary from state to state. This study aims to determine satisfaction with these programs and views towards a unified certifications process for Neurosurgical training.

Methods

An electronic survey was disseminated to European trainees, Fellows and Consultants from 11/21 to 02/22. For descriptive purposes, categorical variables, i.e. Age, Gender, year of training, country and outcomes were analyzed.

Results

A total of 339 responses were submitted, representing all EANS member states except for Cyprus and Macedonia. Seventy-five were <30 years, 82.3% were male, ∼60% were Specialists, and twenty-four per cent held a fellowship with the European Board of Neurosurgery. 80.2% believed that a joint standardized Neurosurgical certificate in Europe is necessary, with 31.6% believing residency had not prepared them fully as a neurosurgeon.

Conclusion

This survey shows that views towards general European-wide certification is positive and that there is ongoing consensus that there is concern with some aspects of training and high variability in its delivery across Europe.

The use of advanced technology for preoperative planning in cranial surgery - A survey by the EANS Young Neurosurgeons Committee

Introduction

Technological advancements provided several preoperative tools allowing for precise preoperative planning in cranial neurosurgery, aiming to increase the efficacy and safety of surgery. However, little data are available regarding if and how young neurosurgeons are trained in using such technologies, how often they use them in clinical practice, and how valuable they consider these technologies.

Research question

How frequently these technologies are used during training and clinical practice as well as to how their perceived value can be qualitatively assessed.

Materials and methods

The Young Neurosurgeons' Committee (YNC) of the European Association of Neurosurgical Societies (EANS) distributed a 14-items survey among young neurosurgeons between June 1st and August 31st, 2022.

Results

A total of 441 responses were collected. Most responders (42.34%) received "formal" training during their residency. Planning techniques were used mainly in neuro-oncology (90.86%), and 3D visualization of patients' DICOM dataset using open-source software was the most frequently used (>20 times/month, 20.34% of responders). Software for 3D visualization of patients' DICOM dataset was the most valuable technology, especially for planning surgical approach (42.03%). Conversely, simulation based on augmented/mixed/virtual reality was considered the less valuable tool, being rated below sufficiency by 39.7% of responders.

Discussion and conclusion

Training for using preoperative planning technologies in cranial neurosurgery is provided by neurosurgical residency programs. Software for 3D visualization of DICOM datasets is the most valuable and used tool, especially in neuro-oncology. Interestingly, simulation tools based on augmented/virtual/mixed reality are considered less valuable and, therefore, less used than other technologies.

Resilience and recovery in neurosurgical residency: Unpacking lessons from video game mechanics

Introduction

Neurosurgical residency is a challenging journey demanding cognitive acuity and resilience, mirrored strikingly in the dynamics of video gaming. Gaming concepts of Down-But-Not-Out (DBNO), Heal-over-Time (HoT), and Damage-over-Time (DoT) can serve as compelling analogues to elements of neurosurgical training.

Material and methods

An innovative, cross-disciplinary methodology was implemented, blending elements of autoethnography, personal reflective narrative, and comprehensive literary review. The cornerstone of this approach was an experiential reflective analysis, where two neurosurgical residents critically examined the parallels between their residency experiences and video game mechanics, thereby applying a lens of heuristic introspection to their professional journey. Complementing this, a comprehensive narrative synthesis of existing literature on resilience, wellness, and stress in neurosurgical residency training was conducted.

Results

The DBNO concept parallels the resilience demonstrated by neurosurgical residents, emphasizing the importance of a supportive network. The HoT concept, analogous to wellness practices, underscores the incremental restoration of energy necessary for maintaining stamina in neurosurgery training. The DoT concept symbolizes the need to manage the often insidious and deleterious effects of chronic stress on residents' wellbeing.

Discussion and conclusion

These gaming concepts provide an integrative framework for understanding the challenges faced and strategies employed in neurosurgical residency. The interplay between resilience, wellness practices, and effective stress management, represented by DBNO, HoT, and DoT respectively, is critical for maintaining health and fostering professional excellence. By embedding these metaphors within the training paradigm, the neurosurgical residency journey can be navigated more effectively, promoting not only professional success but also personal growth and wellbeing.

Key role of microsurgical dissections on cadaveric specimens in neurosurgical training: Setting up a new research anatomical laboratory and defining neuroanatomical milestones

Introduction

Neurosurgery is one of the most complex surgical disciplines where psychomotor skills and deep anatomical and neurological knowledge find their maximum expression. A long period of preparation is necessary to acquire a solid theoretical background and technical skills, improve manual dexterity and visuospatial ability, and try and refine surgical techniques. Moreover, both studying and surgical practice are necessary to deeply understand neuroanatomy, the relationships between structures, and the three-dimensional (3D) orientation that is the core of neurosurgeons' preparation. For all these reasons, a microsurgical neuroanatomy laboratory with human cadaveric specimens results in a unique and irreplaceable training tool that allows the reproduction of patients' positions, 3D anatomy, tissues' consistencies, and step-by-step surgical procedures almost identical to the real ones.

Methods

We describe our experience in setting up a new microsurgical neuroanatomy lab (IRCCS Neuromed, Pozzilli, Italy), focusing on the development of training activity programs and microsurgical milestones useful to train the next generation of surgeons. All the required materials and instruments were listed.

Results

Six competency levels were designed according to the year of residency, with training exercises and procedures defined for each competency level: (1) soft tissue dissections, bone drilling, and microsurgical suturing; (2) basic craniotomies and neurovascular anatomy; (3) white matter dissection; (4) skull base transcranial approaches; (5) endoscopic approaches; and (6) microanastomosis. A checklist with the milestones was provided.

Discussion

Microsurgical dissection of human cadaveric specimens is the optimal way to learn and train on neuroanatomy and neurosurgical procedures before performing them safely in the operating room. We provided a “neurosurgery booklet” with progressive milestones for neurosurgical residents. This step-by-step program may improve the quality of training and guarantee equal skill acquisition across countries. We believe that more efforts should be made to create new microsurgical laboratories, popularize the importance of body donation, and establish a network between universities and laboratories to introduce a compulsory operative training program.

Motivators of becoming and staying a neurosurgeon in the Netherlands: a survey and focus group

OBJECTIVE

The aim of this study was to gain insight in motivators and demotivators of the Dutch neurosurgical residents and neurosurgeons.

METHODS

A mixed method study was conducted. A survey was sent by the Dutch Neurosurgical Society to all Dutch neurosurgeons and residents in the framework of the yearly national quality conference. The focus groups were held during the Dutch national training days for neurosurgical residents. Baseline statistics were made of all survey data. Focus group recordings were transcribed verbatim and open coded in a constant comparative manner.

RESULTS

The survey yielded a response rate of 47.3% of neurosurgeons and 72.5% of residents. 42.5% of residents participated in the focus groups. Overall, motivators according to residents and neurosurgeons were divided between autonomous and controlled motivation. For residents, the motivators to become a neurosurgeon were mostly patient-centered. Neurosurgeons had the same general motivators as residents. Around one-third of neurosurgeons considered ending their career as a neurosurgeon. Among residents, 9.5% considered quitting residency. Neurosurgeons and residents indicated that no time for their family life, increased administrative burden and non-patient-related tasks were reasons to consider leaving the profession. Also, less perceived respect from patients and society was a reason to consider ending their career as a neurosurgeon.

CONCLUSION

Neurosurgeons and residents in neurosurgery are mostly motivated by intrinsic motivators. Factors such as administrative burden, less perceived respect from patients and society, and increase in non-patient-related tasks are large demotivators for both neurosurgeons and residents.

Resources for Operative Neurosurgical Education Among Trainees in the Philippines

BACKGROUND

Operative neurosurgical skills education is a vital part of neurosurgical training, and these skills are usually obtained through operating room experience and supplemented by textbooks and other resources. We aimed to determine the resources used by trainees in the Philippines, both prior to and after the onset of the coronavirus disease 2019 pandemic.

METHODS

An online survey was sent to neurosurgical trainees in the Philippines from January to March 2021. Data on demographics, educational resources used, and weekly hours spent on each were collected, for both the pre- and post-coronavirus disease 2019 periods.

RESULTS

A total of 37 neurosurgical trainees (60% response rate) participated in the survey. Most respondents were female (70%), in their senior levels (58%), and undergoing training in a public institution (65%). The main resources for operative neurosurgical education were operative experience, online academic resources, and neurosurgical textbooks. After the onset of the pandemic, the overall time spent decreased to 61.2 hours/week from 67.7 hours/week, with a significant reduction in the hours spent on operative experience (27.3 vs. 21.3 hours/week, P < 0.0001) and a significant increase in the time spent on webinars (0 vs. 3.2 hours/week, P < 0.0001) and online resources as a whole (14.9 vs. 16.4 hours/week, P = 0.0003).

CONCLUSIONS

Operative experience, online academic resources, and neurosurgical textbooks were the main resources for operative neurosurgical education among trainees in the Philippines. After the onset of the pandemic, the hours spent on operative experience decreased and online academic resources increased significantly. New avenues of neurosurgical education, particularly webinars, also became available locally.

Access to training in neurosurgery (Part 1): Global perspectives and contributing factors of barriers to access

Introduction

Neurological disorders are one of the leading causes of death and disability adjusted life years (DALYs). Efforts have been made to increase the neurosurgical workforce in an attempt to address the global disease burden. Despite these efforts, there continues to be a shortage of neurosurgeons in both high-income countries (HICs) and low-and middle-income countries (LMICs).

Research question

The aim of the study was to identify the barriers to neurosurgical training in LMICs and HICs.

Materials and methods

We administered an electronic survey targeting medical students, neurosurgery residents, and recent neurosurgery graduates from 69 countries in both HICs and LMICs. Questions were framed to assess barriers to training.

Results

Of the 198 responses received (31.3% response rate), 72% identified as male, 27% female, and 0.5% as non-binary gender. 33 respondents were from HICs and 165 were from LMICs. 70.1% of respondents reported no availability of dissection labs in their home institutions. There was a significant difference in availability of subspecialty training between LMICs and HMICs (p ​= ​0.001) but no significance was seen for competitiveness of programs (p ​= ​0.473).

Discussion and conclusion

There are limitations to our study: it is not comprehensive of training programs globally, there is sampling bias, especially among LMICs, and the accuracy of responses is unclear. Nonetheless, our results highlight the need for a deliberate focus on designing and implementing both short and long term goals in tackling barriers to access to neurosurgical training, with a conscientious effort to involve interested stakeholders and governments to invest in the training and education of their neurosurgical workforce.

Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance

At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI - 0.482; - 0.167, p < 0.001), and speed by 25% (ES - 0.25, CI - 0.399; - 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.

Women in Neurosurgery Around the World: A Systematic Review and Discussion of Barriers, Training, Professional Development, and Solutions

BACKGROUND

Women have been a minority in neurosurgery since the foundation of the specialty. Women who choose to pursue neurosurgery or advance in their career must overcome various obstacles. In this article, we discuss the proportion of women in neurosurgery globally and the obstacles they face, as well as the solutions being implemented.

METHODS

A systematic review of studies concerning international women in neurosurgery was conducted. Article inclusion was assessed based on relevance to women of neurosurgery, geographic region, date, and classification (rates/data, barriers, or solutions).

RESULTS

From the specified search, 127 articles were retrieved, and 27 met the inclusion criteria. Of the total, 25 countries were represented and discussed in the articles. Primary classification of articles resulted in 50 for data/rates, 22 for barriers, and 17 for possible solutions.

DISCUSSION

Despite cultural differences among unique regions of the globe, women face similar challenges when pursuing neurosurgery, such as difficulty advancing their careers, balancing duties at work and at home, meeting social and cultural expectations, and finding support and mentorship. Encouragingly, measures are already being implemented worldwide to allow women to fulfill their multiple other roles through maternity leave policies, increasing their access to mentors, and enabling promotions throughout their careers.

CONCLUSIONS

With the shortage of neurosurgeons in many regions of the world, the recruitment of female neurosurgeons plays a vital role in meeting those demands. Our cultures and professional societies should celebrate their inclusion and promotion and accommodate the complex role of women as neurosurgeons, mothers, partners, scientists, and leaders.

State of Neurosurgical Education in Africa: A Narrative Review

BACKGROUND

There is no comprehensive report of neurosurgery postgraduate education in Africa. This narrative review aimed to map out the landscape of neurosurgery training in Africa and highlight similarities and differences in training.

METHODS

The keywords "neurosurgery," "education," and "Africa" were searched on PubMed and Google Scholar from inception to January 17, 2021. Next, a complementary hand search was conducted on Google using the keywords "neurosurgery," "residency," and the individual African countries in English and official languages. The relevant data were extracted and compiled into a narrative review.

RESULTS

A total of 76 African training programs that recruit more than 168 trainees each year were identified. Less than half (40.7%, n = 22) of African countries have at least 1 neurosurgery training program. Egypt (n = 15), Algeria (n = 14), and Nigeria (n = 10) have the highest number of training programs, whereas Algeria (0.33), Egypt (0.15), and Libya (0.15) have the highest number of training programs per 1 million inhabitants. The College of Surgeons of East, Central, and Southern Africa has 16 programs in 8 countries, whereas the West African College of Surgeons has 17 accredited programs in 3 countries. The duration of training varies between 4 and 8 years. There is limited information available in the public domain and academic literature about subspecialty fellowships in Africa.

CONCLUSIONS

This review provides prospective applicants and African and global neurosurgery stakeholders with information to advocate for increased investment in African neurosurgery training programs.

Neurosurgery residency program in Yogyakarta, Indonesia: improving neurosurgical care distribution to reduce inequality

OBJECTIVE

Educating future neurosurgeons is of paramount importance, and there are many aspects that must be addressed within the process. One of the essential issues is the disproportion in neurosurgical care, especially in low- and middle-income countries (LMICs). As stated in their report "Global Surgery 2030," The Lancet Commission on Global Surgery has emphasized that the availability of adequate neurosurgical care does not match the burden of neurosurgical disease. A strong partnership with the local and national government is very desirable to improve the way everyone addresses this issue. In addition, international collaborative effort is absolutely essential for the transfer of knowledge and technology from a developed country to an LMIC. This paper shows what the authors have done in Yogyakarta to build an educational model that helps to improve neurosurgical care distribution in Indonesia and reduce the inequity between provinces.

METHODS

The authors gathered data about the number of neurosurgical procedures that were performed in the sister hospital by using data collected by their residents. Information about the distribution of neurosurgeons in Indonesia was adapted from the Indonesian Society of Neurological Surgeons.

RESULTS

The data show that there remains a huge disparity in terms of distribution of neurosurgeons in Indonesia. To tackle the issue, the authors have been able to develop a model of collaboration that can be applied not only to the educational purpose but also for establishing neurosurgical services throughout Indonesia. Currently they have signed a memorandum of understanding with four sister hospitals, while an agreement with one sister hospital has come to an end. There were more than 400 neurosurgical procedures, ranging from infection to trauma, treated by the authors' team posted outside of Yogyakarta.

CONCLUSIONS

Indonesia has a high level of inequality in neurological surgery care. This model of collaboration, which focuses on the development of healthcare providers, universities, and related stakeholders, might be essential in reducing such a disparity. By using this model, the authors hope they can be involved in achieving the vision of The Lancet Commission on Global Surgery, which is "universal access to safe, affordable surgical and anesthesia care when needed."

Procedures performed during neurosurgery residency in Europe

Background

In a previous article (10.1007/s00701-019-03888-3), preliminary results of a survey, aiming to shed light on the number of surgical procedures performed and assisted during neurosurgery residency in Europe were reported. We here present the final results and extend the analyses.

Methods

Board-certified neurosurgeons of European Association of Neurosurgical Societies (EANS) member countries were asked to review their residency case logs and participate in a 31-question electronic survey (SurveyMonkey Inc., San Mateo, CA). The responses received between April 25, 2018, and April 25, 2020, were considered. We excluded responses that were incomplete, from non-EANS member countries, or from respondents that have not yet completed their residency.

Results

Of 430 responses, 168 were considered for analysis after checking in- and exclusion criteria. Survey responders had a mean age of 42.7 ± 8.8 years, and 88.8% were male. Responses mainly came from surgeons employed at university/teaching hospitals (85.1%) in Germany (22.0%), France (12.5%), the United Kingdom (UK; 8.3%), Switzerland (7.7%), and Greece (7.1%). Most responders graduated in the years between 2011 and 2019 (57.7%). Thirty-eight responders (22.6%) graduated before and 130 responders (77.4%) after the European WTD 2003/88/EC came into effect. The mean number of surgical procedures performed independently, supervised or assisted throughout residency was 540 (95% CI 424–657), 482 (95% CI 398–568), and 579 (95% CI 441–717), respectively. Detailed numbers for cranial, spinal, adult, and pediatric subgroups are presented in the article. There was an annual decrease of about 33 cases in total caseload between 1976 and 2019 (coeff. − 33, 95% CI − 62 to − 4, p = 0.025). Variables associated with lesser total caseload during residency were training abroad (1210 vs. 1747, p = 0.083) and female sex by trend (947 vs. 1671, p = 0.111), whereas case numbers were comparable across the EANS countries (p = 0.443).

Conclusion

The final results of this survey largely confirm the previously reported numbers. They provide an opportunity for current trainees to compare their own case logs with. Again, we confirm a significant decline in surgical exposure during training between 1976 and 2019. In addition, the current analysis reveals that female sex and training abroad may be variables associated with lesser case numbers during residency.

Electronic supplementary material

The online version of this article (10.1007/s00701-020-04513-4) contains supplementary material, which is available to authorized users.

The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data

Background

The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment.

Methods

A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop. Two assessors used a novel modified Objective Structured Assessment of Technical Skills (mOSATS) assessment tool, comprising 5 domains ranked according to a 5-point scale to rate delegates’ ability to create a burr hole. Qualitative data from previous workshops were collected, consisting of open-ended, closed-ended and 5-point Likert scale responses to pre- and post-workshop questionnaires. Data were analysed using SPSS® software.

Results

Delegates scored a mean total of 62.1% (21.75/35) and 85.1% (29.8/35) in pre- and post-workshop assessments respectively revealing a statistically significant improvement. Regarding percentage of improvement, no significant difference was shown amongst candidates when comparing the number of neurosurgical cases observed and/or assisted in the past. There was no significant difference in the overall rating between the last two workshops (4.89 and 4.8 out of 5, respectively). One hundred percent of the attendees reported feeling more confident in assisting in theatre after the last two workshops.

Conclusion

We show that a simulation workshop cannot only objectively quantify the improvement of surgical skill acquisition but can also be beneficial regardless of the extent of prior experience.

The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part I): Demographics, Resources, and Education

BACKGROUND

Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development.

METHODS

This was a cross-sectional study in which a widely disseminated online survey (April 2018-November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ2 tests because of its categorical nature.

RESULTS

There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education.

CONCLUSIONS

These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them.

The SpineBox: A Freely Available, Open-access, 3D-printed Simulator Design for Lumbar Pedicle Screw Placement

Background

The recent COVID-19 pandemic has demonstrated the need for innovation in cost-effective and easily produced surgical simulations for trainee education that are not limited by physical confines of location. This can be accomplished with the use of desktop three-dimensional (3D) printing technology. This study describes the creation of a low-cost and open-access simulation for anatomical learning and pedicle screw placement in the lumbar spine, which is termed the SpineBox.

Materials and methods

An anonymized CT scan of the lumbar spine was obtained and converted into 3D software files of the L1-L5 vertebral bodies. A computer-assisted design (CAD) software was used to assemble the vertebral models into a simulator unit in anatomical order to produce an easily prototyped simulator. The printed simulator was layered with foam in order to replicate soft tissue structures. The models were instrumented with pedicle screws using standard operative technique and examined under fluoroscopy.

Results

Ten SpineBoxes were created using a single desktop 3D printer, with accurate replication of the cortico-cancellous interface using previously validated techniques. The models were able to be instrumented with pedicle screws successfully and demonstrated quality representation of bony structures under fluoroscopy. The total cost of model production was under $10.

Conclusion

The SpineBox represents the first open-access simulator for the instruction of spinal anatomy and pedicle screw placement. This study aims to provide institutions across the world with an economical and feasible means of spine surgical simulation for neurosurgical trainees and to encourage other rapid prototyping laboratories to investigate innovative means of creating educational surgical platforms in the modern era.

Academic performance after neurosurgery residency training in Turkey: a national survey

OBJECTIVE

Neurosurgery training programs aim to train specialists. In addition, they are expected to equip the residents with necessary knowledge and skills for academic development. This study aims to gain insights into academic productivity after neurosurgeons graduated from residency training in Turkey.

METHODS

An electronic survey was sent to all Turkish Neurosurgical Society members (n = 1662 neurosurgeons) between September and November 2019. The number of participants was 289 (17.4%). Participants were divided into subgroups based on three main factors: training institution type (university hospital [UH] vs training and research hospital [TRH]), training institution annual case volume (low [< 1000 or inadequate cranial/spinal case numbers] vs high [> 1000 and adequate cranial/spinal case numbers]), and training program accreditation status (accredited vs nonaccredited).

RESULTS

The majority of the participants (64.7%) graduated from the UHs. Those trained at UHs (vs TRHs) and high- (vs low-) volume centers had their dissertations more frequently published in Science Citation Index/Science Citation Index–Expanded journals, gave more oral presentations after residency, had higher h-indices, had higher rates of reviewership for academic journals, and had greater participation in projects with grant support. In addition, graduates of accredited programs reported more PhD degrees than those of nonaccredited programs.

CONCLUSIONS

Neurosurgeons trained in higher-case-volume, accredited programs, mostly in the UHs, performed better in terms of scientific activities and productivity in Turkey. Strong research emphasis and supportive measures should be instituted to increase academic performance during and after residency training.

Investigation and Feasibility of Combined 3D Printed Thermoplastic Filament and Polymeric Foam to Simulate the Cortiocancellous Interface of Human Vertebrae

Disorders of the spine are among the most common indications for neurosurgical and orthopedic surgical interventions. Spinal fixation in the form of pedicle screw placement is a common form of instrumentation method in the lower cervical, thoracic, and lumbar spine. A vital principle to understand for the safe and accurate placement of pedicle screws is the palpable difference between the cortical and cancellous bone, both of which have different material properties and compositions. Probing and palpation of the hard cortical bone, also known as the “ventral lamina”, covering the neural elements of the spinal canal during screw placement provides manual feedback to the surgeon, indicating an impending breach if continued directional force is applied. Generally, this practice is learned at the expense of patients in live operating room scenarios. Currently, there is a paucity of human vertebra simulation designs that have been validated based on the in vivo ultrastructure and physical properties of human cortical and cancellous bone. In this study, we examined the feasibility of combining three-dimensionally printed thermoplastic polymers with polymeric foam to replicate both the vertebral corticocancellous interface and surface anatomy for procedural education.

Advancing spinal fellowship training: an international multi-centre educational perspective

PURPOSE

The purpose of this article is to review the importance of contemporary spine surgery fellowships and educational strategies to assist with fellowship design and delivery.

METHODS

Spine surgery fellowship includes trainees from orthopaedic and neurosurgical backgrounds and is increasingly indicated for individuals wishing to pursue spine surgery as a career, recognizing how spinal surgery evolved significantly in scope and complexity. We combine expert opinion with a review of the literature and international experience to expound spine fellowship training.

RESULTS

Contemporary learning techniques include boot camps at the start of fellowship which may reinforce previous clinical learning and help prepare fellows for their new clinical roles. There is good evidence that surgical specialty training boot camps improve clinical skills, knowledge and trainee confidence prior to embarking upon new clinical roles with increasing levels of responsibility. Furthermore, as simulation techniques and technologies take on an increasing role in medical and surgical training, we found evidence that trainees' operative skills and knowledge can improve with simulated operations, even if just carried out briefly. Finally, we found evidence to suggest a role for establishing competence-based objectives for training in specific operative and technical procedures. Competence-based objectives are helpful for trainees and trainers to highlight gaps in a trainee's skill set that may then be addressed during training.

CONCLUSIONS

Spinal fellowships may benefit from certain contemporary strategies that assist design and delivery of training in a safe environment. Interpersonal factors that promote healthy teamwork may contribute to an environment conducive to learning. These slides can be retrieved under Electronic Supplementary Material.

The importance of teaching clinical anatomy in surgical skills education: Spare the patient, use a sim!

Anatomical knowledge is a key tenet in graduate medical and surgical education. Classically, these principles are taught in the operating room during live surgical experience. This puts both the learner and the patient at a disadvantage due to environment, time, and safety constraints. Educational adjuncts such as cadaveric courses and surgical skills didactics have been shown to improve resident confidence and proficiency in both anatomical knowledge and surgical techniques. However, the cost-effectiveness of these courses is a limiting factor and in many cases prevents implementation within institutional training programs. Anatomical simulation in the form of "desktop" three-dimensional (3D) printing provides a cost-effective adjunct while maintaining educational value. This article describes the anatomical and patient-centered approach that led to the establishment of our institution's 3D printing laboratory for anatomical and procedural education. Clin. Anat. 32:124-127, 2019. © 2019 Wiley Periodicals, Inc.

Safety of resident training in the microsurgical resection of intracranial tumors: Data from a prospective registry of complications and outcome

The aim of the present study was to assess the safety of microsurgical resection of intracranial tumors performed by supervised neurosurgical residents. We analyzed prospectively collected data from our institutional patient registry and dichotomized between procedures performed by supervised neurosurgery residents (defined as teaching procedures) or board-certified faculty neurosurgeons (defined as non-teaching procedures). The primary endpoint was morbidity at discharge, defined as a postoperative decrease of ≥10 points on the Karnofsky Performance Scale (KPS). Secondary endpoints included 3-month (M3) morbidity, mortality, the in-hospital complication rate, and complication type and severity. Of 1,446 consecutive procedures, 221 (15.3%) were teaching procedures. Patients in the teaching group were as likely as patients in the non-teaching group to experience discharge morbidity in both uni- (OR 0.85, 95%CI 0.60-1.22, p = 0.391) and multivariate analysis (adjusted OR 1.08, 95%CI 0.74-1.58, p = 0.680). The results were consistent at time of the M3 follow-up and in subgroup analyses. In-hospital mortality was equally low (0.24 vs. 0%, p = 0.461) and the likelihood (p = 0.499), type (p = 0.581) and severity of complications (p = 0.373) were similar. These results suggest that microsurgical resection of carefully selected intracranial tumors can be performed safely by supervised neurosurgical residents without increasing the risk of morbidity, mortality or perioperative complications. Appropriate allocation of operations according to case complexity and the resident's experience level, however, appears essential.

Neurosurgical digital teaching in low-middle income countries: beyond the frontiers of traditional education

OBJECTIVE

Neurosurgical training is usually based on traditional sources of education, such as papers, books, direct surgical experience, and cadaveric hands-on courses. In low-middle income countries, standard education programs are often unavailable, mainly owing to the lack of human and economic resources. Introducing digital platforms in these settings could be an alternative solution for bridging the gap between Western and poor countries in neurosurgical knowledge.

METHODS

The authors identified from the Internet the main digital platforms that could easily be adopted in low-middle income countries. They selected free/low-cost mobile content with high educational impact.

RESULTS

The platforms that were identified as fulfilling the characteristics described above are WFNS Young Neurosurgeons Forum Stream, Brainbook, NeuroMind, UpSurgeOn, The Neurosurgical Atlas, Touch surgery, The 100 UCLA Subjects in Neurosurgery, Neurosurgery Survival Guide, EANS (European Association of Neurosurgical Societies) Academy, Neurosurgical.TV, 3D Neuroanatomy, The Rhoton Collection, and Hinari. These platforms consist of webinars, 3D interactive neuroanatomy and neurosurgery content, videos, and e-learning programs supported by neurosurgical associations or journals.

CONCLUSIONS

Digital education is an emerging tool for contributing to the spread of information in the neurosurgical community. The continuous improvement in the quality of content will rapidly increase the scientific validity of digital programs. In conclusion, the fast and easy access to digital resources could contribute to promote neurosurgical education in countries with limited facilities.

Burr hole trepanation for chronic subdural hematomas: is surgical education safe?

BACKGROUND

There is a paucity of data concerning the safety and efficacy of surgical education for neurosurgical residents in the evacuation of chronic subdural hematomas (cSDH) by burr hole trepanation.

METHODS

This is a retrospective analysis of prospectively collected data on consecutive patients receiving burr hole trepanation for uni- or bilateral cSDH. Patients operated by a supervised neurosurgery resident (teaching cases) were compared to patients operated by a board-certified faculty neurosurgeon (BCFN; non-teaching cases). The primary endpoint was surgical revision for any reason until the last follow-up. The secondary endpoint was occurrence of any complication until the last follow-up. Clinical status, type of complications, mortality, length of surgery (LOS), and hospitalization (LOH) were tertiary endpoints.

RESULTS

A total of n = 253 cases were analyzed, of which n = 217 (85.8%) were teaching and n = 36 (14.2%) non-teaching cases. The study groups were balanced in terms of age, sex, surgical risk (ASA score), and preoperative status (Karnofsky Performance Scale (KPS), modified Rankin Scale (mRS), National Institute of Health Stroke Scale (NIHSS)). The cohort was followed for a mean of 242 days (standard deviation 302). In multivariate analysis, teaching cases were as likely as non-teaching cases to require revision surgery (OR 0.65, 95% CI 0.27-1.59; p = 0.348) as well as to experience any complication until the last follow-up (OR 0.79, 95% CI 0.37-1.67; p = 0.532). Mean LOS was about 10 min longer in teaching cases (53.0 ± 26.1 min vs. 43.5 ± 17.8 min; p = 0.036), but LOH was similar. There were no group differences in clinical status, mortality and type of complication at discharge, and the last follow-up.

CONCLUSIONS

Burr hole trepanation for cSDH can be safely performed by supervised neurosurgical residents enrolled in a structured training program, without increasing the risk for revision surgery, perioperative complications, or worse outcome.

UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

Background

The predecessor of today’s Department of Neurosurgery, UniversitätsSpital Zürich (USZ), was founded 80 years ago as the first independent Swiss clinic dedicated to neurosurgical patient care. On the occasion of this anniversary, we aimed to highlight the history of neurosurgery as a specialty at the USZ, and to put it into the historical context of Swiss and European Neurosurgery.

Method

A literature review was conducted and we searched the archives of the USZ and the city of Zurich, as well as those of Swiss journals to extract relevant published articles, books, historical reports and pictures. The USZ Department of Medical History, the Museum of Medical History and the Swiss National Library were contacted to provide source material. To further verify the content, (emeritus) faculty from the USZ and external experts on the history of Swiss neurosurgery reviewed the manuscript.

Results

Surgeries of the head and spine had occasionally been conducted in Zurich by the general surgeons, Rudolf Ulrich Krönlein and Paul Clairmont, before an independent neurosurgical clinic was founded by Hugo Krayenbühl on 6 July 1937. This was the first Swiss department dedicated to neurosurgical patient care. Besides providing high-quality medicine for both the local and wider population, the department was chaired by eminent leaders of neurosurgery, who influenced the scientific and clinical neurosurgery of their time. As such, it has long been regarded as one of the top teaching and research hospitals in Switzerland and in Europe.

Conclusions

On the occasion of its 80th anniversary, we have performed an in-depth review of its development, successes and challenges, with a special focus on the early decades. Reflecting on the past, we have identified common denominators of success in neurosurgery that remain valid today.

Electronic supplementary material

The online version of this article (10.1007/s00701-017-3357-z) contains supplementary material, which is available to authorised users.

Demographics, Interests, and Quality of Life of Canadian Neurosurgery Residents

Background:Neurosurgical residents face a unique combination of challenges, including long duty hours, technically challenging cases, and uncertain employment prospects. We sought to assess the demographics, interests, career goals, self-rated happiness, and overall well-being of Canadian neurosurgery residents.Methods:A cross-sectional survey was developed and sent through the Canadian Neurosurgery Research Collaborative to every resident enrolled in a Canadian neurosurgery program as of April 1, 2016.Results:We analyzed 76 completed surveys of 146 eligible residents (52% response rate). The median age was 29 years, with 76% of respondents being males. The most popular subspecialties of interest for fellowship were spine, oncology, and open vascular neurosurgery. The most frequent self-reported number of worked hours per week was the 80- to 89-hour range. The majority of respondents reported a high level of happiness as well as stress. Sense of accomplishment and fatigue were reported as average to high and overall quality of life was low for 19%, average for 49%, and high for 32%. Satisfaction with work-life balance was average for 44% of respondents and was the only tested domain in which significant dissatisfaction was identified (18%). Overall, respondents were highly satisfied with their choice of specialty, choice of program, surgical exposure, and work environment; however, intimidation was reported in 36% of respondents and depression by 17%.Conclusions:Despite a challenging residency and high workload, the majority of Canadian neurosurgery residents are happy and satisfied with their choice of specialty and program. However, work-life balance, employability, resident intimidation, and depression were identified as areas of active concern.

eLearning resources to supplement postgraduate neurosurgery training

BACKGROUND

In an increasingly complex and competitive professional environment, improving methods to educate neurosurgical residents is key to ensure high-quality patient care. Electronic (e)Learning resources promise interactive knowledge acquisition. We set out to give a comprehensive overview on available eLearning resources that aim to improve postgraduate neurosurgical training and review the available literature.

MATERIAL AND METHODS

A MEDLINE query was performed, using the search term "electronic AND learning AND neurosurgery". Only peer-reviewed English-language articles on the use of any means of eLearning to improve theoretical knowledge in postgraduate neurosurgical training were included. Reference lists were crosschecked for further relevant articles. Captured parameters were the year, country of origin, method of eLearning reported, and type of article, as well as its conclusion. eLearning resources were additionally searched for using Google.

RESULTS

Of n = 301 identified articles by the MEDLINE search, n = 43 articles were analysed in detail. Applying defined criteria, n = 28 articles were excluded and n = 15 included. Most articles were generated within this decade, with groups from the USA, the UK and India having a leadership role. The majority of articles reviewed existing eLearning resources, others reported on the concept, development and use of generated eLearning resources. There was no article that scientifically assessed the effectiveness of eLearning resources (against traditional learning methods) in terms of efficacy or costs. Only one article reported on satisfaction rates with an eLearning tool. All authors of articles dealing with eLearning and the use of new media in neurosurgery uniformly agreed on its great potential and increasing future use, but most also highlighted some weaknesses and possible dangers.

CONCLUSION

This review found only a few articles dealing with the modern aspects of eLearning as an adjunct to postgraduate neurosurgery training. Comprehensive eLearning platforms offering didactic modules with clear learning objectives are rare. Two decades after the rise of eLearning in neurosurgery, some promising solutions are readily available, but the potential of eLearning has not yet been sufficiently exploited.

Residency program trainee-satisfaction correlate with results of the European board examination in neurosurgery

INTRODUCTION

Substantial country differences in neurosurgical training throughout Europe have recently been described, ranging from subjective rating of training quality to objective working hours per week. The aim of this study was to analyse whether these differences translate into the results of the written and oral part of the European Board Examination in Neurological Surgery (EBE-NS).

METHODS

Country-specific composite scores for satisfaction with quality of theoretical and practical training, as well as working hours per week, were obtained from an electronic survey distributed among European neurosurgical residents between June 2014 and March 2015. These were related to anonymous country-specific results of the EBE-NS between 2009 and 2016, using uni- and multivariate linear regression analysis.

RESULTS

A total of n = 1025 written and n = 63 oral examination results were included. There was a significant linear relationship between the country-specific EBE-NS result in the written part and the country-specific composite score for satisfaction with quality of theoretical training [adjusted regression coefficient (RC) -3.80, 95 % confidence interval (CI) -5.43-7 -2.17, p < 0.001], but not with practical training or working time. For the oral part, there was a linear relationship between the country-specific EBE-NS result and the country-specific composite score for satisfaction with quality of practical training (RC 9.47, 95 % CI 1.47-17.47, p = 0.021), however neither with satisfaction with quality of theoretical training nor with working time.

CONCLUSION

With every one-step improvement on the country-specific satisfaction score for theoretical training, the score in the EBE-NS Part 1 increased by 3.8 %. With every one-step improvement on the country-specific satisfaction score for practical training, the score in the EBE-NS Part 2 increased by 9.47 %. Improving training conditions is likely to have a direct positive influence on the knowledge level of trainees, as measured by the EBE-NS. The effect of the actual working time on the theoretical and practical knowledge of neurosurgical trainees appears to be insignificant.

Promoting Undergraduate Surgical Education: Current Evidence and Students' Views on ESMSC International Wet Lab Course

BACKGROUND

Undergraduate Surgical Education is becoming an essential element in the training of the future generation of safe and efficient surgeons. Essential Skills in the Management of Surgical Cases (ESMSC), is an international, joint applied surgical science and simulation-based learning wet lab course.

METHODS

We performed a review of the existing literature on the topic of undergraduate surgical education. Following that, we analyzed the feedback questionnaire received 480 from 2 recent series of ESMSC courses (May 2015, n = 49 and November 2015, n = 40), in order to evaluate European Union students' (UK, Germany, Greece) views on the ESMSC course, as well as on the undergraduate surgical education. Results Using a 10 point graded scale, the overall ESMSC concept was positively evaluated, with a mean score of 9.41 ± 0.72 (range: 8-10) and 8.94 ± 1.1 (range: 7-10). The majority of delegates from both series [9.86 ± 0.43 (range: 8-10) and 9.58 ± 0.91 (range: 6-10), respectively] believed that ESMSC should be incorporated in the undergraduate surgical curriculum. Comparison of responses from the UK to the Greek Medical Student, as well as the findings from the third and fourth year versus the fifth and sixth year Medical Students, revealed no statistically significant differences pertaining to any of the questions (p > 0.05).

CONCLUSIONS

Current evidence in the literature supports the enhancement of surgical education through the systematic use of various modalities that provide Simulation-Based Training (SBT) hands-on experience, starting from the early undergraduate level. The findings of the present study are in agreement with these previous reports.