Neurosurgical procedures performed during residency in Europe—preliminary numbers and time trends

Abstract

Background: Differences in the postgraduate training programs of neurosurgical residents are suspected throughout Europe. The influence of working hour restrictions by the European Working Time Directive (WTD) 2003/88/EC on the number of surgical procedures remains unclear. We designed a survey to collect information on the number of surgical procedures, performed by European neurosurgical trainees during residency. This article reports preliminary data. Methods: An electronic survey was distributed among the European Association of Neurosurgical Societies (EANS) member countries by national delegates of the training committee, as well as by members of the young neurosurgeons committee. The EANS mailing list of individual members was also used for distribution. All responses received between 04/2018 and 12/2018 were considered. Results: From n=180 responses received, 42 were omitted as responders were still in residency and for 58 relevant information was missing. The final sample was n=80, with a mean responder's age of 43.0 years (SD 8.6) and 88.8% being male. Responses came from 16 European countries; board certification was received between the years of 1976-2018. The numbers of surgical procedures performed independently were 511 (mean, 95% confidence interval (CI) 413-610), supervised were 514 (95%CI 360-668) and assisted were 752 (95%CI 485-1019) throughout residency. More detailed numbers for specific procedure types are reported in the article. Independently performed cranial procedures outnumbered spinal procedures (p<0.006) and adult procedures outnumbered pediatric procedures (p<0.001). There was a strong decrease in case-load between 1976-2018, with trainees performing on average 65 cases less throughout residency for each calendar year increase in board-certification (95% CI-116-15, p=0.012). Trainees graduating residency before introduction of the European WTD 2003/88/EC participated in more procedures than those graduating afterwards (mean 2797 vs. 1418, p=0.005). Conclusions: The preliminary analysis of the first 80 responses now provides a first reference frame for case-load that can be used by current and future European residents to critically compare their own operative numbers to. There was a strong decline in surgical cases over time, and trainees graduating after introduction of the European WTD 2003/88/EC had less surgical exposure. The survey remains open and we invite further European neurosurgeons to provide their data in order to get even more robust estimates.

Surgical experience of neurosurgical residents in Europe: an alarming trend

“…This preliminary report is not suited to draw any conclusions concerning neither the amount of working hours or specific procedural exposure needed during neurosurgical residency [10]. Nevertheless, to get the best possible overview of current status in Europe, we encourage readers of Acta Neurochirurgica eligible for participation to contribute to the ongoing survey.…”

“…The study by Stienen and coworkers aim to establish the amount of procedures performed by European neurosurgical residents and explores the time trends concerning surgical training during residency. With respect to time trends, they specifically evaluate the caseload of residents before and after the European 48-h workweek restriction (2003/88/EC) [10].…”

Procedures performed during neurosurgery residency in Europe

“…Details on the survey design and methods for distribution have been reported previously [20]. Ever since the publication of the preliminary results, further survey invitations were sent via email to EANS members once (October 2, 2019) and the survey link was advertised during the Young Neurosurgeon's session at the EANS annual meeting in Dublin (Appendix).…”

“…Albeit interesting, it remained unclear how representative the results were, since residents across all stages of training had been included. Therefore, to substantiate the prior work, we had now chosen a different approach, where we collected residency case logs from neurosurgeons who had already completed their training [16,19,20].…”

The EANS specialist of neurosurgery diploma

“…We started the EANS Hands-On Course in Lyon back in 2012, and it has been an extraordinary success. Regretfully, a recent article in Acta Neurochirurgica demonstrated a strong decline in surgical cases performed by European neurosurgical trainees during residency, especially for trainees graduating after introduction of the European work-time directive (WTD 2003/88/EC) [5].…”