Procedures performed during neurosurgery residency in Europe

Abstract

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.

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents

“…Neurosurgery residency is characterized by high levels of competence and an intense hands-on experience. Due to monetary restrictions, infrastructure conditions, and recent work time restrictions ( 11 ), it is hard for a resident to reach an adequate operative case volume over the education program ( 3 ). To counter these drawbacks in neurosurgical training, cadaveric specimen ( 12 ) and animal model courses ( 13 ) are some of the common alternatives for the improvement of surgical skills in neurosurgery, even if their high maintenance costs and ethical issues represent some of the principal limitations to date ( 14 ).…”

“…Factors such as the cost-effectiveness of the operating room, medico-legal and ethics implications, the actual restrictions for residents in terms of hours spent on work-related activities, and reduced time availability for surgical instruction during surgical activities are the elements most likely connected with a reduction in operative case volume during residency ( 2 ). After recent changes in disease management and technological advances, especially for surgical subspecializations, a growing attention has been paid to patient safety during surgical care, keeping back residents from the operating rooms while redirecting them into more administrative mansions ( 3 ).…”

“…Traditionally, practical solutions for surgical training implementation include cadaveric and animal models and abroad fellowships ( 2 , 3 ). However, some drawbacks and limitations must be taken into account.…”

“…To counter the lack of surgical exposure, more recently, courses based on virtual reality (VR) and three-dimensional (3D)-printed models are available ( 2 , 3 ). In particular, we validated a hybrid (virtual and physical) neurosurgical simulator equipped with augmented reality (AR) capabilities that can be used repeatedly to increase familiarity and improve technical skills in human brain anatomy and neurosurgical approaches.…”

Risk Factors for Malfunction of Ventriculoperitoneal Shunts Performed by Medical Residents in Children: An Exploratory Study

“…Although guidelines and recommendations for shunt implantation emphasize that the procedure should be performed by an experienced neurosurgeon, 9 shunt procedures are performed by residents at many centers, especially in teaching hospitals in low-and middle-income countries (LMICs), as well as in developed countries. 10 This dilemma between patient safety and surgical education has made it important to monitor the surgical results of procedures performed by trainee neurosurgeons. In the present study, we aimed to analyze the malfunction rates of VPSs performed in children by residents as well as the risk factors for shunt revision.…”