The evolution of British neurosurgical selection and training over the past decade

Abstract

Selection of junior doctors into the British neurosurgical training program and subsequent speciality training have undergone several key changes over the past decade. Shift patterns in the era of the European Working Time Directive (EWTD) have had a major impact on surgical training. We discuss the national selection process, formalization of surgical simulation training and the need to encompass generic professional capabilities within the neurosurgical curriculum in order to create the "well-rounded surgeon". Future directions including hybrid cerebrovascular training, training in stereotactic radiosurgery, and dedicated training opportunities in spinal surgery.

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

“…Similar improvement in objective assessments during simulation workshops was described in an analysis of data from 12 2-day courses held at Queen's Medical Centre in Nottingham [4]. High-fidelity simulation training, incorporating core operative skills, has been provided in the form of the ST1 boot camp since its inception in 2014 [2]. There has been suggestion to develop further boot camp programmes at ST8 level, although no mention of provision of simulation training for earlier stage trainees and medical students.…”

Challenges in the Australasian neurosurgery training program: who should be trained and where should they train?

“…The first consideration, if training is to involve the hardship of moving between multiple institutions, including interstate or international moves, is to ensure excellent training, including a superior experience for the trainee. There is little in the literature to guide the accreditation of neurosurgical units apart from specific considerations for subspecialty training such as endovascular/cerebrovas- cular surgery 2 or spine neurosurgery, 4 and there is little discussion of trainee welfare and satisfaction. The rigorous accreditation process outlined above appears to at least conform to best practice and is monitored through reaccreditation every 5 years as well as biannual trainee feedback, with scores across multiple years aggregated and released to the training unit to highlight deficiencies while maintaining trainee anonymity.…”

“…There has never been a rigorous evaluation of neurosurgery (or any other surgical specialty) trainee selection, and no superior method has been agreed upon. 1,2,17 In the Australasian system, the choice of trainees by a binational central selection panel, with subsequent allocation of that trainee to rotation through a number of training units, has led to much discussion, particularly when an underperforming trainee is recognized. While the selection process (discussed below) is arduous and transparent, not all trainees complete training, and disciplinary proceedings due to poor performance, even late in training, are not uncommon.…”

Postgraduate medical education – Challenges and innovative solutions

“…The innovative national selection process in the UK Neurosurgical training set up in 2007 (Alamri et al 2018) and the RACP aims to select trainees who will uphold the high standards and professionalism of their speciality.…”

“…The selection stations in neurosurgery consist of clinical knowledge and technical skills, judgement under pressure, problem solving, communication skills, motivation, professional integrity, and understanding of the specialty. Included are situational judgement tests which assess integrity, empathy, resilience, commitment to continuous professional development, and duty of care (Alamri et al 2018).…”