Procedures performed during neurosurgery residency in Europe

Abstract

Background: In a previous article ( https://doi.org/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.

Keywords: Caseload; Europe; Neurosurgery; Residency; Training program; Working hour restriction.

Fig. 1

Linear prediction plot with 95% confidence intervals (CI), illustrating time trends (x-axis, year of residency graduation) in annual caseload (y-axis, number of procedures/year) for European neurosurgical residents. The fitted line indicates a decrease in caseload over time. In a linear regression model, there was an annual decrease of about 6 cases (coeff. − 6, 95% CI − 12 to − 1, p = 0.025). The red reference lines indicate the proposed threshold for adequate surgical training, ranging around 275 (250–300) per year and resident

Fig. 2

Bar chart illustration of the mean total number of surgical procedures (y-axis) performed throughout residency before and after introduction of the European Working Time Directive (WTD) 2003/88/ EC (x-axis). It was higher before as compared with after introduction of the WTD 2003/88/EC (2130 vs. 1338, p = 0.007).