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Spine surgery training and competence of European Neurosurgical Trainees

  • Spinal Neurosurgery
  • Published:
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Abstract

Background

Little is known about the nature of spine surgery training received by European neurosurgical trainees during their residency and the level of competence they acquire in dealing with spinal disorders.

Methods

A three-part questionnaire entailing 32 questions was devised and distributed to the neurosurgical trainees attending the EANS (European Association of Neurosurgical Societies) training courses of 2004.

Results

Of 126 questionnaires, 32% were returned. The majority of trainees responding to the questionnaire were in their final (6th) year of training or had completed their training (60.3% of total). Spinal surgery training in European residency programs has clear strengths in the traditional areas of microsurgical decompression for spinal stenosis and disc herniation (77-90% competence in senior trainees). Deficits are revealed in the management of spinal trauma (34-48% competence in senior trainees) and spinal conditions requiring the use of implants and anterior approaches, with the exception of anterior cervical stabilisation.

Conclusions

European neurosurgical trainees possess incomplete competence in dealing with spinal disorders. EANS trainees advocate the development of a postresidency spine subspecialty training program.

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Author information

Authors and Affiliations

  1. The Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, NG7 2UH, United Kingdom

    Bronek Maximilian Boszczyk & Baroum Baroum Fakouri

  2. Academisch Ziekenhuis Groningen, Hanzeplein 1, Postbus 30.001, 9700 RB, Groningen, Netherlands

    Jan Jakob Mooij

  3. Department of Neurosurgery, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Strasse 8, D-82418, Murnau, Germany

    Natascha Schmitt

  4. Institute of Neurosurgery, Catholic University Medical School, Policlinico Gemelli, Largo Gemelli 8, 00186, Rome, Italy

    Concezio Di Rocco

  5. Department of Neurosurgery, Institute of Neurological Sciences Southern General Hospital, Glasgow, Scotland

    Kenneth W Lindsay

Authors
  1. Bronek Maximilian Boszczyk
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  2. Jan Jakob Mooij
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  3. Natascha Schmitt
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  4. Concezio Di Rocco
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  5. Baroum Baroum Fakouri
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  6. Kenneth W Lindsay
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Corresponding author

Correspondence to Bronek Maximilian Boszczyk.

Appendix

Appendix

The full questionnaire is reproduced.

Percentage results for the entire collective are marked as “all” (n = 126) and results of the senior group as “sen” (n = 76). Multiple and blank answers were accounted for as a “no recorded response” percentage. The subgroup of senior EANS trainees (those who had completed their residency or were in their 6th year of training) was analysed separately for questions relating to surgical skills (Part II). Relevant percentage rates in relation to the entire collective “all” or the senior group “sen” are provided in Table 1.

Part I

  1. 1.

    In which country are you completing your residency training?

Germany 28.6%, Italy 10.3%, Spain 9%, Czech Republic 5.6%, Austria 4%, Turkey 3.2%, Greece 2.4%, UK 2.4%, Ireland 2.4%, France 2.4%, Belgium 2.4%, Netherlands 2.4%, Denmark 1.6%, Finland 1.6%, Sweden 1.6%, Norway 1.6%, Poland 1.6%, Lithuania 1.6%, Bosnia-Herzegovina 0.8%, Hungary 0.8%, Rumania 0.8%, Slovakia 0.8%, Portugal 0.8%, Switzerland 0.8%, Soviet Union 0.8%

No country stated: 11.9%

  1. 2.

    What is your year of residency training?

First 0.8%, second 0.8%, third 4.8%, fourth 15.1%, fifth 18.3%, sixth 15.9%, completed 44.4%

No recorded response: 0%

  1. 3.

    In what type of institution are you completing your residency training?

University or teaching hospital 79.4%, general hospital 7.5%, private practice 0.8%, other 0%

No recorded response: 2.4%

  1. 4.

    What type of spine surgery sub specialisation does your institution have?

Sub specialised department 10.3%, dedicated sub specialised surgeon 49.2%, none 38.9%

No recorded response: 1.6%

  1. 5.

    Have you had specific spinal surgery training (e.g. fellowship) in addition to your general neurosurgical (residency) training?

Full (12 months) fellowship 12.7%, short (<6 months) 9.5%, informal rotation 30.2%, none 47.6%

No recorded response: 0%

  1. 6.

    How many spinal procedures are performed yearly by neurosurgery at your institution?

0–100 7.9%, 100–1,000 74.6%, >1000 17.5%

No recorded response: 0%

  1. 7.

    What percentage of the procedures performed yearly by neurosurgery at your institution are spinal procedures?

>80percent 2.4%, 80–50percent 38.9%, 50–20percent 50.8%, < 20percent 6.3%

No recorded response: 1,6%

  1. 8.

    How many spinal procedures will you have performed by the end of residency?

< 100 27%, 100–300 44.4%, 300–500 16.7%, > 500 10.3%

No recorded response: 1.6%

  1. 9.

    In your institution, which speciality treats the following spine conditions?

Spinal cord injury

Neurosurgery 72.2%, orthopaedic surgery 6.3%, interdisciplinary approach 19%, not treated 2.4%

No recorded response: 2.4%

Cervical spine injury (decompression and stabilisation)

Neurosurgery 74.6%, orthopaedic surgery 14.3%, interdisciplinary approach 15.1%, not treated 2.4%

No recorded response: 1.6%

Thoracic and lumbar spine injury (decompression and stabilisation)

Neurosurgery 44.4%, orthopaedic surgery 23.8%, interdisciplinary approach 35.7%, not treated 4%

No recorded response: 1.6%

Spinal deformity

Neurosurgery 17.5%, orthopaedic surgery 53.2%, interdisciplinary approach 15.9%, not treated 12%

No recorded response: 1.6%

Spinal tumours (extradural)

Neurosurgery 88.9%, orthopaedic surgery 4%, interdisciplinary approach 9.5%, not treated 0%

No recorded response: 0.8%

Spinal stenosis and disc herniation

Neurosurgery 85.7%, orthopaedic surgery 8.7%, interdisciplinary approach 11.9%, not treated 0%

No recorded response: 0.8%

Spine arthroplasty procedures (non-fusion procedures such as disc prosthesis etc.)

Neurosurgery 50%, orthopaedic surgery 14.3%, interdisciplinary approach 14.3%, not treated 23%

No recorded response: 2.4%

  1. 10.

    How do you rate the quality of training on spinal imaging (MRI, CT, functional x-ray) you received during your residency?

Excellent 17.5%, good 52.4%, basic 25.4%, poor 4%

No recorded response: 0.8%

  1. 11.

    How do you rate the quality of training in conservative spinal treatment you received during your residency (pain management, nerve blocks, facet blocks etc.)?

Theoretical skills: Excellent 6.3%, good 31%, basic 42.9%, poor 19%

No recorded response: 0.8%

Practical skills: Excellent 5.6%, good 27%, basic 35.7%, poor 29.4%

No recorded response: 2.5%

  1. 12.

    How do you rate the quality of training in spinal surgery you received during your residency?

Theoretical training: Excellent 9.5%, good 61.1%, basic 22.2%, poor 5.6%

No recorded response: 1.6%

Practical training: Excellent 11.9%, good 53.2%, basic 26.2%, poor 5.6%

No recorded response: 3.2%

Part II:

  1. 13.

    Are you competent in treatment of cervical disc herniation and cervical spinal stenosis (anterior microsurgical technique)?

Theoretical skills:

Excellent 23%, good 58.7%, basic 15.1%, poor 2.4%

(all)

Excellent 23.7%, good 59.2%, basic 14.5%, poor 2.6%

(sen)

No recorded response: 0.8%

Practical skills:

Not able to perform the procedure

10.3% (all), 6.6% (sen)

Can perform the procedure under direct supervision

29.4% (all), 13.2% (sen)

Can perform the procedure without direct supervision

25.4% (all), 32.9% (sen)

Can deal with complications and difficulties, which may arise

31.7% (all), 44.7% (sen)

No recorded response: 3.2%

  1. 14.

    Are you competent in treatment of lumbar disc herniation and spinal stenosis (microsurgical technique)?

Theoretical skills:

Excellent 31%, good 58.7%, basic 6.3%, poor 0.8% (all)

Excellent 32.9%, good 57.9%, basic 5.3%, poor 0% (sen)

No recorded response: 1.6%

Practical skills:

Not able to perform the procedure

1.6% (all), 0% (sen)

Can perform the procedure under direct supervision

17.5% (all), 5.3% (sen)

Can perform the procedure without direct supervision

24.6% (all), 21.1% (sen)

Can deal with complications and difficulties, which may arise

52,4% (all), 69,7% (sen)

No recorded response: 4%

  1. 15.

    Are you competent in extradural tumour surgery?

Theoretical skills:

Excellent 15.1%, good 55.6%, basic 20.6%, poor 6.3% (all)

Excellent 15.8%, good 60.5%, basic 14.5%, poor 6.6% (sen)

No recorded response: 2.4%

Practical skills:

Not able to perform the procedure

13.5% (all), 10.5% (sen)

Can perform the procedure under direct supervision

36.5% (all), 23.7% (sen)

Can perform the procedure without direct supervision

24.6% (all), 32.9% (sen)

Can deal with complications and difficulties which may arise

22.2% (all), 30.3% (sen)

No recorded response: 4%

  1. 16.

    Are you competent in intradural tumour surgery?

Theoretical skills:

Excellent 13.5%, good 48.4%, basic 26.2%, poor 8.7% (all)

Excellent 13.2%, good 55.3%, basic 21.1%, poor 7.9% (sen)

No recorded response: 3.2%

Practical skills:

Not able to perform the procedure

27.0% (all), 15.8% (sen)

Can perform the procedure under direct supervision

34.1% (all), 34.2% (sen)

Can perform the procedure without direct supervision

15.1% (all), 17.1% (sen)

Can deal with complications and difficulties, which may arise

19% (all), 30.3% (sen)

No recorded response: 4%

  1. 17.

    Are you competent in myelomeningocele, Chiari malformation and syringomyelia surgery?

Theoretical skills:

Excellent 10.3%, good 42.1%, basic 33.3%, poor 11.1% (all)

Excellent 9.2%, good 44.7%, basic 34.2%, poor 10.5% (sen)

No recorded response: 3.2%

Practical skills:

Not able to perform the procedure

33.3% (all), 26.3% (sen)

Can perform the procedure under direct supervision

38.9% (all), 34.2% (sen)

Can perform the procedure without direct supervision

8.7% (all), 11.8% (sen)

Can deal with complications and difficulties, which may arise

16.7% (all), 26.3% (sen)

No recorded response: 1.3%

  1. 18.

    Are you competent in spinal deformity techniques (kyphosis, scoliosis, and spondylolisthesis)?

Theoretical skills:

Excellent 4%, good 25.4%, basic 41.3%, poor 27.8% (all)

Excellent 3.9%, good 32.9%, basic 35.5%, poor 26.3% (sen)

No recorded response: 1.6%

Practical skills:

Not able to perform the procedure

57.1% (all), 47.4% (sen)

Can perform the procedure under direct supervision

21.4% (all), 26.3% (sen)

Can perform the procedure without direct supervision

8.7% (all), 11.8% (sen)

Can deal with complications and difficulties, which may arise

9.5% (all), 11.8% (sen)

No recorded response: 3.2%

  1. 19.

    Are you competent in emergency management of cervical spinal trauma?

Theoretical skills:

Excellent 15.9%, good 50%, basic 23.8%, poor 7.1% (all)

Excellent 15.8%, good 52.6%, basic 21.1%, poor 6.6% (sen)

No recorded response: 3.2%

Practical skills:

Not able to perform the procedure

28.6% (all), 21.1% (sen)

Can perform the procedure under direct supervision

30.2% (all), 26.3% (sen)

Can perform the procedure without direct supervision

22.2% (all), 25% (sen)

Can deal with complications and difficulties, which may arise

14.3% (all), 22.4% (sen)

No recorded response: 4%

  1. 20.

    Are you competent in anterior cervical stabilisation techniques?

Theoretical skills:

Excellent 17.5%, good 50.8%, basic 26.2%, poor 4% (all)

Excellent 17.1%, good 57.9%, basic 17.1%, poor 5.3% (sen)

No recorded response: 2.4%

Practical skills:

Not able to perform the procedure

18.3% (all), 10.5% (sen)

Can perform the procedure under direct supervision

34.1% (all), 28.9% (sen)

Can perform the procedure without direct supervision

21.4% (all), 23.7% (sen)

Can deal with complications and difficulties, which may arise

22.2% (all), 32.9% (sen)

No recorded response: 4%

  1. 21.

    Are you competent in posterior cervical stabilisation techniques?

Theoretical skills:

Excellent 11.9%, good 35.7%, basic 35.7%, poor 15.1% (all)

Excellent 11.8%, good 35.5%, basic 35.5%, poor 15.8% (sen)

No recorded response: 1.6%

Practical skills:

Not able to perform the procedure

37.3% (all), 31.6% (sen)

Can perform the procedure under direct supervision

34.9% (all), 35.5% (sen)

Can perform the procedure without direct supervision

14.3% (all), 15.8% (sen)

Can deal with complications and difficulties, which may arise

10.3% (all), 14.5% (sen)

No recorded response: 3.2%

  1. 22.

    Are you competent in craniocervical stabilisation techniques?

Theoretical skills:

Excellent 7.1%, good 31%, basic 32.5%, poor 27.8% (all)

Excellent 6.6%, good 30.3%, basic36.8%, poor 25% (sen)

No recorded response: 1.6%

Practical skills:

Not able to perform the procedure

54% (all), 46.1% (sen)

Can perform the procedure under direct supervision

27.8% (all), 30.3% (sen)

Can perform the procedure without direct supervision

9.5% (all), 13.2% (sen)

Can deal with complications and difficulties, which may arise

5.6% (all), 7.9% (sen)

No recorded response: 3.2%

  1. 23.

    Are you competent in emergency management of thoracic and lumbar spinal trauma?

Theoretical skills:

Excellent 11.9%, good 47.6%, basic 25.4%, poor 11.9% (all),

Excellent 15.8%, good 48.7%, basic 21.1%, poor 11.8% (sen)

No recorded response: 3.2%

Practical skills:

Not able to perform the procedure

33.3% (all), 27.6% (sen)

Can perform the procedure under direct supervision

30.2% (all), 28.9% (sen)

Can perform the procedure without direct supervision

19% (all), 21.1% (sen)

Can deal with complications and difficulties, which may arise

12.7% (all), 18.4% (sen)

No recorded response: 4.8%

  1. 24.

    Are you competent in posterior thoracic and lumbar stabilisation techniques?

Theoretical skills:

Excellent 11.9%, good 41.3%, basic 32.5%, poor 10.3% (all)

Excellent 13.2%, good 43.4%, basic 28.9%, poor 10.5% (sen)

No recorded response: 4%

Practical skills:

Not able to perform the procedure

30.2% (all), 22.4% (sen)

Can perform the procedure under direct supervision

41.3% (all), 39.5% (sen)

Can perform the procedure without direct supervision

9.5% (all), 14.5% (sen)

Can deal with complications and difficulties, which may arise

15.1% (all), 21.1% (sen)

No recorded response: 4%

  1. 25.

    Are you competent in anterior thoracic and lumbar stabilisation techniques?

Theoretical skills:

Excellent 4.8%, good 16.7%, basic 37.3%, poor 37.3% (all)

Excellent 5.3%, good 18.4%, basic 36.8%, poor 35.5% (sen)

No recorded response: 4%

Practical skills:

Not able to perform the procedure

70.6% (all), 65.8% (sen)

Can perform the procedure under direct supervision

15.9% (all), 18.4% (sen)

Can perform the procedure without direct supervision

7.1% (all), 9.2% (sen)

Can deal with complications and difficulties, which may arise

2.4% (all), 2.6% (sen)

No recorded response: 4%

Part III:

  1. 26.

    Do you think there is a need for spine subspecialty training in neurosurgery?

Yes 66.7%, maybe 21.4%, no 6.3%

No recorded response: 4%

  1. 27.

    Do you think stabilisation techniques should be part of general neurosurgical training or subspecialty spine training?

Subspecialty only 28.6%, general neurosurgery 66.7%

No recorded response: 4.8%

  1. 28.

    Do you think anterior thoracic and lumbar approaches should be part of general neurosurgical training or subspecialty spine training?

Subspecialty only 65.9%, general neurosurgery 29.4%

No recorded response: 4.8%

  1. 29.

    Do you think a subspecialty period of one year (after completion of the current 5–6 year national neurosurgical training programs) should be considered in order to provide a certification of competence in a given subspecialty?

Yes 54.8%, maybe 28.6%, no 11.9% (all)

Yes 48.7%, maybe 31.6%, no13.2% (sen)

No recorded response: 4.8%

  1. 30.

    Would you personally be interested in a subspecialty spine fellowship-training program (minimum 1 year)?

Yes 50%, maybe 22.2%, no 24.6% (all)

Yes 50%, maybe 22.4%, no 23.7% (sen)

No recorded response: 3.2%

  1. 31.

    Do you think a combined (neurosurgery and orthopaedic) spine fellowship should be offered?

Yes 38.9%, maybe 40.5%, no 15.9% (all)

Yes 44.7%, maybe 40.8%, no 9.2% (sen)

No recorded response: 5.6%

  1. 32.

    Do you think the EANS should develop a spine subspecialty-training program and fellowships?

Yes 56.3%, maybe 31%, no 8.7% (all)

Yes 59.2%, maybe 23.7%, no 13.2% (sen)

No recorded response: 3.2%

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Boszczyk, B.M., Mooij, J.J., Schmitt, N. et al. Spine surgery training and competence of European Neurosurgical Trainees. Acta Neurochir 151, 619–628 (2009). https://doi.org/10.1007/s00701-009-0259-8

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