Continuing education: the British experience.

The methods used to assess proficiency in neurosurgical trainees and consultant staff are reviewed. Under the auspice of the Surgical Royal Colleges trainees undergo a formal assessment 6 monthly by their trainer, annually by a local training committee and in their 3rd year of training by the Specialist Advisory Committee (SAC) in Neurosurgery. This committee supervises all neurosurgical training in the UK and Ireland and recommends trainees for the Certificate of Completion of Training if their training assessments and operative experience are satisfactory and if they have passed the Intercollegiate Specialty Examination in Neurosurgery. Assessing proficiency of consultant staff in the UK poses greater difficulty. For several years neurosurgeons have registered Continuing Medical Education (CME) credits on a voluntary basis. Such action is insufficient to reassure the public of professional competence. The General Medical Council (GMC) have submitted proposals for revalidation based on- (i) the maintenance of a 'folder' including details of performance, CME and complaints, (ii) annual appraisals carried out internally, (iii) a 5 yearly external assessment which if satisfactory would lead to revalidation by the GMC. Team working will be encouraged and consultants made responsible for the quality of service of their professional colleagues. A national comparative audit of subarachnoid haemorrhage should permit comparison of outcomes between neurosurgical units.