Stienen Martin N, Netuka David, Demetriades Andreas K, Ringel Florian, Gautschi Oliver P, Gempt Jens, Kuhlen Dominique, Schaller Karl
Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
Department of Neurosurgery, 1st Medical Faculty, Central Military Hospital, Charles University, Prague, Czech Republic.
Acta Neurochir (Wien). 2016 Jan;158(1):3-15. doi: 10.1007/s00701-015-2632-0. Epub 2015 Nov 17.
Neurosurgical training aims at educating future generations of specialist neurosurgeons and at providing the highest-quality medical services to patients. Attaining and maintaining these highest standards constitutes a major responsibility of academic or other training medical centers.
An electronic survey was sent to European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression analysis was used to assess the effect size of the relationship between responder-specific variables (e.g., age, gender, postgraduate year (PGY), country) and the outcomes (e.g., satisfaction).
A total of 652 responses were collected, of which n = 532 were taken into consideration. Eighty-five percent were 26-35 years old, 76 % male, 62 % PGY 4 or higher, and 73.5 % working at a university clinic. Satisfaction rates with theoretical education such as clinical lectures (overall: 50.2 %), anatomical lectures (31.2 %), amongst others, differed largely between the EANS member countries. Likewise, satisfaction rates with practical aspects of training such as hands-on surgical experience (overall: 73.9 %), microsurgical training (52.5 %), simulator training (13.4 %), amongst others, were highly country-dependant. In general, 89.1 % of European residents carried out the first surgical procedure under supervision within the first year of training. Supervised lumbar-/cervical spine surgeries were performed by 78.2 and 17.9 % of European residents within 12 and 24 months of training, respectively, and 54.6 % of European residents operate a cranial case within the first 36 months of training. Logistic regression analysis identified countries where residents were much more or much less likely to operate as primary surgeons compared to the European average. The caseload of craniotomies per trainee (overall: 30.6 % ≥10 craniotomies/month) and spinal procedures (overall: 29.7 % ≥10 spinal surgeries/month) varied throughout the countries and was significantly associated with more advanced residency (craniotomy: OR 1.35, 95 % CI 1.18-1.53, p < 0.001; spinal surgery: OR 1.37, 95 % CI 1.20-1.57, p < 0.001).
Theoretical and practical aspects of neurosurgical training are highly variable throughout European countries, despite some efforts within the last two decades to harmonize this. Some countries are rated significantly above (and others significantly below) the current European average for several analyzed parameters. It is hoped that the results of this survey should provide the incentive as well as the opportunity for a critical analysis of the local conditions for all training centers, but especially those in countries scoring significantly below the European average.
神经外科培训旨在培养未来的专科神经外科医生，并为患者提供最高质量的医疗服务。达到并维持这些最高标准是学术或其他培训医疗中心的一项主要责任。
在2014年6月至2015年3月期间，向欧洲神经外科住院医师发送了一份电子调查问卷。采用多元逻辑回归分析来评估应答者特定变量（如年龄、性别、研究生年级（PGY）、国家）与结果（如满意度）之间关系的效应大小。
共收集到652份回复，其中532份被纳入考虑。85%的应答者年龄在26 - 35岁之间，76%为男性，62%为PGY 4及以上，73.5%在大学诊所工作。欧洲神经外科协会（EANS）成员国之间，对临床讲座等理论教育的满意度（总体：50.2%）、解剖学讲座（31.2%）等差异很大。同样，对手术实践方面的培训满意度，如实际手术经验（总体：73.9%）、显微外科培训（52.5%）、模拟器培训（13.4%）等，也高度依赖于国家。总体而言，89.1%的欧洲住院医师在培训的第一年内就在监督下进行了第一台手术。分别有78.2%和17.9%的欧洲住院医师在培训12个月和24个月内进行了有监督的腰椎/颈椎手术，54.6%的欧洲住院医师在培训的前36个月内进行了颅脑手术。逻辑回归分析确定了与欧洲平均水平相比，住院医师作为主刀医生进行手术可能性更高或更低的国家。每个受训者的开颅手术例数（总体：30.6%≥每月10例开颅手术）和脊柱手术例数（总体：29.7%≥每月10例脊柱手术）在各国有所不同，并且与更高年级的住院医师显著相关（开颅手术：比值比1.35，95%置信区间1.18 - 1.53，p < 0.001；脊柱手术：比值比1.37，95%置信区间1.20 - 1.57，p < 0.001）。
尽管在过去二十年里做出了一些协调神经外科培训的努力，但欧洲各国在神经外科培训的理论和实践方面仍存在很大差异。在几个分析参数方面，一些国家的评分显著高于（其他国家显著低于）当前的欧洲平均水平。希望本次调查结果能为所有培训中心，尤其是那些评分显著低于欧洲平均水平国家的培训中心，提供对当地情况进行批判性分析的动力和机会。
