1Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, Victoria.
2Department of Surgery, University of Melbourne, Parkville, Victoria.
Neurosurg Focus. 2020 Mar 1;48(3):E10. doi: 10.3171/2019.12.FOCUS19870.
Neurosurgical training poses particular challenges in Australia and New Zealand, given the large landmass, small population, and widely separated, often small, neurosurgical units. Such factors have necessitated a move away from autonomous, single-institution-based training to the selection of trainees by a centralized binational process. The success of this system is based on rigorous standardized evaluation of candidates' academic achievements, anatomical knowledge, references, and interview performance. Similarly, the accreditation of hospitals to train successful candidates has been standardized. The authors review the evolution of trainee selection and the accreditation of training posts in Australia and New Zealand.
The records of the Neurosurgical Society of Australasia Surgical Education and Training Board were reviewed for documents pertaining to the selection of neurosurgical trainees and the accreditation of training posts. Application records and referee scores from 2014 to the present were reviewed to encompass process changes, in particular the change from written referee reports to standardized interviews of referees. Surgical logbook case numbers for 23 trainees completing training in 2016, 2017, and 2018 were collated and presented in an aggregated, de-identified form as a measure of adherence to accreditation standards. Written evaluations of the training experience were also sought from two trainees reflecting on the selection process, the quality of training posts, and training limitations.
While a time-consuming process, the method of obtaining referee reports by interview has resulted in a wider spread of scores, more able to separate high- and low-scoring applicants than other components of the selection process. Review of the training post accreditation records for the last 2 years showed that adherence to standards has resulted in loss of accreditation for one unit and shortened periods of review for units with more minor deficiencies. Two applications for accreditation have been denied. Examination of caseload data showed that trainees more than fulfill minimum requirements in accredited training posts, confirming the robust nature of this aspect of unit accreditation.
A key factor determining the success of neurosurgical training in Australia and New Zealand has been a willingness to evolve selection and other processes to overcome challenges as they become apparent. According to available analyses, the revised referee process and strict accreditation standards appear effective. The benefits and challenges of the current training system are discussed in the context of a paucity of international literature.
鉴于澳大利亚和新西兰地域辽阔、人口稀少，且神经外科单位分布广泛且往往规模较小，神经外科培训带来了特殊挑战。这些因素使得培训模式从自主的、单一机构的培训转向了由集中的两国联合程序选拔学员。该系统的成功基于对候选人学术成就、解剖知识、参考文献和面试表现的严格标准化评估。同样，对培训医院的认证也已标准化。作者回顾了澳大利亚和新西兰神经外科培训学员的选拔和培训职位认证的演变过程。
查阅澳大利亚神经外科学会外科教育和培训委员会的记录，获取与神经外科培训学员选拔和培训职位认证相关的文件。审查了 2014 年至今的申请记录和推荐人评分，以涵盖流程变化，特别是从书面推荐人报告改为标准化推荐人面试。整理并汇总了 2016 年、2017 年和 2018 年完成培训的 23 名学员的手术日志记录病例数，作为遵守认证标准的指标。还从两名反映选拔流程、培训职位质量和培训限制的学员那里寻求了对培训经历的书面评价。
虽然这是一个耗时的过程，但通过面试获取推荐人报告的方法导致评分范围更广，能够更好地区分高分和低分申请人，比选拔过程的其他组成部分更具区分度。对过去 2 年的培训职位认证记录的审查显示，遵守标准导致一个单位失去认证，而对存在较小缺陷的单位缩短了审查期。有两个认证申请被拒绝。对病例数量数据的检查表明，学员在认证培训职位中远远超过了最低要求，这证实了单位认证这一方面的稳健性。
决定澳大利亚和新西兰神经外科培训成功的一个关键因素是愿意随着问题的出现而不断发展选拔和其他流程。根据现有分析，经修订的推荐人流程和严格的认证标准似乎是有效的。在国际文献匮乏的情况下，讨论了当前培训系统的优势和挑战。
