Neurosurgical Training in Europe

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Dear colleagues,

Neurosurgical training varies widely across the EANS member states and across the individual training facilities today. While a substantial amount of clinics continue to follow the “traditional concept” of neurosurgical training including long working hours, little autonomous decision-making of the resident and sparse own surgeries for the initial years, others have introduced structured training programs, enabling a fast and goal-orientated resident training.

Today, we are facing profound changes in the way young neurosurgeons are trained. The introduction of the European Working Time directive 2003/88/EC has led to a reduction of the working hours with distinct and inevitable impact on the exposure of residents in training to the operative environment. This law has been implemented quickly and rigorously at some institutions, while in other clinics the effects are just beginning to emerge. As a conceivable consequence of the ongoing amendments, however, neurosurgical trainees will finish their residency with much less practical experience, whilst it is expected from them to maintain a high quality of care. We should be worried when already today European residents encounter only half the amount of cases when compared to Northern American-/US-trainees.

This paradigm shift comes in a time of increasing expectations from patients, who are well informed about modern high-tech developments. Ultimately, increasing societies demands for a safer operating environment and optimized outcomes have to be fulfilled by less-trained future physicians, which stresses the importance of earlier and more goal-oriented surgical training.

In addition, the Working Time Directive has substantial influence on our future job and career options. As the number of working hours is restricted by law, many clinic directors have to react by employing more residents. Unavoidably, this hampers the surgical training of all trainees, as a stable amount of procedures performed at the training facility is now distributed among more residents. As a consequence, a markedly higher number of neurosurgical residents will have finished their residency and must now compete for only few attractive consultant job positions available in a small specialty such as neurosurgery.

There are some possibilities to deal with this new situation, and the generation of young neurosurgeons should get involved and decide on their own future. In order to assess the quality of resident education today and to find out the opinion of most young neurosurgeons, we have thus initiated an online survey. Your opinions regarding

a) resident training at your institution today
b) implications of the European Working Time directive 2003/88/EC
c) future perspectives

will be collected and the results will be published in the Acta Neurochirurgica as official organ of the EANS. You will see in the survey that there are no limits to this discussion – options like the progressive use of simulator training, compulsory training courses, or even the extension of the residency to 7 or 8 years in the context of improved resident training are included in this discussion.

We would welcome your participation in order to being able and represent the opinion of the vast majority of neurosurgical residents in Europe. Despite some efforts to keep this survey as short as possible, a certain amount of questions are required to fulfil the responsibility of a comprehensive data collection. Thus, your participation will take about 15 minutes.

We assure you that confidentiality is kept on your data. We hope to obtain interesting results that will help to improve resident education in Europe and influence the political decision-making.

We are happy to answer any questions/comments regarding this survey.


Andreas Demetriades, MD (UK) 
Oliver P. Gautschi, MD (CH) 
Dominique Kuhlen, MD (CH) 
David Netuka, MD (CZ) 
Florian Ringel, MD (DE) 
Karl Schaller, MD (CH) 
Martin N. Stienen, MD (CH)