Preparedness of neurosurgery graduates for neuroendovascular fellowship: a national survey of fellowship programs

Abstract

OBJECT Endovascular interventions have become an essential part of a neurosurgeon’s practice. Whether endovascular procedures have been effectively integrated into residency curricula, however, remains uncertain. The purpose of this study was to assess the preparedness of US neurosurgery graduate trainees for neuroendovascular fellowship. METHODS A multidomain, global assessment survey was sent to all directors/faculty of neuroendovascular fellowship programs involved in training of US neurosurgery graduates. Surveyees were asked to assess trainees as they entered fellowship. RESULTS The response rate was 78% (25/32). Of respondent program directors, 38% reported that new fellows did not know the history and imaging of the patient and 50% were unable to formulate an appropriate treatment plan. As many as 79% of fellows were unfamiliar with endovascular devices and 75% were unfamiliar with angiographic equipment. Furthermore, 58% of fellows were unable to perform femoral access, 54% were unable to perform femoral closure, 79% were unable to catheterize a major vessel, 86% were unable to perform a 4-vessel angiogram, and 100% were unable to catheterize an aneurysm. Additionally, program directors reported that over 50% of fellows could not recognize neurovascular anatomy and 54% could not recognize/classify vascular abnormalities. There was an overall agreement that fellows demonstrated professionalism and interest in research and had good communication/clinical skills. CONCLUSIONS The results of this study suggest potential gaps in the training of neurosurgery residents with regard to endovascular neurosurgery. In an era of minimally invasive therapies, changes in residency curricula may be needed to keep pace with the ever-changing field of neurosurgery.

Graduating otolaryngology resident preparedness for fellowship as assessed by fellowship faculty

“…The participating PDs had significant concerns about resident preparedness for fellowship in several domains, including independence in the operating room (OR), laparoscopic skills, suturing, and clinical abilities. Studies in obstetrics and gynecology and neurosurgery yielded similar results . Additionally, recent general surgery residency graduates expressed a significant lack of confidence upon graduation due to limited experiential learning …”

“…Studies in obstetrics and gynecology and neurosurgery yielded similar results. 1,7 Additionally, recent general surgery residency graduates expressed a significant lack of confidence upon graduation due to limited experiential learning. [8][9][10][11] The results of these surveys suggest that residents may not have the surgical expertise expected of a new graduate entering fellowship, raising significant concerns about the current structure of residency training with increased regulation and less autonomy.…”

Simple training tricks for mastering and taming bypass procedures in neurosurgery

“…Neurosurgery is considered to be a highly demanding field with time consuming and intensive training. [ 4 13 ] Vascular and bypass neurosurgery may be considered even more demanding, requiring meticulous and long training hours. [ 1 8 15 18 19 ] The need for vascular neurosurgeons will probably decrease in the future with the changes in the landscape of neurovascular diseases in combination with advances in endovascular techniques.…”

Hybrid Neurosurgeon: Panacea to Debate on Coiling versus Clipping

“…In an era of minimally invasive therapies, changes in residency curricula may be needed to keep pace with the ever-changing field of neurosurgery. 7 In our institute, once our department decided to start the program, I and one more faculty member went for training in the endovascular procedures. Since then we could start coiling of the aneurysms and our residents are now getting the training simultaneously in both conventional neurosurgery and endovascular surgery.…”

“…These training programs should be scrutinized and monitored and critical evaluation of the outcome should be done. 6,7…”