Radiation oncology partnership and its impact on neurosurgery
Leksell Gamma Knife Conference in the land down under
Jason P. Sheehan
Neurosurgical training is critical in providing residents with the skill set, knowledge, and confidence to perform challenging neurosurgical procedures. Radiosurgery, which neurosurgeons helped define and refine, differs from more traditional, open neurosurgical approaches. This study evaluates the opinions of residents on current radiosurgical training and the effect of a focused educational course on those residents.
The American Association of Neurological Surgeons sponsored a 3-day course focused on intracranial and spinal radiosurgery. Senior-level residents were nominated by US program directors to participate in the course. Twenty-eight residents from distinct training programs were surveyed before and after the course to discern current training practices in radiosurgery and the effect of the focused educational program. The median training level of the participants was postgraduate Year 5 (mean 5.3 years, range 3–7 years).
Two-thirds of residents reported that their training institutions had no formal radiosurgery rotation. Twenty-five percent planned to obtain postresidency fellowship training that would include radiosurgery. Before the course, 79% of the residents expected to include radiosurgery in their practice. However, prior to the course, those describing themselves as “very uncomfortable” with performing intracranial or spinal radiosurgery were 33.3 and 45.8%, respectively. After the course, mean self-assessment scores for understanding the indications and performing intracranial radiosurgery increased by 43 and 89%, respectively. The mean scores for understanding the indications and comfort with performing spinal radiosurgery increased by 79 and 200%, respectively. Following the course, there was a 12.3% increase in the number of residents planning to perform radiosurgery following residency.
Current neurosurgical residents appear uneasy about their grasp of radiosurgical indications and their ability to perform the procedure. Focused training courses sponsored by professional societies may improve resident education and training in this area of neurosurgery, which has a skill set and basis of knowledge different from traditional open neurosurgical procedures. Further evaluation of the radiosurgical training process for residents must be performed so as to ensure competency and sufficient workforce to meet expanding demands for neurosurgeons performing radiosurgery in a multidisciplinary climate.