Professionalism and performance issues during neurosurgical training and job satisfaction after training: a single training center 50-year experience

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Neurosurgery is often self-selecting. Concern has been raised that residents in the millennial era (born between 1982 and 2004) may have more serious professionalism and performance issues (PPIs) during training compared to prior trainees. Serious PPIs were defined as concerns that led to specific resident disciplinary actions ranging from initial warnings to termination. In order to evaluate this concern, the authors retrospectively reviewed a 50-year experience at a single training center. They then prospectively surveyed living graduates of the program to assess variations in practice patterns and job satisfaction over 5 decades.


The PPIs of 141 residents admitted for training at the University of Pittsburgh (subsequently UPMC) Department of Neurological Surgery were reviewed by decade starting in 1971 when the first department chair was appointed. The review was conducted by the senior author, who served from 1975 to 1980 as a resident, as a faculty member since 1980, and as the resident director since 1986. A review of resident PPIs between 1971 and 1974 was performed in consultation with a senior faculty member active at that time. During the last decade, electronic reporting of PPIs was performed by entry into an electronic reporting system. In order to further evaluate whether the frequency of PPIs affected subsequent job satisfaction and practice patterns after completion of training, the authors surveyed living graduates.


There was no statistically significant difference by decade in serious PPIs. Although millennial residents had no significant increase in the reporting of serious PPIs, the increased use of electronic event reporting over the most recent 2 decades coincided with a trend of increased reporting of all levels of suspected PPIs (p < 0.05). Residents surveyed after completion of training showed no difference by decade in types of practice or satisfaction-based metrics (p > 0.05) but reported increasing concerns related to the impact of their profession on their own lifestyle as well as their family’s.


There was no statistically significant difference in the incidence of serious PPIs over 5 decades of training neurosurgery residents at the authors’ institution. During the millennial era, serious PPIs have not been increasing. However, reporting of all levels of PPIs is increasing coincident with the ease of electronic reporting. There was remarkably little variance in satisfaction metrics or type of practice over the 5 decades studied.

ABBREVIATIONS ACGME = Accreditation Council on Graduate Medical Education; EMR = electronic medical record; PPI = professionalism and performance issue.

Article Information

Correspondence L. Dade Lunsford: University of Pittsburgh Medical Center, Pittsburgh, PA.

INCLUDE WHEN CITING Published online August 17, 2018; DOI: 10.3171/2018.3.JNS172347.

Disclosures Dr. Lunsford reports a consultant relationship with Insightec where he serves on the DSMB and direct stock ownership in AB Elekta.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Number of resident PPIs and program-exiting events by decade. Includes projections regarding future neurosurgical graduates from 2017 to 2020.

  • View in gallery

    Percentage of residents with an incident report over time from 2001 to 2017. Black line represents the trend over time.



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