Acta Neurochirurgica

, Volume 158, Issue 10, pp 1823–1830 | Cite as

Residency program trainee-satisfaction correlate with results of the European board examination in neurosurgery

  • Martin N. StienenEmail author
  • David Netuka
  • Andreas K. Demetriades
  • Florian Ringel
  • Oliver P. Gautschi
  • Jens Gempt
  • Dominique Kuhlen
  • Karl Schaller
Clinical Article - Neurosurgical Training



Substantial country differences in neurosurgical training throughout Europe have recently been described, ranging from subjective rating of training quality to objective working hours per week. The aim of this study was to analyse whether these differences translate into the results of the written and oral part of the European Board Examination in Neurological Surgery (EBE-NS).


Country-specific composite scores for satisfaction with quality of theoretical and practical training, as well as working hours per week, were obtained from an electronic survey distributed among European neurosurgical residents between June 2014 and March 2015. These were related to anonymous country-specific results of the EBE-NS between 2009 and 2016, using uni- and multivariate linear regression analysis.


A total of n = 1025 written and n = 63 oral examination results were included. There was a significant linear relationship between the country-specific EBE-NS result in the written part and the country-specific composite score for satisfaction with quality of theoretical training [adjusted regression coefficient (RC) −3.80, 95 % confidence interval (CI) -5.43–7 -2.17, p < 0.001], but not with practical training or working time. For the oral part, there was a linear relationship between the country-specific EBE-NS result and the country-specific composite score for satisfaction with quality of practical training (RC 9.47, 95 % CI 1.47–17.47, p = 0.021), however neither with satisfaction with quality of theoretical training nor with working time.


With every one-step improvement on the country-specific satisfaction score for theoretical training, the score in the EBE-NS Part 1 increased by 3.8 %. With every one-step improvement on the country-specific satisfaction score for practical training, the score in the EBE-NS Part 2 increased by 9.47 %. Improving training conditions is likely to have a direct positive influence on the knowledge level of trainees, as measured by the EBE-NS. The effect of the actual working time on the theoretical and practical knowledge of neurosurgical trainees appears to be insignificant.


Residency Training Country difference Board examination Residency Quality EANS European Board Examination Neurosurgery education Trainee satisfaction 



The authors thank Petra Koubova and Susie Hide from the European Association of Neurological Surgeons (EANS) for providing anonymous results of the EBE-NS.

Compliance with ethical standards


No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Supplementary material

701_2016_2917_MOESM1_ESM.docx (87 kb)
Supplementary Table 1 (DOCX 87 kb)


  1. 1.
    AlZhrani G, Alotaibi F, Azarnoush H, Winkler-Schwartz A, Sabbagh A, Bajunaid K, Lajoie SP, Del Maestro RF (2015) Proficiency performance benchmarks for removal of simulated brain tumors using a virtual reality simulator NeuroTouch. J Surg Educ 72:685–696CrossRefPubMedGoogle Scholar
  2. 2.
    Babu MA, Nahed BV, Heary RF (2012) Investigating the scope of resident patient care handoffs within neurosurgery. PLoS One 7:e41810CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Babu R, Thomas S, Hazzard MA, Friedman AH, Sampson JH, Adamson C, Zomorodi AR, Haglund MM, Patil CG, Boakye M, Lad SP (2014) Worse outcomes for patients undergoing brain tumor and cerebrovascular procedures following the ACGME resident duty-hour restrictions. J Neurosurg 121:262–276CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Babu R, Thomas S, Hazzard MA, Lokhnygina YV, Friedman AH, Gottfried ON, Isaacs RE, Boakye M, Patil CG, Bagley CA, Haglund MM, Lad SP (2014) Morbidity, mortality, and health care costs for patients undergoing spine surgery following the ACGME resident duty-hour reform: clinical article. J Neurosurg Spine 21:502–515CrossRefPubMedGoogle Scholar
  5. 5.
    Benzel EC (2010) Neurosurgery education: the pursuit of excellence. Clin Neurosurg 57:49–55PubMedGoogle Scholar
  6. 6.
    Bina RW, Lemole GM, Jr., Dumont TM (2015) On resident duty hour restrictions and neurosurgical training: review of the literature. J Neurosurg 1–7Google Scholar
  7. 7.
    Bohm PE, Arnold PM (2015) Simulation and resident education in spinal neurosurgery. Surg Neurol Int 6:33CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Brennum J (2000) European neurosurgical education–the next generation. Acta Neurochir (Wien) 142:1081–1087CrossRefGoogle Scholar
  9. 9.
    Brennum J, van Loon J (2016) Neurosurgical education in Europe. Acta Neurochir (Wien) 158:1–2CrossRefGoogle Scholar
  10. 10.
    Burkhardt JK, Zinn PO, Bozinov O, Colen RR, Bertalanffy H, Kasper EM (2010) Neurosurgical education in Europe and the United States of America. Neurosurg Rev 33:409–417CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Cappabianca P (2016) Reply to: “Neurosurgical resident education in Europe-results of a multinational survey”. Acta Neurochir (Wien)Google Scholar
  12. 12.
    Chan S, Conti F, Salisbury K, Blevins NH (2013) Virtual reality simulation in neurosurgery: technologies and evolution. Neurosurgery 72(Suppl 1):154–164CrossRefPubMedGoogle Scholar
  13. 13.
    Chowdhry SA, Spetzler RF (2014) Genealogy of training in vascular neurosurgery. Neurosurgery 74(Suppl 1):S198–S203CrossRefPubMedGoogle Scholar
  14. 14.
    Dumont TM, Rughani AI, Penar PL, Horgan MA, Tranmer BI, Jewell RP (2012) Increased rate of complications on a neurological surgery service after implementation of the Accreditation Council for Graduate Medical Education work-hour restriction. J Neurosurg 116:483–486CrossRefPubMedGoogle Scholar
  15. 15.
    EANS (accessed: February 29th, 2016) Accessed 29 Feb 2016
  16. 16.
    Gasco J (2014) Present and future of neurosurgery training and education. Malays J Med Sci 21:1–3PubMedPubMedCentralGoogle Scholar
  17. 17.
    Gephart MH, Derstine P, Oyesiku NM, Grady MS, Burchiel K, Batjer HH, Popp AJ, Barbaro NM (2015) Resident away rotations allow adaptive neurosurgical training. Neurosurgery 76:421–425, discussion 425–426CrossRefPubMedGoogle Scholar
  18. 18.
    Hoh BL, Neal DW, Kleinhenz DT, Hoh DJ, Mocco J, Barker FG 2nd (2012) Higher complications and no improvement in mortality in the ACGME resident duty-hour restriction era: an analysis of more than 107,000 neurosurgical trauma patients in the Nationwide Inpatient Sample database. Neurosurgery 70:1369–1381, discussion 1381–1362CrossRefPubMedGoogle Scholar
  19. 19.
    Joswig H, Hock C, Hildebrandt G, Schaller K, Stienen MN (2016) Microscopic lumbar spinal stenosis decompression: is surgical education safe? Acta Neurochir (Wien) 158:357–366CrossRefGoogle Scholar
  20. 20.
    Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC (2014) The role of laboratory dissection training in neurosurgical residency: results of a national survey. World Neurosurg 82:554–559CrossRefPubMedGoogle Scholar
  21. 21.
    Lister JR, Friedman WA, Murad GJ, Dow J, Lombard GJ (2010) Evaluation of a transition to practice program for neurosurgery residents: creating a safe transition from resident to independent practitioner. J Grad Med Educ 2:366–372CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Norby K, Siddiq F, Adil MM, Haines SJ (2014) The effect of duty hour regulations on outcomes of neurological surgery in training hospitals in the United States: duty hour regulations and patient outcomes. J Neurosurg 121:247–261CrossRefPubMedGoogle Scholar
  23. 23.
    Oliveira MM, Araujo AB, Nicolato A, Prosdocimi A, Godinho JV, Valle AL, Santos M, Reis AB, Ferreira MT, Sabbagh A, Gusmao S, Del Maestro R (2015) Face, content, and construct validity of brain tumor microsurgery simulation using a human placenta model. NeurosurgeryGoogle Scholar
  24. 24.
    Omerhodzic I, Tonge M, Matos B, Musabeliu E, Raspanti C, Ferdinandov D, Galimova R, Muroi C, Balik V, Kursumovic A (2012) Neurosurgical training programme in selected European countries: from the young neurosurgeons’ point of view. Turk Neurosurg 22:286–293PubMedGoogle Scholar
  25. 25.
    Parker SL, McGirt MJ, Asher AL, Selden NR (2015) Quality improvement in neurological surgery graduate medical education. Neurosurg Clin N Am 26(231–238):ixGoogle Scholar
  26. 26.
    Robison RA, Liu CY, Apuzzo ML (2011) Man, mind, and machine: the past and future of virtual reality simulation in neurologic surgery. World Neurosurg 76:419–430CrossRefPubMedGoogle Scholar
  27. 27.
    Rosseau G, Bailes J, del Maestro R, Cabral A, Choudhury N, Comas O, Debergue P, De Luca G, Hovdebo J, Jiang D, Laroche D, Neubauer A, Pazos V, Thibault F, Diraddo R (2013) The development of a virtual simulator for training neurosurgeons to perform and perfect endoscopic endonasal transsphenoidal surgery. Neurosurgery 73(Suppl 1):85–93CrossRefPubMedGoogle Scholar
  28. 28.
    Schaller K (2013) Neurosurgical training under European law. Acta Neurochir (Wien) 155:547CrossRefGoogle Scholar
  29. 29.
    Starke RM, Jane JA Jr, Asthagiri AR, Jane JA Sr (2015) International rotations and resident education. J Neurosurg 122:237–239CrossRefPubMedGoogle Scholar
  30. 30.
    Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K (2016) Neurosurgical resident education in Europe—results of a multinational survey. Acta Neurochir (Wien) 158:3–15CrossRefGoogle Scholar
  31. 31.
    Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K (2016) Training and career aspects of female neurosurgical residents in Europe. J Neurosurg. doi: 10.3171/2016.4.JNS16788
  32. 32.
    Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K (2016) Working time of neurosurgical residents in Europe—results of a multinational survey. Acta Neurochir (Wien) 158:17–25CrossRefGoogle Scholar
  33. 33.
    Sure U, Miller D, Bozinov O (2007) Neurosurgical training in Europe, problems and possible solutions. Surg Neurol 67:626–628, discussion 628–633CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Martin N. Stienen
    • 1
    • 2
    Email author
  • David Netuka
    • 3
  • Andreas K. Demetriades
    • 4
  • Florian Ringel
    • 5
    • 6
  • Oliver P. Gautschi
    • 1
    • 2
  • Jens Gempt
    • 5
  • Dominique Kuhlen
    • 7
  • Karl Schaller
    • 1
    • 2
  1. 1.Department of Neurosurgery and Faculté de MédicineUniversity Hospital of GenevaGenevaSwitzerland
  2. 2.Service de Neurochirurgie, Département des Neurosciences CliniquesHôpitaux Universitaires de GenèveGenèveSuisse
  3. 3.Department of NeurosurgeryCharles University, 1st Medical Faculty, Central Military HospitalPragueCzech Republic
  4. 4.Department of NeurosurgeryWestern General HospitalEdinburghUK
  5. 5.Department of Neurosurgery, Klinikum Rechts der IsarTechnical University MunichMunichGermany
  6. 6.Department of NeurosurgeryUniversitätsmedizin MainzMainzGermany
  7. 7.Department of NeurosurgeryEnte Ospedaliero CantonaleBellinzonaSwitzerland

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