view PDF - American Association of Neurological Surgeons

P ERSONAL P ERSPECTIVE
W ILLIAM T .
C OULDWELL, MD
Considering the Evidence
AANS Bulletin Delivers Data
On July 1, 2003, resident work-hour
restrictions were imposed by the
Accreditation Council for Graduate
Medical Education. In this issue of
the Bulletin, we highlight two studies that
examine the effects of the 80-hour workweek
on neurosurgical resident education.
At the University of Oklahoma, both junior
and chief residents were exposed to less volume
of surgery following introduction of
the restrictions. In the University of Utah
study, the number of cases in which the
junior residents were involved decreased 45
percent after the implementation of the
work hour restrictions.
The reduced work hour rules were
imposed without neurosurgical program
directors’ input, and many do not agree
with the changes implemented. Many residents,
on the other hand, have welcomed
the work hour limitations. What will be the
impact of these changes on the practicing
neurosurgical graduate As noted by Martin
and Wolfla, while it is apparent that many in
our field do not agree with these rules, it is
imperative that further study be carried out
to ensure that trainees graduating from
neurosurgical residency are competent.
Further, while the issue of competency
has been a concern for many program
directors, no studies to date have objectively
assessed the effect of such work
restrictions on trainee technical competency.
Will this limitation of experience
affect competency, or will extra nonwork-hour
time be compensated by
increased reading and hence knowledge of
the resident These questions should be
the focus for careful analysis over the next
few years. If the residency training will
limit technical involvement and competency,
then we must consider other alternative
means for education, such as
surgical simulation training. Alternatively,
fellowship training will continue to propagate
as a mechanism to develop competency
in focused areas of practice.
As many neurosurgeons are contemplating
practice restrictions, Richard N.W.
Wohns, MD, has compiled a thoughtful
analysis of the microeconomics of per-
William T. Couldwell,
MD, is editor of the
AANS Bulletin.
forming cranial surgeries. Individual
neurosurgeons will be able to mirror this
template analysis and consider the implications
of ceasing performance of these procedures
in the context of their own
particular practice demographics, reimbursement
patterns, malpractice premiums,
AANS Bulletin:
A Top Member Benefit and a
Leading Predictor of Satisfaction
With AANS Membership
The AANS Bulletin is the primary source
of news that affects the practice of neurosurgery:
practice management, legislation,
coding and reimbursement, professional
development and education, and
more. Readers are invited to participate
in the Bulletin:
Neurosurgical Professionals
• Write a letter to the editor.
• Submit an article or article idea.
and on-call responsibilities. These factors
impact the profitability of cranial procedures,
another of the many factors that
must be considered when weighing the
decision to restrict one’s practice.
Also in this issue is an overview of the
Maintenance of Certification program put
forth by the American Board of Neurological
Surgery for rollout in January 2006.
The key elements are published in the
MOC handbook and are summarized in
this issue of the Bulletin. MOC will be a
foremost consideration for many neurosurgeons
in the coming years. Neurosurgery
has been one of the last medical
specialties to adopt an MOC initiative, and
we thank the ABNS and the many individuals
involved with the question-writing
committee for their efforts in the development
of the MOC program. 3
William T. Couldwell, MD, is professor and Joseph J.
Yager Chair of the Department of Neurosurgery at the
University of Utah School of Medicine.
• Submit socioeconomic research papers
for peer review.
• Provide news briefs to News.org.
• Submit a neurosurgical meeting to the
online calendar.
Corporations
• Advertise in the Bulletin.
• Sponsor the Bulletin
(an exclusive opportunity).
Learn more at www.aans.org/bulletin.
Volume 14, Number 4 • AANS Bulletin 11