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Neurological Surgery Training Abroad as a Progression to the Final Year of Training and Transition to Independent Practice.

BACKGROUND
Residents at the University of Virginia spend 1 year abroad at a neurological surgery program prior to their chief year. The Accreditation Council for Graduate Medical Education (ACGME) considers international rotations elective experiences and does not count them toward clinical accreditation.


OBJECTIVE
We compared clinical training obtained in New Zealand (NZ) to data from US ACGME-accredited programs to see if it was reasonable to reconsider the former as clinical training.


METHODS
We compared US national average chief case volumes to those performed by University of Virginia residents rotating in NZ over the past 3 years, using case volume comparisons and a survey of the residents' experience.


RESULTS
The mean number of cases performed in NZ was above the 50th percentile for US averages for adult cranial cases, including the 70th to 90th percentile for aneurysms and 50th to 70th percentile for tumors. The average number of cases performed in 1 year in NZ satisfied the cranial case quota for 4 of 6 adult and 2 of 3 pediatric areas over the entire residency. The rotation doubled the cranial exposure of graduating residents at the chief level without diluting the experience of residents in the core program. All residents reported being "very satisfied" with the experience, noting it facilitated their transition to chief year and independent practice.


CONCLUSIONS
Clinical training obtained during an international rotation in NZ is comparable to that attained in the United States. The international experience in NZ facilitated advancement in all 6 competencies, and should be considered adequate for clinical neurological surgery education.