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Enhancing competence in graduates through a transition to practice program in neurological surgery.

Residency training in the United States has undergone a striking change with the advent of the 80-hour workweek in 2003 (Figure 1). Surgical disciplines have been especially affected because of the acuity of patient illness and the need for time-intensive, hands-on procedural training. Neurosurgical training has also been affected, and many in the neurosurgery establishment believe that this reduction in hours has had a negative effect on training. In particular, the traditional chief residency has suffered. The dictum of the American Board of Neurological Surgery requires that as senior-most, or chief, resident, ‘‘the trainee shall have major or primary responsibility for patient management, as well as administrative responsibilities, as designated and deemed appropriate by the program director.’’ In the last decade, because of rules requiring immediate availability of faculty for all surgical cases, changing patient expectations at academic centers, and oppressive malpractice environments, this period of training has changed. Chief residents are no longer easily able to embrace this comprehensive and primary responsibility for patient care. Similarly, other aspects of training, including administrative responsibilities, billing practices, and coding education, have been left lacking. To address these changes, the University of Florida has adopted a transition to practice (TTP) program. This program allows residents a 6to 12month period as a heavily mentored junior faculty member with independent operative, clinic, and on-call time. We reviewed the experience of the 8 residents who have completed this program since 2005.