Resident peripheral nerve surgery competence: An assessment of procedural exposure, self-reported competence and technical ability

Background: Identifying peripheral nerve surgery procedure (PNSP) competencies is crucial to ensure adequate resident training. We examine PNSP training at neurosurgical centers in the US and Canada to compare residentreported competence, PNSP exposure, and resident technical abilities in performing 3 peripheral nerve coaptations (PNC). Methods: Resident-reported PNSP competence and PNSP exposure data were collected using questionnaires from neurosurgical residents at North American neurosurgical training centers. Exposure and self-reported competency were correlated with technical skills. Technical PNC variables collected included: time-to-completion, nerve-handling from video-analysis, independent and blinded visual-analog-scale (VAS) PNC quality grading by 3 judges, and training level.Results: A total of 40 neurosurgical residents participated in the study. Although self-reported competency scores correlated with procedural exposure (P < 0.01, rs = 0.88), a discrepancy was found between the degree of selfreported competency and amount of exposure. The discrepancy was greater in senior residents. A significant VAS difference was found between PNC types with the direct-suture and connector-assister groups scoring higher than connector-only (P = 0.02, P < 0.01, respectively). No difference was observed between training level and VAS grading, nor time-to completion (P = 0.33 and 0.25, respectively). No correlation was found between selfreported competency performing PNSPs and PNC VAS scores, nor nerve handling.Conclusions: Despite more exposure and a higher self-reported PNSP competency in senior residents, no difference was seen between senior/junior residents in PNC quality. A discrepancy in PNSP exposure and self-reported competency exists. This information will provide guidance for the direction of resident PNS training.

Automated summary

This study investigated PNSP training at neurosurgical centers in the US and Canada, finding a disparity in self-reported competence and exposure between senior and junior residents. There were differences in PNC quality between different types, but training level and time-to-completion were not correlated with quality grading.