Supplementary Table 1: Questionnaire That Was Used

Supplementary table 1: Questionnaire that was used.

A)General information

1)What is your age?

< 25 years
25 – 30 years
30 – 35 years
35 – 40 years
> 40 years

2)What is your gender?

Female
Male

3)Are you a neurosurgical resident?

4)How advanced are you with your neurosurgical residency?

1st year
2nd year
3rd year
4th year
5th year
6th year
> 6th year

5)Did general surgery precede your neurosurgical residency (“common trunk”; e.g. 1 or 2 years)?

6)In which hospital/clinic do you work?

University Hospital
Non-university (public) hospital
Private clinic
Other (please specify: ______)

7)In which country do you work?

______(to be filled out by participant)

8)How many residents work at your neurosurgical department?

______(to be filled out by participant)

9)How many board-certified consultants/attendings (incl. leading physicians/head of department) work at your neurosurgical department?

______(to be filled out by participant)

10)How many surgeries are performed at your neurosurgical department per year?

Cranial (e.g. 300): ______
Spinal (e.g. 1200): ______
Peripheral nerve (e.g. 800): ______
Pediatric (e.g. 180): ______
Functional (e.g. 175): ______

11)What career do you currently aim for (multiple answers possible)?

University career
Consultant/attending at a general hospital
Private practice
Scientific career, not practical neurosurgery
Different specialty, not neurosurgery
Family, wife/husband and kids, neurosurgery possibly part-time
Other (please specify: ______)

12) Is there a defined amount of time during your residency dedicated to scientific work (by contract with your employer/clinic/institution)?

No
Yes; hours per week: ______

13) What are your main specialties in neurosurgery that you already focus on, or that you intend to focus on in the near future (multiple choice possible)?

Spine
Vascular, skull base
Trauma
Neurooncology, epilepsy surgery
Functional/stereotactic neurosurgery
Pediatric neurosurgery
General neurosurgery
Other (please specify: ______)

B)Present situation / neurosurgical resident education

14) How satisfied are you with your current training facility/clinic in terms of … clinical lectures?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

anatomical lectures?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

journal club?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

multi-disciplinary meetings (e.g. tumor board)?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

ward rounds?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

radiology meetings?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

15) How satisfied are you with your current training facility/clinic in terms of…hands-on operative exposure (own surgical procedures)?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

hands-on microsurgical training?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

hands-on simulation training (computerized models/virtual surgery)?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

hands-on cadaveric training?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

decision-making in patient management?

Very satisfied
Satisfied
It`s allright
Dissatisfied
Very dissatisfied
Non-existing

16) Have you used neurosurgical (computerized) simulator training before?

17) When do residents at your training facility/clinic begin with any own surgeries (including relatively simple procedures, e.g. burr holes for ventriculostomy, chronic subdural hematomas, ICP probes)?

< 3 months of training
> 3 months and < 6 months of training
> 6 months and < 12 months of training
> 12 months and < 24 months of training
after 24 months of training
residents perform no own surgeries as primary surgeon at my institution

18) When do residents at your training facility/clinic begin with own lumbar spinal surgeries (e.g. sequestrectomy for lumbar disc herniation, decompression of degenerative lumbar stenosis)?

< 3 months of training
> 3 months and < 6 months of training
> 6 months and < 12 months of training
> 12 months and < 24 months of training
after 24 months of training
residents perform no own lumbar surgeries as primary surgeon at my institution

19) When do residents at your training facility/clinic begin with own cervical spinal surgeries (e.g. anterior cervical discectomy with/without fusion)?

< 6 months of training
> 6 months and < 12 months of training
after 12 months of training (1 year)
after 24 months of training (2 years)
after 36 months of training (3 years)
residents perform no own cervical surgeries as primary surgeon at my institution

20) When do residents at your training facility/clinic begin with own cranial surgeries (e.g. intracranial meningiomas, epidural/subdural hematomas; IMPORTANT: the complete procedure should be performed by the resident in training, not the craniotomy only)?

< 12 months
after 12 months of training (1 year)
after 24 months of training (2 years)
after 36 months of training (3 years)
after 48 months of training (4 years)
residents perform no cranial surgeries as primary surgeon at my institution

21) How many own peripheral nerve procedures on a patient have you performed in average per month over the last three months (e.g. carpal tunnel syndrome; best estimate)?

None
1-3
4-10
11-20
20-40
>40

22) How many own burr hole trepanations on a patient have you performed in average per month over the last three months (e.g. ICP probe, ventriculostomy, chronic subdural hematoma; best estimate)?

None
1-3
4-10
11-20
20-40
>40

23) How many own spinal surgeries on a patient have you performed in average per month over the last three months (whole spine - e.g. discectomy, decompression, spinal fusion; no infiltrations!; best estimate)?

None
1-3
4-10
11-20
20-40
>40

24) How many own craniotomies on a patient have you performed in average per month over the last three months (best estimate)?

None
1-3
4-10
11-20
20-40
>40

C)Working Time – Working Time Directive 2003/88/EC

25) How do you estimate the percentage of practical/surgical activity during a regular week (day time, monday - friday, no nightshift or weekend; best estimate)?

I am currently not involved in the operation room
< 25% of my daily working time
25 – 50% of my daily working time
51 – 75% of my daily working time
> 75% of my daily working time

26) How do you estimate the percentage of administrative activity/paper work during a regular week (day time, monday - friday, no nightshift or weekend; best estimate)?

I do not have to do administrative or paper work
< 25% of my daily working time
25 – 50% of my daily working time
51 – 75% of my daily working time
> 75% of my daily working time

27) How many hours are you present at your training facility/clinic per week for clinical work (IMPORTANT: only Monday – Friday, no weekend, no nightshift, no scientific work; best estimate)?

< 40
41 – 50
51 – 60
61 – 70
71 – 80
> 80

28) How many hours per week do you additionally spend for scientific work (may include the weekend or free-time; best estimate)?

None
< 10
10 - 20
20 - 30
30 – 40
> 40

29) Do you know what the content of the Working Time Directive 2003/88/EC and what it implies?

Yes
No details, but I have heard of it
No

30) How do you feel about your current working time (please chose the answer that comes closest to your opinion)?

I would prefer working more hours if I then received a better surgical education (more time in the operation room)
I am satisfied with the current situation
I work too many hours/week and prefer reduced working time, even if this could negatively affect my surgical education
I have no opinion

31) How do you feel about working time restrictions by law, e.g. the Working Time Directive 2003/88/EC (please chose the answer that comes closest to your opinion)?

Positive - I am glad that the politic has reacted adequately on this issue
Positive - but working time needs to be even more restricted
Negative - I am against working time restrictions by law
I have no opinion

32) How do you think should neurosurgical clinic directors react on the Working Time Directive 2003/88/EC (multiple answers possible)?

Employ more residents, even though this could impair the surgical education of all trainees at the institution
Reduce administrative work for residents (e.g. employ physician assistants, case managers, internal medicine physicists to do the work on the ward)
Ignore the Working Time Directive
Other (please specify: ______)

D)Future perspectives

33) Do you currently believe that after completion of your residency – based on your clinical education – you will be able to manage every clinical situation on your own full responsibility as consultant/attending?

Yes, surely
Yes, if especially my practical/surgical/technical training improves in the remaining residency period
Yes, if especially my theoretical training improves in the remaining residency period
Yes, if both my practical and theoretical training improved in the remaining residency period
No, I feel I especially have too little practical/surgical/technical experience
No, I feel I especially have too little theoretical experience
No, I have neither received enough practical nor theoretical training in my residency

34) Have you completed a fellowship / internship in a foreign country (e.g. Europe, USA, Canada, etc.) during your residency?

No
Yes; how many months: ______

35) Do you intend to complete a fellowship after your neurosurgical residency in order to get more operative exposure before you take up an independent position as consultant/attending?

Yes
No
Not sure yet

36) How do you feel about extending the residency (e.g. 7 or 8 years) in order to ensure a better and more complete clinical education in times of reduced working hours (multiple answers possible)?

A good option, because more cases are seen and managed by the resident until he/she has to work on own full responsibility
A good option, but only if wages of residents are notably elevated in their final years of education
A bad option, because residency would be adequately long today if administrative/paper work could be reduced
A bad option, since this would discourage medical students to take on an education in neurosurgery
A bad option, since it is more difficult for residents to apply for research grants, etc. than for consultants, which would hamper my scientific career
Other (please specify: ______)

37) How do you feel about obligatory practical training courses for all European residents (e.g. cervical/lumbar spine course; craniotomy course organized by the EANS or other qualified organisations) in order to ensure a better and more complete clinical education?

I believe this would be good
I do not believe that this is necessary

38) How do you feel about the progressive use of simulator training (e.g. video-assisted cranial endoscopy; transsphenoid pituitary surgery; etc.) in resident education?

I believe it is of value
I do not believe it is of value

39) Are you worried about future career chances?