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?
- Yes
- No
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)?
- No
- Yes
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?
- No
- Yes
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?
- No
- Yes