Training of Cerebrovascular Specialists: The Surgeon's View.

The key to becoming an expert in a surgical field is mainly practice and perseverance. The old-fashioned system of teaching from one older person to a younger one, by simple demonstration, imitation, and practice, cannot be replaced in the surgical field by more modern didactic tools. Structured and explicit concepts, however, can accelerate the learning process. Structured concepts consist of a system of specifics-for example, types of aneurysms in the field of vascular pathology-and standard operating procedures. It is important to realize that the teaching requirements of the surgical disciplines differ substantially from those of the conservative disciplines. The number of procedures performed is probably the most critical factor for competence. At our center we have used the target number of 100 microsurgical aneurysm cases treated under supervision before sufficient competence is considered to have been achieved for independent surgery. Following initial training a certain amount of practice is required to remain current or competent. The proficiency requirements accepted in aviation could be seen as a guide for proficiency requirements in neurosurgery. In aviation, a minimum of 12 per year is specified for most critical procedures.