The role of audit in a neurosurgical training programme in Saudi Arabia

Background: The future of a speciality depends on, among other factors, its training programme; this involves the education contract. Surgical audit provides a mechanism for educators to monitor in real-time the performance of residents and hospitals. Setting: Department of Neurosurgery, King Faisal University, Dammam, Saudi Arabia. Methods: A prospective audit was established. 'Magnitude' of operations and 'intermediate equivalent' (IE) were defined by the BUPA classification and assigned weighting. Audit on audit was also done for 1990-1992 inclusive. Results: Total number of admissions was 1325. The commonest components of our case mix were trauma, congenital anomalies especially hydrocephalus and prolapsed disc; rare cases were vascular anomalies and infections. On average 50% of admissions were emergencies and 41% were operated upon. The IEs were 398.2, 304 and 354.3 for the 3 years respectively. Senior residents' share of the operative workload was 22% in 1990, 35% in 1991 and 39% in 1992; for trainee residents, the corresponding figures were 1%, 5% and 16%. Conclusions: First, contrary to clinical impression, we found no evidence that the 'magnitude' of operations had declined. Second, residents received a fair share of the available operative workload. Third, audit had played a useful role in the development of our neurosurgical training programme.