1012 Autonomy Development in Functional Neurosurgery: Implications for Resident Training

• DOI: 10.1227/neu.0000000000003360_1012
• Publication Date: 2025-03-14T13:42:08Z
• Authors: Katrina Hon; Pranav Warman; Vishal Venkatraman; Alexander Suarez; Stephen C. Harward; Derek Southwell; Dennis A. Turner; Rajeev Dharmapurikar; Michael M. Haglund; Shivanand P. Lad

INTRODUCTION: Determining and measuring neurosurgical resident operative competency is challenging due to non-standardized methods for teaching and evaluation.

METHODS: We analyzed 2,260 functional neurosurgery cases performed by 146 residents across 14 institutions between the years of 2017 to 2024. TAGS scores, which measure surgical autonomy from 1 (lowest) to 4 (highest), along with zones of proximal development (ZPD) stages—ZPD1 (positioning and opening), ZPD2 (second most complex portion), ZPD3 (most critical/complex portion), ZPD4 (closing)—were used to track autonomy progression. Results were analyzed with descriptive statistics.

RESULTS: Our analysis revealed a trend towards autonomy with a steady increase in TAGS scores from PGY-1 to PGY-5 and a subsequent plateau in PGY-5 that remained stable through PGY-7. Notably, beginning in PGY-5 we also saw the largest shift in ZPD focus to ZPD3, identifying PGY-5 as a potential pivotal transition zone that may play a role in increased resident autonomy.

CONCLUSIONS: The findings illustrate the nuanced trajectory of autonomy progression in functional neurosurgery training. We identified peaks and plateaus of resident autonomy in addition to transitions in ZPD focus that can be used to inform individualized educational interventions and enhance resident learning and readiness for independent practice.