title: The teaching of neurosurgery in UK medical schools: a message from British medical students.
abstract: BACKGROUND
  A great variability exists in the clinical exposure of neurosurgery across all academic years in UK medical schools, although the effects of this on knowledge level and confidence in referring cases appropriately to specialists have not been reported.
  
  
  METHODS
  A cross-sectional study was carried out involving students in years 1-5 across nine British medical schools. An electronic questionnaire was sent out which consisted of questions concerning the teaching of the subject; and questions assessing the knowledge of basic neurosurgery through mini clinical scenarios testing which specialty should receive a referral.
  
  
  RESULTS
  Of 417 participants, 60 were excluded due to incomplete participation. Senior years outperformed students in junior years for correctly answered questions on five neurosurgical scenarios (mean score: years 1-3 (184/357) = 3.33/5, years 4-5 (173/357) = 3.79/5, p < 0.05). Participants in years 1-5 with prior clinical exposure in neurosurgery scored higher than participants who had no exposure (mean score: exposed (247/357) = 4.21/5, not-exposed (110/357) = 3 · 50/5, p < 0.05). Sixty-one percent prefer receiving neurosurgical teaching via increased exposure to operations. Students in years 4-5 with exposure in both classroom and operating theatre scored higher than students with classroom-only experience (mean classroom (69/131) = 3.62/5, mean classroom and operating theatre (62/131) = 4.21/5, p < 0.05); 33.3 % of final-year students reported difficulty in identifying patients that require neurosurgical referral.
  
  
  CONCLUSIONS
  Students with exposure to an operating theatre outperformed those students exposed to just classroom teaching. Students indicated an increased preference for teaching through the operating theatre scene. One in three final-year medical students had difficulty identifying the need for a neurosurgical referral.If neurosurgical teaching were further enhanced at medical school, it could lead to increased confidence and efficiency in junior-year doctors when facing the neurosurgical referral process. Increased exposure to clinical neurosurgery may significantly improve the ability of future doctors to tackle neurosurgical scenarios.
authors.affiliation: General Surgery, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK, AB25 2ZN. yiannis.skarparis@nhs.net.|, 53 Westburn Road, Aberdeen, AB25 2SH, UK. yiannis.skarparis@nhs.net.
authors.forename: Yiannis
authors.identifier: http://orcid.org/0000-0001-7327-6903
authors.initials: Y
authors.lastname: Skarparis
authors.affiliation: King's College London School of Medicine, London, UK, WC2R 2LS. callum.findlay@icloud.com.
authors.forename: Callum A
authors.initials: CA
authors.lastname: Findlay
authors.affiliation: Department of Neurosurgery, Western General Hospital, Edinburgh, UK, EH4 2XU. andreas.demetriades@gmail.com.
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Demetriades
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009493:Neurosurgery / Q000193:education*; D009873:Operating Rooms; D012017:Referral and Consultation; D012577:Schools, Medical / Q000706:statistics & numerical data*; D013337:Students, Medical; D011795:Surveys and Questionnaires; D013663:Teaching; D006113:United Kingdom
keywords: British medical schools; Education; Neurosurgery; Neurosurgical training; Undergraduate