Neuroanatomy Education as a Strategic Human Resources Tool in Neurosurgical Residency Programs: A Tailored Training Concept Based on Subgroup Preferences

Technical Summary: Neuroanatomy Education as a Strategic Human Resources Tool in Neurosurgical Residency Programs

Problem Statement
The global healthcare system faces a chronic shortage of physicians, a challenge exacerbated in high-demand, workload-intensive disciplines like neurosurgery. Demographic shifts and evolving work-life expectations have intensified pressure on hospital human resources (HR) strategies. While structured training environments are known to be vital for neurosurgical residents, the perceived value of specific educational offerings—particularly in foundational domains like neuroanatomy—as a lever for employer attractiveness and workforce stability remains insufficiently quantified.

In Germany, neurosurgical residency training is highly decentralized. Although national regulations exist, the implementation of educational content often relies on individual institutions or self-directed learning by the resident. Consequently, structured curricula in neuroanatomy are not uniformly applied. This is compounded by undergraduate medical education, where neuroanatomy is typically confined to a single preclinical semester, potentially leaving graduates entering residency with inadequate confidence in knowledge crucial for surgical orientation and risk minimization. The study addresses the gap between undergraduate preparation and clinical requirements, questioning whether targeted investments in structured neuroanatomy education can improve training quality and enhance departmental attractiveness.

Methodology
This study employed a cross-sectional survey design conducted over three months among German neurosurgeons and medical students from a Berlin-based university. The participant pool (N=44) was stratified into three subgroups to capture perspectives across the professional lifecycle:

• Medical Students (n=30): Representing entry-level physicians with no prior professional experience.
• Neurosurgical Residents (n=6): Early-career entrants.
• Board-Certified Neurosurgeons (n=8): Experienced specialists.

Participation was voluntary and anonymous. The instrument was a structured 20-item questionnaire developed via Microsoft Forms, distributed electronically without financial incentives. Medical students without an interest in neuro-specialties were excluded.

The questionnaire utilized Likert scales (1 = very good/strongly agree to 5 = very poor/strongly disagree) to assess:

1. Perceived neuroanatomical competence and confidence.
2. The importance of neuroanatomy and perceived gaps in undergraduate training.
3. Interest in structured residency education.
4. HR-related outcomes, including motivation, employer attractiveness, and retention intentions.
5. Preferred educational formats (e.g., dissection, digital tools, rotations) and barriers to participation.

Data analysis was primarily descriptive, comparing mean scores and frequency distributions across the three professional subgroups.

Key Results

• Perceived Competence and Gaps: A clear educational gradient was observed. Residents reported the lowest level of preparedness (mean score 3.67 on a 1–5 scale, where 1 is very good), indicating significant self-perceived deficits. Medical students and board-certified specialists reported higher confidence (means of 2.23 and 2.25, respectively). Notably, specialists retrospectively confirmed similar educational gaps during their own residency, suggesting a persistent deficit in current training models.
• Demand for Structured Education: There was a high, consistent demand for structured neuroanatomy education across all groups. Medical students and residents showed strong agreement (mean 1.33) regarding the necessity of regular training during residency. The majority viewed such training as an essential component of residency education.
• HR-Related Outcomes: Structured education was consistently associated with positive HR metrics. Medical students and residents indicated that such offerings would increase employer attractiveness (means 1.70 and 1.83) and boost motivation (means 1.80 and 2.00). While retention intentions were also positive, they were rated slightly lower than motivation scores. Participants across all groups agreed that structured training would reduce stress and improve clinical confidence.
• Preferred Formats: Preferences varied by experience level:
  • Medical Students: Favored practice-oriented approaches (dissection courses, regular clinical teaching sessions) and digital tools (VR/AI).
  • Residents: Strongly preferred hands-on formats, with 100% of the resident subgroup selecting dissection courses and 83% selecting rotations in anatomy institutes. Digital simulations were less favored by this group.
  • Specialists: Showed the highest preference for virtual and digital simulation-based learning (selected by 7 of 8 participants), followed by dissection courses.
  • Universal Barriers: Across all groups, the primary barriers to participation were time constraints, clinical workload, and a lack of available structured programs. "Lack of interest" was rarely cited. Purely online courses were consistently among the least preferred formats.

Key Contributions
The study proposes a tailored training concept based on subgroup preferences, moving away from a "one-size-fits-all" approach. It identifies neuroanatomy education not merely as a clinical necessity but as a strategic HR instrument. The paper contributes a specific educational portfolio (Table 2) that aligns training formats with professional experience levels:

• Entry-stage (Students): Emphasis on hands-on dissection, anatomy rotations, mentorship, and virtual simulations.
• Residents: Focus on dissection courses and anatomy rotations, with optional virtual simulation.
• Specialists: Prioritization of virtual/digital simulations and AI-based learning, alongside dissection.

The research highlights that while online courses are generally unpopular, blended learning and hands-on formats are critical. It further suggests that addressing structural barriers (time and workload) is essential for the success of such programs.

Significance and Claims
The paper claims that investing in structured, high-quality neuroanatomy education can function as a strategic lever for workforce development in competitive specialties like neurosurgery. By addressing the specific educational needs of different career stages, hospitals can enhance employer attractiveness, support professional confidence, and potentially improve retention.

The authors position these findings within the broader context of strategic HR management in healthcare, noting that workforce development investments are linked to job satisfaction and potentially patient care outcomes. The study concludes that integrating structured neuroanatomy education as a central component of residency training could be a useful tool for attracting ambitious applicants. However, the authors maintain a modest tone regarding causality; the cross-sectional design identifies associations rather than proving that such education directly leads to improved recruitment or retention outcomes. The paper calls for interdisciplinary collaboration between medical departments and HR to implement these tailored strategies, emphasizing the need for protected time and sustainable training structures.