Perspectives on Minimum Neurotology Fellowship Case Numbers: A Survey of American Neurotology Society Members.

Objective: Compare the Accreditation Council for Graduate Medical Education (ACGME) Neurotology Minimum Number case requirements for graduating neurotology fellows with what American Neurotology Society (ANS) members believe to be the number of cases needed to achieve competency and other clinically relevant benchmarks.

Methods: An anonymous Internet-based ratio scale survey of current ANS members to assess 1) respondents' demographic and practice characteristics (e.g., years in practice, practice environment); 2) self-reflection estimates regarding fellowship case numbers needed to achieve surgical competency and case numbers post-training needed to achieve key benchmarks (current case duration, outcomes comparable to the literature); and 3) opinions on what minimum case numbers should be for conventional lateral skull base approaches.

Results: A total of 143 ANS members (24% response rate) completed the survey, representing both academic and private practice neurotology and a broad range of years in practice. To achieve competency, respondents reported needing approximately 20 translabyrinthine approaches, 15 retrosigmoid approaches, 18 middle cranial fossa (MCF) approaches for tumors, and 13 MCF approaches for non-neoplastic indications each. Most (85%) respondents believed the translabyrinthine approach should be assigned a minimum case number requirement. A substantial proportion of respondents (21-31%) reported rarely or never using the MCF approach for vestibular schwannoma resection.

Conclusion: For any single lateral skull base approach, ANS members' responses fell within the ACGME's current 25-case minimum. Cumulatively, however, for competency in multiple conventional approaches coming out of fellowship, these data may suggest that more cases are necessary. Additionally, making a specific requirement for translabyrinthine approach should be considered.