Current attitudes toward neuroanatomy: a comparative cross-sectional survey of neurosurgeons from the United Kingdom and around the world.

Abstract Objective: How attitudes towards neuroanatomy and preferences of studying resources vary by grade or geographical location amongst neurosurgeons is currently unknown. The impact of the COVID-19 pandemic on anatomy learning habits is also yet to be elucidated. In this study we explore these objectives, aiming to guide the development of future neurosurgeon-tailored anatomy education and resources.Methods: This was a 2-stage, cross-sectional survey. A local pilot survey was followed by a structured 17-item questionnaire which was distributed to neurosurgical trainees and consultants via social media, newsletters, and mailing lists. Survey data was collected from 20/09/2021 to 20/12/2021. Grade and nationality differences in sentiment agreement and frequency were statistically compared.Results: A total of 365 responses were received, with an overall survey response rate of 23.2% (25% U.K. response rate; 15.2-30.7% international response rate). Overall, neuroanatomy is highly regarded among most neurosurgeons and takes a central role in their professional identity. Yet, 69% of neurosurgeons stated they would like to spend more time learning neuroanatomy. Frequent prompts to study included perceived operative complexity (90%), lack of familiarity (92%) and teaching (89%) whereas factors such as operative responsibility and patient risk significantly varied by grade. Grade-dependent obstacles limiting neuroanatomy learning included financial barriers and lack of motivation, with personal commitments barriers significantly varying across geographical location. Surgical relevance (89%), accessibility (90%) and image quality (90%) were important factors when selecting anatomy resources, with cost and up-to-datedness being significantly more important to trainees than consultants. Online image searches, case-based and multidisciplinary discussions were the most frequently used learning method outside of theater. Finally, the COVID-19 pandemic saw a shift towards online or virtual resources, whilst also causing a greater impact on neuroanatomy learning amongst trainees and U.K.-based neurosurgeons.Conclusions: Attitudes towards neuroanatomy and preferences of resources vary by grade and location of neurosurgeons. Although neuroanatomy is a highly regarded, barriers exist which impede those who wish to pursue further neuroanatomy learning. Neurosurgical training programs should tailor anatomy education according to the seniority and background of their residents. Furthermore, resources that are surgically relevant, accessible and of high image-quality or more likely to be better utilized. Remedial learning after the COVID-19 pandemic must account for persistent gaps in teaching, utilizing cadaveric and operative exposure which cannot be replicated virtually.