Neurosurgery in Victoria, Australia: training and practice compared with the United Kingdom

In the UK there are currently great changes taking place in both higher surgical training and consultant practice. Australia inherited the British system, many aspects of which it retains, but has moved to a US type training programme. Recent experience of British and Australian neurosurgical practice allows useful comparisons to be made with possible benefit to both. Neurosurgery in Australia is a more consultant based service than that in the UK, with 73 consultants for a population of 18 million. Consultants work primarily from their private rooms and consultant numbers in the public sector are misleading as few of them approach full time. Neurosurgical training is organized on a national basis with a finite training programme. This consists of a rotation of different jobs supplemented by consultant led lectures and tutorials. Training is regularly monitored, with a final exit examination. The disadvantages are the relative lack of operating whilst training, many neurosurgeons becoming accredited with the personal operating experience expected of a British registrar; and the working hours; most trainees work 1 in 1, which precludes any sort of normal family life. In summary, the relative strengths of the British and Australian systems are largely complementary, there being ample scope for each to learn from the other.