Background: The future of a speciality depends on, among other factors
, its training programme; this involves the education contract. Surgic
al audit provides a mechanism for educators to monitor in real-time th
e performance of residents and hospitals. Setting: Department of Neuro
surgery, King Faisal University, Dammam, Saudi Arabia. Methods: A pros
pective audit was established. 'Magnitude' of operations and 'intermed
iate equivalent' (IE) were defined by the BUPA classification and assi
gned weighting. Audit on audit was also done for 1990-1992 inclusive.
Results: Total number of admissions was 1325. The commonest components
of our case mix were trauma, congenital anomalies especially hydrocep
halus and prolapsed disc; rare cases were vascular anomalies and infec
tions. On average 50% of admissions were emergencies and 41% were oper
ated upon. The Ifs were 398.2, 304 and 354.3 for the 3 years respectiv
ely. Senior residents' share of the operative workload was 22% in 1990
, 35% in 1991 and 39% in 1992; for trainee residents, the correspondin
g figures were 1%, 5% and 16%. Conclusions: First, contrary to clinica
l impression, we found no evidence that the 'magnitude' of operations
had declined. Second, residents received a fair share of the available
operative workload. Third, audit had played a useful role in the deve
lopment of our neurosurgical training programme.