Neurosurgical education: the "other" competencies. The 2003 presidential address

In his 2003 Presidential Address to the American Association of Neurological Surgeons, Dr. Heros discusses his personal additions to the six basic competencies for which all neurosurgical residents must be tested. The basic competencies are as follows: 1) patient care; 2) medical knowledge; 3) practice-based learning and improvement; 4) interpersonal and communication skills; 5) professionalism; and 6) system-based practice. To these, Dr. Heros proposes to add six supplemental competencies: 1) intellectual honesty, which involves frank discussions about patient complications and admissions of the physician's frailties; 2) scholarship--the art and science of medicine, which recognizes the value of evidence-based medicine but does not discount knowledge derived from experience; 3) practicing in a hyperlegalistic society, which involves tailoring informed consent to fit individual patients' circumstances; 4) time- and cost-efficient practices, in which the physician strives to conserve time and resources by forgoing testing that is not strictly necessary, doing only what is needed to return patients to wellness; 5) approach to patients, which entails acknowledging and respecting the dignity of all patients; and 6) pride in being a neurosurgeon, which carries a sense of elitism without arrogance.