The 6 + 1 model: Redefining the final year of neurosurgical training

Since nationwide adoption of a 7-year neurosurgical residency training in 2013, most programs designate postgraduate year 7 (PGY7) as the chief resident year. This article investigates the transition to a 6 + 1 Model, which encourages flexibility in the final year of training, highlighting its benefits, potential pitfalls, and practical implementation across residency programs nationwide.

We detail the structural changes of the 6 + 1 model at the University of Miami and evaluate operative case volume across three senior resident cohorts spanning pre-implementation, transition, and post-implementation periods. Case volumes were compared internally and against national benchmarks. Program-specific strategies to address potential challenges, including coverage gaps, research continuity, and perceptions of enfolded fellowships are discussed.

Transitioning the chief year to PGY6 led to preserved and increased cumulative operative case volume. Residents completing the PGY6 chief year accrued comparable or higher case numbers than prior PGY7 chiefs, maintaining high national percentile benchmarks. The PGY7 year enabled CAST-accredited enfolded fellowships, both internal and external, without compromising service coverage through reciprocal senior resident exchanges. Early outcomes demonstrate maintained clinical productivity, enhanced subspecialty momentum, and expanded academic collaboration.

The 6 + 1 model offers a viable alternative to a traditional PGY7 chief-year structure by combining earlier leadership responsibility with a flexible final year encouraging fellowship training, research endeavors, or transition-to-practice goals. With thoughtful implementation, this approach can preserve operative experience, shorten training pathways, and better prepare neurosurgeons for modern practice demands.