Educational and Surgical Impact of the Far East Stroke Advanced Clinical / Observership Program at Teishinkai Hospital, Sapporo, in an Era of Declining Open Cerebrovascular Surgery

To evaluate the perceived educational impact and post-return implementation of the Far East Stroke Advanced Clinical and Observership Program at Sapporo Teishinkai Hospital in the contemporary endovascular era. We conducted an anonymous cross-sectional alumni survey of program participants. Outcomes included self-rated (1 to 5 Likert scale) vascular anatomy understanding, microsurgical skill, and confidence in managing vascular neurosurgery before versus after the program, and ratings of drawing-based learning. Operative exposure, structured educational elements, and post-return dissemination and practice changes were collected, including free-text responses. Before-versus-after comparisons used the Wilcoxon signed-rank test. Self-assessed ratings were significantly higher after the program across all primary outcomes. Vascular anatomy understanding, microsurgical skill, and confidence in managing vascular neurosurgery all increased significantly after participation, based on paired ordinal analysis using the Wilcoxon signed-rank test (all p < 0.001). Drawing exercises were rated highly, with a median score of 5. Most respondents reported subsequent knowledge transfer and changes in practice. Given the retrospective self-assessment design, these findings reflect perceived rather than objectively measured improvements. Participation in a high-volume, structured microsurgical observership/fellowship program was associated with substantial self-reported improvements in competence and confidence, along with frequent translation into practice and teaching after return. These findings should be interpreted in the context of subjective outcomes and potential sources of bias inherent to survey-based designs.