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INTRODUCTION: Out of programme (OOP) experience from training increases the skill pool of the neurosurgical workforce and drives innovation in the specialty. OOP approval criteria are well defined but transition back to clinical work can be challenging with a paucity of data published on trainee perspectives. Our study aimed to investigate factors influencing transition from OOP back to clinical work among neurosurgical trainees in the UK. METHODS: An online survey was sent to all members of the Society of British Neurological Surgeons. Questions pertained to details of OOP and factors influencing transition back to clinical work. RESULTS: Among the 73 respondents, 7 were currently on OOP and 27 had completed OOP in the past. Research was the most common reason for OOP (28/34, 82%) and this was generally motivated by the aspiration of an academic neurosurgery career (17/34, 50%). Although the majority (27/34, 79%) continued clinical work during OOP, 37% of this group (10/27) reported a reduction in their surgical skills. Fewer than half (15/34, 44%) had a return to work plan, of which only half (8/34, 24%) were formal plans. The majority of respondents who had completed OOP in the past (22/27, 81%) felt that they were able to apply the skills gained during OOP to their clinical work on return. CONCLUSIONS: Skills learnt during OOP are relevant and transferable to the clinical environment but mainly limited to research with OOP for management and education underrepresented. Deterioration of surgical skills is a concern. However, recognition of this problem has prompted new methods and schemes to address challenges faced on return to work. [ABSTRACT FROM AUTHOR]