Background: Prior to its recent introduction into Canadian neurosurgical curriculum, Competence by Design (CBD) principles have been implemented across many international neurosurgical training programs for several years. As such, comparing other international competency-based educational frameworks and curricula can help anticipate, avoid or mitigate potential future challenges for Canadian neurosurgical trainees. Methods: A comparative web-based analysis of neurosurgical postgraduate medical education documents and resources provided by medical accreditation and regulatory bodies of Canada, the United States, the United Kingdom and Australasia, was performed. Results: All four countries varied considerably across four major curriculum-based themes: 1) general program structure; 2) overarching foundational competency frameworks; 3) types and numbers of performance assessments required and; 4) curricular learning outcomes. In particular, the expected progression and degree of competence required of neurosurgical residents when performing entrustable professional activities (EPAs) or defined tasks of neurosurgical practice, varied across all countries. Differences in types of neurosurgical EPAs and number of required assessments demonstrating a trainee’s competence achievement were also appreciated. Conclusions: This study revealed variations across competency-based neurosurgical curricula proposed by four international medical training regulatory bodies. Differences in types of EPAs and their required degree of competence achievement suggests potential disconnects between neurosurgical educational outcomes and actual medical practice.