Orthopaedic surgery core curriculum: the spine (original) (raw)
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SPINE, 2015
Study Design. Modified-Delphi expert consensus method. Objective. The aim of this study was to develop competencebased spine fellowship curricula as a set of learning goals through expert consensus methodology in order to provide an educational tool for surgical educators and trainees. Secondarily, we aimed to determine potential differences among specialties in their rating of learning objectives to defined curriculum documents. Summary of Background Data. There has been recent interest in competence-based education in the training of future surgeons. Current spine fellowships often work on a preceptorbased model, and recent studies have demonstrated that graduating spine fellows may not necessarily be exposed to key cognitive and procedural competencies throughout their training that are expected of a practicing spine surgeon. Methods. A consensus group of 32 spine surgeons from across Canada was assembled. A modified-Delphi approach refined an initial fellowship-level curriculum set of learning objectives (108 cognitive and 84 procedural competencies obtained from open sources). A consensus threshold of 70% was chosen with up to 5 rounds of blinded voting performed. Members were asked to ratify objectives into either a general comprehensive or focused/ advanced curriculum. Results. Twenty-eight of 32 consultants (88%) responded and participated in voting rounds. Seventy-eight (72%) cognitive and 63 (75%) procedural competency objectives reached 70% consensus in the first round. This increased to 82 cognitive and 73 procedural objectives by round 4. The final curriculum document evolved to include a general comprehensive curriculum (91 cognitive and 53 procedural objectives), a focused/ advanced curriculum (22 procedural objectives), and a pediatrics curriculum (22 cognitive and 9 procedural objectives). Conclusion. Through a consensus-building approach, the study authors have developed a competence-based curriculum set of learning objectives anticipated to be of educational value to spine surgery fellowship educators and trainees. To our knowledge, this is one of the first nationally based efforts of its kind that is also anticipated to be of interest by international colleagues.
The Journal of bone and joint surgery. American volume, 2014
Current spine surgeon training in the United States consists of either an orthopaedic or neurological surgery residency, followed by an optional spine surgery fellowship. Resident spine surgery procedure volume may vary between and within specialties. The Accreditation Council for Graduate Medical Education surgical case logs for graduating orthopaedic surgery and neurosurgery residents from 2009 to 2012 were examined and were compared for spine surgery resident experience. The average number of reported spine surgery procedures performed during residency was 160.2 spine surgery procedures performed by orthopaedic surgery residents and 375.0 procedures performed by neurosurgery residents; the mean difference of 214.8 procedures (95% confidence interval, 196.3 to 231.7 procedures) was significant (p = 0.002). From 2009 to 2012, the average total spinal surgery procedures logged by orthopaedic surgery residents increased 24.3% from 141.1 to 175.4 procedures, and those logged by neuros...
Core curriculum (CC) of spinal surgery: a step forward in defining our profession
ACTA ORTHOPAEDICA et TRAUMATOLOGICA TURCICA, 2014
Objective: The aim our study was to establish a core curriculum (CC) for spine surgery incorporating knowledge, skills and attitudes to help define spine surgery as a medical specialty and serve as a guide for specific spine surgery training. Methods: A committee was established to prepare the CC. Five modules were established; Basic Sciences, Spinal Trauma, Degenerative Spine Diseases, Destructive Spine Pathologies and Spinal Deformity. Prepared CC modules were evaluated in a consensus meeting, translated and reevaluated in a second consensus meeting before being accepted as final. Results: In the five modules, 54 subject headings (19 for Basic Sciences, 10 for Spinal Trauma, 4 for Degenerative Spine Diseases, 4 for Destructive Spine Pathologies and 17 for Spinal Deformity) and 165 specific subjects (59 for Basic Sciences, 32 for Spinal Trauma, 10 for Degenerative Spine Diseases, 23 for Destructive Spine Pathologies and 41 for Spinal Deformity) were defined. Learning outcomes and entry and exit criteria were defined for all subjects. Conclusion: This CC may form the basis of spinal surgery training, defining spinal surgery as a medical specialty and help us spine surgeons to develop better defined identities.
Spine surgery training: is it time to consider categorical spine surgery residency?
The spine journal : official journal of the North American Spine Society, 2014
Current spine surgeon training in the United States consists of either an orthopedic surgery or a neurological surgery residency followed by an optional spine surgery fellowship. In recent years, spine surgery has matured into a complex medical and surgical specialty, with a large number of procedures and techniques for spinal surgeons to understand and learn before entering independent practice. The current training system with two parallel paths to spine surgery may not be the optimal model to train tomorrow's spine surgeons. To propose a spinal surgery training pathway of categorical spine surgery residency which would complement (rather than replace) the existing training pathways. Review of literature and proposal of novel training pathway. Integration of the orthopedic spine and neurosurgical spine surgery educational programs offers one option to enhance spine surgeon training in an effort to improve patient outcomes and advance scientific knowledge. The development of ca...
World neurosurgery, 2018
Spinal surgery is taught and practiced within two different surgical disciplines: neurological surgery and orthopedic surgery. This article provides a unified analysis of spine-focused faculty at U.S. residency programs. 278 Accreditation Council for Graduate Medical Education (ACGME) training programs were assessed to identify 923 full-time faculty members with spinal surgery designation defined by spine fellowship training or surgeon case volume >75% spine surgeries. Faculty were assessed with respect to parent discipline, years of fellowship training, academic rank, gender, and academic productivity (h-index). The spine-teaching workforce contains 55% orthopedic surgeons and 45% neurosurgeons with wide gender asymmetry overall and at all faculty ranks. Of the female spine surgeons, those with neurosurgical training (64.44%) nearly doubled the number with orthopedic training (35.56%). Academic productivity increased with academic rank similarly for both genders and subspecialti...
Preoperative education for lumbar radiculopathy: A survey of US spine surgeons
We sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Methods: An online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of preoperative education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy. Results: Of 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide preoperative education informally during the course of clinical consultation versus a formal preoperative education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the preoperative education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model. Conclusions: Spine surgeons believe that preoperative education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings.
Journal of Clinical Neuroscience, 2019
Medical student (MS) observation and assistance in the operating room (OR) is a critical component of medical education. Though participation in the operating room has many benefits to the medical student, the potential cost of these experiences to the patients must be taken into account. Other studies have shown differences in outcomes with resident involvement, but the effect of medical students in the OR has been poorly understood. The objective of this study was to understand how medical students and residents impacted surgical outcomes in posterior spinal fusions, anterior cervical discectomy and fusions (ACDFs), and lumbar discectomies. We conducted a retrospective study of patients undergoing posterior spinal fusions, ACDFs, and lumbar discectomies over 15 years. There were 6485 patients met the inclusion criteria of either undergoing a posterior fusion, ACDF or lumbar discectomy (1250 posterior fusion, 1381 ACDF, 3854 lumbar discectomies). Overall, little difference was observed when a medical student was present for surgical outcomes including length of stay, infection, and readmission. For ACDFs, having a medical student present had a significantly longer procedure durations (OR = 1.612, p = 0.001) than cases without. Besides slightly longer operative time (in posterior fusions), there were no major differences in outcomes when a medical student was present in the OR.
Effect of Spine Fellow Training on Operative Outcomes, Affirming Graduated Responsibility
Spine, 2013
Study Design. Retrospective review of prospectively collected surgical data. Objective. This study sought to determine the effect of fellow education during the course of the academic year (August-July) on surgical outcomes in adolescent idiopathic scoliosis. One surgeon and one type of surgery were chosen to minimize confounding factors. Summary of Bacitground Data. Educating and training the next generation of physicians and surgeons is necessary for the survival and continuation of medical care. There has been recent momentum to document scientifically that medical education is safe. Spine surgery is complex and demanding, with a steep learning curve, making it an ideal model to detect any potential negative impact of medical education. Methods. Subjects: adolescent patients undergoing posterior spinalsurgery, between August 2007 and July 2010, by a single senior surgeon at one institution with a fellow as the only surgical assistant. Demographic and perioperative data were collected and then segmented by surgical date into quarters according to the rotations of the academic year. One fellow was included in each quarter during the 4 years, resulting in 16 fellows across the 4 quarters. An analysis of variance model was used to assess differences in operative time, blood loss, length of stay, and complications between the quarters of the year. Results. There were no significant differences between the groups regarding age, sex, or Lenke curve type. No statistically significant differences were found between the 4 quarters of the fellowship year for estimated blood loss, use of cell saver, length of stay, operative ' time, and complication rate. Conclusion. This study is the first to show that fellow education during the course of the academic year did not impact the patient
Spine surgery training and competence of European Neurosurgical Trainees
Acta Neurochirurgica, 2009
Background Little is known about the nature of spine surgery training received by European neurosurgical trainees during their residency and the level of competence they acquire in dealing with spinal disorders. Methods A three-part questionnaire entailing 32 questions was devised and distributed to the neurosurgical trainees attending the EANS (European Association of Neurosurgical Societies) training courses of 2004. Results Of 126 questionnaires, 32% were returned. The majority of trainees responding to the questionnaire were in their final (6 th ) year of training or had completed their training (60.3% of total). Spinal surgery training in European residency programs has clear strengths in the traditional areas of microsurgical decompression for spinal stenosis and disc herniation (77-90% competence in senior trainees). Deficits are revealed in the management of spinal trauma (34-48% competence in senior trainees) and spinal conditions requiring the use of implants and anterior approaches, with the exception of anterior cervical stabilisation. Conclusions European neurosurgical trainees possess incomplete competence in dealing with spinal disorders. EANS trainees advocate the development of a postresidency spine subspecialty training program.