Skip to main content

Advertisement

Log in

Advancing spinal fellowship training: an international multi-centre educational perspective

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this article is to review the importance of contemporary spine surgery fellowships and educational strategies to assist with fellowship design and delivery.

Methods

Spine surgery fellowship includes trainees from orthopaedic and neurosurgical backgrounds and is increasingly indicated for individuals wishing to pursue spine surgery as a career, recognizing how spinal surgery evolved significantly in scope and complexity. We combine expert opinion with a review of the literature and international experience to expound spine fellowship training.

Results

Contemporary learning techniques include boot camps at the start of fellowship which may reinforce previous clinical learning and help prepare fellows for their new clinical roles. There is good evidence that surgical specialty training boot camps improve clinical skills, knowledge and trainee confidence prior to embarking upon new clinical roles with increasing levels of responsibility. Furthermore, as simulation techniques and technologies take on an increasing role in medical and surgical training, we found evidence that trainees’ operative skills and knowledge can improve with simulated operations, even if just carried out briefly. Finally, we found evidence to suggest a role for establishing competence-based objectives for training in specific operative and technical procedures. Competence-based objectives are helpful for trainees and trainers to highlight gaps in a trainee’s skill set that may then be addressed during training.

Conclusions

Spinal fellowships may benefit from certain contemporary strategies that assist design and delivery of training in a safe environment. Interpersonal factors that promote healthy teamwork may contribute to an environment conducive to learning.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Lenehan B, Dvorak MF, Madrazo I, Yukawa Y, Fisher CG (2010) Diversity and commonalities in the care of spine trauma internationally. Spine (Phila Pa 1976) 35(21 supple):S174–S179. https://doi.org/10.1097/BRS.0b013e3181f32c82

    Article  Google Scholar 

  2. Hussain M, Nasir S, Moed A, Murtaza G (2011) Variations in practice patterns among neurosurgeons and orthopaedic surgeons in the management of spinal disorders. Asian Spine J 5(4):208–212. https://doi.org/10.4184/asj.2011.5.4.208

    Article  PubMed  PubMed Central  Google Scholar 

  3. Grauer JN, Vaccaro AR, Beiner JM, Kwon BK, Hilibrand AS, Harrop JS, Anderson G, Hurlbert J, Fehlings MG, Ludwig SC, Hedlund R, Arnold PM, Bono CM, Brodke DS, Dvorak MF, Fischer CG, Sledge JB, Shaffrey CI, Schwartz DG, Sears WR, Dickman C, Sharan A, Albert TJ, Rechtine GR, 2nd (2004) Similarities and differences in the treatment of spine trauma between surgical specialties and location of practice. Spine (Phila Pa 1976) 29(6):685–696

    Article  Google Scholar 

  4. Sollmann N, Morandell C, Albers L, Behr M, Preuss A, Dinkel A, Meyer B, Krieg SM (2018) Association of decision-making in spinal surgery with specialty and emotional involvement-the Indications in Spinal Surgery (INDIANA) survey. Acta Neurochir (Wien) 160(3):425–438. https://doi.org/10.1007/s00701-017-3459-7

    Article  Google Scholar 

  5. ACGME website. https://www.acgme.org/Portals/0/PDFs/ab_ACGMEglossary.pdf

  6. Larouche J, Yee AJ, Wadey V, Ahn H, Hedden DM, Hall H, Broad R, Bailey C, Nataraj A, Fisher C, Christie S, Fehlings M, Moroz PJ, Bouchard J, Carey T, Chapman M, Chow D, Lundine K, Dommisse I, Finkelstein J, Fox R, Goytan M, Hurlbert J, Massicotte E, Paquet J, Splawinski J, Tsai E, Wai E, Wheelock B, Paquette S (2016) Development of a competence-based spine surgery fellowship curriculum set of learning objectives in Canada. Spine (Phila Pa 1976) 41(6):530–537. https://doi.org/10.1097/BRS.0000000000001251

    Article  Google Scholar 

  7. Konczalik W, Elsayed S, Boszczyk B (2014) Experience of a fellowship in spinal surgery: a quantitative analysis. Eur Spine J 23(suppl 1):S40–S54. https://doi.org/10.1007/s00586-014-3209-y

    Article  PubMed  Google Scholar 

  8. Vitale MA, Heyworth BE, Skaggs DL, Roye DP Jr, Lipton CB, Vitale MG (2005) Comparison of the volume of scoliosis surgery between spine and pediatric orthopaedic fellowship-trained surgeons in New York and California. J Bone Joint Surg Am 87(12):2687–2692. https://doi.org/10.2106/JBJS.D.01825

    Article  PubMed  Google Scholar 

  9. Woodrow SI, Dubrowski A, Khokhotva M, Backstein D, Rampersaud YR, Massicotte EM (2007) Training and evaluating spinal surgeons: the development of novel performance measures. Spine (Phila Pa 1976) 32(25):2921–2925. https://doi.org/10.1097/BRS.0b013e31815b6495

    Article  Google Scholar 

  10. Boszczyk BM, Mooij JJ, Schmitt N, Di Rocco C, Fakouri BB, Lindsay KW (2009) Spine surgery training and competence of European neurosurgical trainees. Acta Neurochir (Wien) 151(6):619–628. https://doi.org/10.1007/s00701-009-0259-8

    Article  Google Scholar 

  11. Dvorak MF, Collins JB, Murnaghan L, Hurlbert RJ, Fehlings M, Fox R, Hedden D, Rampersaud YR, Bouchard J, Guy P, Fisher CG (2006) Confidence in spine training among senior neurosurgical and orthopedic residents. Spine (Phila Pa 1976) 31(7):831–837. https://doi.org/10.1097/01.brs.0000207238.48446.ce

    Article  Google Scholar 

  12. Daniels AH, Ames CP, Garfin SR, Shaffrey CI, Riew KD, Smith JS, Anderson PA, Hart RA (2015) Spine surgery training: is it time to consider categorical spine surgery residency? Spine J 15(7):1513–1518. https://doi.org/10.1016/j.spinee.2014.08.452

    Article  PubMed  Google Scholar 

  13. Horst PK, Choo K, Bharucha N, Vail TP (2015) Graduates of orthopaedic residency training are increasingly subspecialized: a review of the American board of orthopaedic surgery part II database. J Bone Joint Surg Am 97(10):869–875. https://doi.org/10.2106/JBJS.N.00995

    Article  PubMed  Google Scholar 

  14. Kusuma SK, Mehta S, Sirkin M, Yates AJ, Miclau T, Templeton KJ, Friedlaender GE (2007) Measuring the attitudes and impact of the eighty-hour workweek rules on orthopaedic surgery residents. J Bone Joint Surg Am 89(3):679–685. https://doi.org/10.2106/JBJS.F.00526

    Article  PubMed  Google Scholar 

  15. Harris JD, Staheli G, LeClere L, Andersone D, McCormick F (2015) What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review. Clin Orthop Relat Res 473(5):1600–1608. https://doi.org/10.1007/s11999-014-3968-0

    Article  PubMed  Google Scholar 

  16. Datta ST, Davies SJ (2014) Training for the future NHS: training junior doctors in the United Kingdom within the 48-h European working time directive. BMC Med Educ 14(suppl 1):S12. https://doi.org/10.1186/1472-6920-14-S1-S12

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cowie CJ, Pesic-Smith JD, Boukas A, Nelson RJ, British Neurosurgical Trainees A (2013) Has the impact of the working time regulations changed neurosurgical trainees' attitudes towards the European working time directive 5 years on? Br J Neurosurg 27(5):580–585. https://doi.org/10.3109/02688697.2013.834530

    Article  PubMed  Google Scholar 

  18. Stienen MN, Netuka D, Demetriades AK, Ringel F, Gautschi OP, Gempt J, Kuhlen D, Schaller K (2016) Neurosurgical resident education in Europe-results of a multinational survey. Acta Neurochir (Wien) 158(1):3–15. https://doi.org/10.1007/s00701-015-2632-0

    Article  Google Scholar 

  19. Rimmer A (2017) The impact of the junior doctor contract-one year on. BMJ 358:j4125. https://doi.org/10.1136/bmj.j4125

    Article  PubMed  Google Scholar 

  20. Maxwell AJ, Crocker M, Jones TL, Bhagawati D, Papadopoulos MC, Bell BA (2010) Implementation of the European working time directive in neurosurgery reduces continuity of care and training opportunities. Acta Neurochir (Wien) 152(7):1207–1210. https://doi.org/10.1007/s00701-010-0648-z

    Article  Google Scholar 

  21. TT Lee JL Klose 1999 Survey on neurosurgery subspecialty fellowship training. Congress of Neurological Surgeons Education Committee. Surg Neurol 52 6 641 644 discussion 644–645.

    Article  CAS  Google Scholar 

  22. Gaskill T, Cook C, Nunley J, Mather RC (2009) The financial impact of orthopaedic fellowship training. J Bone Joint Surg Am 91(7):1814–1821. https://doi.org/10.2106/JBJS.H.01139

    Article  PubMed  Google Scholar 

  23. Incorvaia AN, Ringley CD, Boysen DA (2005) Factors influencing surgical career decisions. Curr Surg 62(4):429–435. https://doi.org/10.1016/j.cursur.2005.02.002

    Article  PubMed  Google Scholar 

  24. Daniels AH, Ruttiman R, Eltorai AEM, DePasse JM, Brea BA, Palumbo MA (2017) Malpractice litigation following spine surgery. J Neurosurg Spine 27(4):470–475. https://doi.org/10.3171/2016.11.SPINE16646

    Article  PubMed  Google Scholar 

  25. Quraishi NA, Hammett TC, Todd DB, Bhutta MA, Kapoor V (2012) Malpractice litigation and the spine: the NHS perspective on 235 successful claims in England. Eur Spine J 21(suppl 2):S196–S199. https://doi.org/10.1007/s00586-012-2203-5

    Article  PubMed  Google Scholar 

  26. Yule S, Gupta A, Gazarian D, Geraghty A, Smink DS, Beard J, Sundt T, Youngson G, McIlhenny C, Paterson-Brown S (2018) Construct and criterion validity testing of the Non-Technical Skills for Surgeons (NOTSS) behaviour assessment tool using videos of simulated operations. Br J Surg 105(6):719–727. https://doi.org/10.1002/bjs.10779

    Article  CAS  PubMed  Google Scholar 

  27. Jung JJ Yule S Boet S Szasz P Schulthess P Grantcharov T 2019 Nontechnical skill assessment of the collective surgical team using the non-technical skills for surgeons (NOTSS) system. Ann Surg doi:10.1097/SLA.0000000000003250.

  28. Keyser DJ, Lakoski JM, Lara-Cinisomo S, Schultz DJ, Williams VL, Zellers DF, Pincus HA (2008) Advancing institutional efforts to support research mentorship: a conceptual framework and self-assessment tool. Acad Med 83(3):217–225. https://doi.org/10.1097/ACM.0b13e318163700a

    Article  PubMed  Google Scholar 

  29. Chang SD, Nicolaou S, Forster BB (2017) Research mentorship for our residents and fellows: a vital supplement for the health of our specialty. Curr Probl Diagn Radiol 46(5):349–350. https://doi.org/10.1067/j.cpradiol.2017.02.003

    Article  PubMed  Google Scholar 

  30. Schoenfeld AJ, Bhalla A, George J, Harris MB, Bono CM (2015) Academic productivity and contributions to the literature among spine surgery fellowship faculty. Spine J 15(10):2126–2131. https://doi.org/10.1016/j.spinee.2015.03.026

    Article  PubMed  Google Scholar 

  31. Barratt H, Turner S, Hutchings A, Pizzo E, Hudson E, Briggs T, Hurd R, Day J, Yates R, Gikas P, Morris S, Fulop NJ, Raine R (2017) Mixed methods evaluation of the getting it right first time programme—improvements to NHS orthopaedic care in England: study protocol. BMC Health Serv Res 17(1):71. https://doi.org/10.1186/s12913-017-2012-y

    Article  PubMed  PubMed Central  Google Scholar 

  32. American Board of Neurological Surgery. https://www.abns.org/8591-2/

  33. Parent RJ, Plerhoples TA, Long EE, Zimmer DM, Teshome M, Mohr CJ, Ly DP, Hernandez-Boussard T, Curet MJ, Dutta S (2010) Early, intermediate, and late effects of a surgical skills "boot camp" on an objective structured assessment of technical skills: a randomized controlled study. J Am Coll Surg 210(6):984–989. https://doi.org/10.1016/j.jamcollsurg.2010.03.006

    Article  PubMed  Google Scholar 

  34. Selden NR, Barbaro N, Origitano TC, Burchiel KJ (2011) Fundamental skills for entering neurosurgery residents: report of a Pacific region "boot camp" pilot course, 2009. Neurosurgery 68(3):759–764. https://doi.org/10.1227/NEU.0b013e3182077969 (discussion 764)

    Article  PubMed  Google Scholar 

  35. Selden NR, Origitano TC, Burchiel KJ, Getch CC, Anderson VC, McCartney S, Abdulrauf SI, Barrow DL, Ehni BL, Grady MS, Hadjipanayis CG, Heilman CB, Popp AJ, Sawaya R, Schuster JM, Wu JK, Barbaro NM (2012) A national fundamentals curriculum for neurosurgery PGY1 residents: the 2010 Society of Neurological Surgeons boot camp courses. Neurosurgery 70(4):971–981. https://doi.org/10.1227/NEU.0b013e31823d7a45 (discussion 981)

    Article  PubMed  Google Scholar 

  36. Sonnadara RR, Van Vliet A, Safir O, Alman B, Ferguson P, Kraemer W, Reznick R (2011) Orthopedic boot camp: examining the effectiveness of an intensive surgical skills course. Surgery 149(6):745–749. https://doi.org/10.1016/j.surg.2010.11.011

    Article  PubMed  Google Scholar 

  37. Sonnadara RR, Garbedian S, Safir O, Nousiainen M, Alman B, Ferguson P, Kraemer W, Reznick R (2012) Orthopaedic Boot Camp II: examining the retention rates of an intensive surgical skills course. Surgery 151(6):803–807. https://doi.org/10.1016/j.surg.2012.03.017

    Article  PubMed  Google Scholar 

  38. Selden NR, Anderson VC, McCartney S, Origitano TC, Burchiel KJ, Barbaro NM (2013) Society of Neurological Surgeons boot camp courses: knowledge retention and relevance of hands-on learning after 6 months of postgraduate year 1 training. J Neurosurg 119(3):796–802. https://doi.org/10.3171/2013.3.JNS122114

    Article  PubMed  Google Scholar 

  39. Sonnadara RR, Garbedian S, Safir O, Mui C, Mironova P, Nousiainen M, Ferguson P, Alman B, Kraemer W, Reznick R (2013) Toronto orthopaedic boot camp III: examining the efficacy of student-regulated learning during an intensive, laboratory-based surgical skills course. Surgery 154(1):29–33. https://doi.org/10.1016/j.surg.2013.05.003

    Article  PubMed  Google Scholar 

  40. Ghobrial GM, Hamade YJ, Bendok BR, Harrop JS 2015 Technology and simulation to improve patient safety. Neurosurg Clin N Am 26 2 239 243. doi:10.1016/j.nec.2014.11.002.

    Article  Google Scholar 

  41. Zhang L, Kamaly I, Luthra P, Whitfield P (2016) Simulation in neurosurgical training: a blueprint and national approach to implementation for initial years trainees. Br J Neurosurg 30(5):577–581. https://doi.org/10.1080/02688697.2016.1211252

    Article  PubMed  Google Scholar 

  42. Kirkman MA, Muirhead W, Nandi D, Sevdalis N (2014) Development and psychometric evaluation of the "Neurosurgical Evaluation of Attitudes towards simulation Training" (NEAT) tool for use in neurosurgical education and training. World Neurosurg 82(3–4):284–291. https://doi.org/10.1016/j.wneu.2014.05.030

    Article  PubMed  Google Scholar 

  43. Bohm PE, Arnold PM (2015) Simulation and resident education in spinal neurosurgery. Surg Neurol Int 6:33. https://doi.org/10.4103/2152-7806.152146

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kshettry VR, Mullin JP, Schlenk R, Recinos PF, Benzel EC (2014) The role of laboratory dissection training in neurosurgical residency: results of a national survey. World Neurosurg 82(5):554–559. https://doi.org/10.1016/j.wneu.2014.05.028

    Article  PubMed  Google Scholar 

  45. Gnanakumar S, Kostusiak M, Budohoski KP, Barone D, Pizzuti V, Kirollos R, Santarius T, Trivedi R (2018) Effectiveness of cadaveric simulation in neurosurgical training: a review of the literature. World Neurosurg 118:88–96. https://doi.org/10.1016/j.wneu.2018.07.015

    Article  PubMed  Google Scholar 

  46. Mattei TA, Frank C, Bailey J, Lesle E, Macuk A, Lesniak M, Patel A, Morris MJ, Nair K, Lin JJ (2013) Design of a synthetic simulator for pediatric lumbar spine pathologies. J Neurosurg Pediatr 12(2):192–201. https://doi.org/10.3171/2013.4.PEDS12540

    Article  PubMed  Google Scholar 

  47. Ghobrial GM, Anderson PA, Chitale R, Campbell PG, Lobel DA, Harrop J (2013) Simulated spinal cerebrospinal fluid leak repair: an educational model with didactic and technical components. Neurosurgery 73(suppl 1):111–115. https://doi.org/10.1227/NEU.0000000000000100

    Article  PubMed  Google Scholar 

  48. Chitale R, Ghobrial GM, Lobel D, Harrop J (2013) Simulated lumbar minimally invasive surgery educational model with didactic and technical components. Neurosurgery 73(suppl 1):107–110. https://doi.org/10.1227/NEU.0000000000000091

    Article  PubMed  Google Scholar 

  49. Harrop J, Rezai AR, Hoh DJ, Ghobrial GM, Sharan A (2013) Neurosurgical training with a novel cervical spine simulator: posterior foraminotomy and laminectomy. Neurosurgery 73(suppl 1):94–99. https://doi.org/10.1227/NEU.0000000000000103

    Article  PubMed  Google Scholar 

  50. Ray WZ, Ganju A, Harrop JS, Hoh DJ (2013) Developing an anterior cervical diskectomy and fusion simulator for neurosurgical resident training. Neurosurgery 73(suppl 1):100–106. https://doi.org/10.1227/NEU.0000000000000088

    Article  PubMed  Google Scholar 

  51. Pfandler M, Lazarovici M, Stefan P, Wucherer P, Weigl M (2017) Virtual reality-based simulators for spine surgery: a systematic review. Spine J 17(9):1352–1363. https://doi.org/10.1016/j.spinee.2017.05.016

    Article  PubMed  Google Scholar 

  52. Alaraj A, Charbel FT, Birk D, Tobin M, Luciano C, Banerjee PP, Rizzi S, Sorenson J, Foley K, Slavin K, Roitberg B (2013) Role of cranial and spinal virtual and augmented reality simulation using immersive touch modules in neurosurgical training. Neurosurgery 72(suppl 1):115–123. https://doi.org/10.1227/NEU.0b013e3182753093

    Article  PubMed  PubMed Central  Google Scholar 

  53. Coelho G, Defino HLA (2018) The role of mixed reality simulation for surgical training in spine: phase 1 validation. Spine (Phila Pa 1976) 43(22):1609–1616. https://doi.org/10.1097/BRS.0000000000002856

    Article  Google Scholar 

  54. Gilbody J, Prasthofer AW, Ho K, Costa ML (2011) The use and effectiveness of cadaveric workshops in higher surgical training: a systematic review. Ann R Coll Surg Engl 93(5):347–352. https://doi.org/10.1308/147870811X582954

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Kockro RA (2013) Neurosurgery simulators—beyond the experiment. World Neurosurg 80(5):e101–102. https://doi.org/10.1016/j.wneu.2013.02.017

    Article  PubMed  Google Scholar 

  56. Gelinas-Phaneuf N, Del Maestro RF (2013) Surgical expertise in neurosurgery: integrating theory into practice. Neurosurgery 73(suppl 1):30–38. https://doi.org/10.1227/NEU.0000000000000115

    Article  PubMed  Google Scholar 

  57. Harrop J, Lobel DA, Bendok B, Sharan A, Rezai AR (2013) Developing a neurosurgical simulation-based educational curriculum: an overview. Neurosurgery 73(suppl 1):25–29. https://doi.org/10.1227/NEU.0000000000000101

    Article  PubMed  Google Scholar 

  58. UKSSB STIG. https://www.ukssb.com/stig.

  59. Polavarapu HV, Kulaylat AN, Sun S, Hamed OH (2013) 100 years of surgical education: the past, present, and future. Bull Am Coll Surg 98(7):22–27

    PubMed  Google Scholar 

  60. Barnes RW, Lang NP, Whiteside MF 1989 Halstedian technique revisited. Innovations in teaching surgical skills. Ann Surg 210 1 118 121.

    Article  CAS  Google Scholar 

  61. Civility Saves Lives. https://www.civilitysaveslives.com/.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Antony H. Bateman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest relating to this review article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 138 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kumaria, A., Bateman, A.H., Eames, N. et al. Advancing spinal fellowship training: an international multi-centre educational perspective. Eur Spine J 28, 2437–2443 (2019). https://doi.org/10.1007/s00586-019-06098-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06098-8

Keywords

Navigation