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

  • Ashwin Kumaria
  • Antony H. BatemanEmail author
  • Niall Eames
  • Michael G. Fehlings
  • Christina Goldstein
  • Bernhard Meyer
  • Scott J. Paquette
  • Albert J. M. Yee
Review Article



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.


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.


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.


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.


Spine surgery fellowship Postgraduate education Surgical training Boot camps Surgical simulation Competency 


Compliance with ethical standards

Conflict of interest

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

Supplementary material

586_2019_6098_MOESM1_ESM.pptx (139 kb)
Supplementary file1 (PPTX 138 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Royal Derby Spinal CentreRoyal Derby HospitalDerbyUK
  2. 2.Belfast Health and Social Care Trust, Royal Victoria HospitalBelfastUK
  3. 3.Division of Neurosurgery and Spine ProgramUniversity of TorontoTorontoCanada
  4. 4.Missouri Orthopaedic InstituteUniversity of MissouriColumbiaUSA
  5. 5.Department of Neurosurgery, Klinikum rechts der IsarTechnical University of MunichMunichGermany
  6. 6.The University of British ColumbiaVancouverCanada
  7. 7.Department of SurgeryUniversity of TorontoTorontoCanada
  8. 8.University of Toronto Spine ProgramTorontoCanada
  9. 9.Marvin Tile Chair, Division Head of Orthopaedic SurgerySunnybrook Health Sciences CentreTorontoCanada

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