Development of a Competence-Based Spine Surgery Fellowship Curriculum Set of Learning Objectives in Canada

Longitudinal Assessment of Modern Spine Surgery Training: 10-Year Follow-up of a Nationwide Survey of Residency and Spine Fellowship Program Directors

Spine surgeons complete training through residency in orthopaedic surgery (ORTH) or neurosurgery (NSGY). A survey was conducted in 2013 to evaluate spine surgery training. Over the past decade, advances in surgical techniques and the changing dynamics in fellowship training may have affected training and program director (PD) perceptions may have shifted.

Methods

This study is a cross-sectional survey distributed to all PDs of ORTH and NSGY residencies and spine fellowships in the United States. Participants were queried regarding characteristics of their program, ideal characteristics of residency training, and opinions regarding the current training environment. χ2 tests were used to compare answers over the years.

Results

In total, 241 PDs completed the survey. From 2013 to 2023, NSGY increased the proportion of residents with >300 spine cases (86%-100%) while ORTH remained with >90% of residents with < 225 cases (p < 0.05). A greater number of NSGY PDs encouraged spine fellowship even for community spine surgery practice (0% in 2013 vs. 14% in 2023, p < 0.05), which continued to be significantly different from ORTH PDs (∼88% agreed, p > 0.05). 100% of NSGY PDs remained confident in their residents performing spine surgery, whereas ORTH confidence significantly decreased from 43% in 2013 to 25% in 2023 (p < 0.05). For spinal deformity, orthopaedic PDs (92%), NSGY PDs (96%), and fellowship directors (95%), all agreed that a spine fellowship should be pursued (p = 0.99). In both 2013 and 2023, approximately 44% were satisfied with the spine training model in the United States. In 2013, 24% of all PDs believed we should have a dedicated spine residency, which increased to 39% in 2023 (fellowship: 57%, ORTH: 38%, NSGY: 21%) (p < 0.05).

Conclusion

Spine surgery training continues to evolve, yet ORTH and neurological surgery training remains significantly different in case volumes and educational strengths. In both 2013 and 2023, less than 50% of PDs were satisfied with the current spine surgery training model, and a growing minority believe that spine surgery should have its own residency training pathway.

Level of Evidence

IV.

Simulation Training in Spine Surgery

Simulated surgery is part of a growing paradigm shift in surgical education as a whole. Various modalities from cadaver models to virtual reality have been developed and studied within the context of surgical education. Simulation training in spine surgery has an immense potential to improve education and ultimately improve patient safety. This is due to the inherent risk of operating the spine and the technical difficulty of modern techniques. Common procedures in the modern orthopaedic armamentarium, such as pedicle screw placement, can be simulated, and proficiency is rapidly achieved before application in patients. Furthermore, complications such as dural tears can be simulated and effectively managed in a safe environment with simulation. New techniques with steeper learning curves, such as minimally invasive techniques, can now be safely simulated. Hence, augmenting surgical education through simulation has great potential to benefit trainees and practicing orthopaedic surgeons in modern spine surgery techniques. Additional work will aim to improve access to such technologies and integrate them into the current orthopaedic training curriculum.

Monitoring and reporting gaps in spine surgery education through an international needs assessment survey

Background A critical step in curriculum development is conducting a needs assessment of learners. In spine surgery, the educational needs of trainees, and especially of practicing surgeons, evolve frequently due to changes in practice, technology, etc. To monitor these changes and adapt the educational offerings, organizations delivering continuing medical education (CME) and continuing professional development (CPD) periodically repeat needs assessments. Methods An international needs assessment in the form of a set of 15 online questions was designed and circulated in 2017 and in 2021 to the AO Spine community of members and registered users to gather input in five main areas: educational needs in spine pathologies and techniques, required improvements in practice, preferences for types of educational offerings, and profiling information. Results We received and analyzed 1,204 responses in English during the main reporting period in the 2017 needs assessment from residents, fellows, and practicing surgeons in orthopedics and neurosurgery, and 1,845 in 2021. Spine surgeons wish to improve their knowledge related to all the common pathologies, with some variability among regions and stage of career. Minimally invasive spine surgery (MISS) was the highest-rated need within surgical techniques in all regions (except North America) and all stages of career. Data show a strong preference for face-to-face courses with hands-on training, high demand for mentorship/fellowship/observership, and solid interest in online and blended education. Conclusions The needs assessment process pointed out general trends but also identified varying needs depending on the local situation and stage of career. For this reason, CME/CPD providers must adapt to the local situation to provide educational offerings that meet learner needs.

Development and assessment of competency-based neurotrauma course curriculum for international neurosurgery residents and neurosurgeons

OBJECTIVE

Traumatic brain injuries (TBIs) are a significant disease burden worldwide. It is imperative to improve neurosurgeons' training during and after their medical residency with appropriate neurotrauma competencies. Unfortunately, the development of these competencies during neurosurgeons' careers and in daily practice is very heterogeneous. This article aimed to describe the development and evaluation of a competency-based international course curriculum designed to address a broad spectrum of needs for taking care of patients with neurotrauma with basic and advanced interventions in different scenarios around the world.

METHODS

A committee of 5 academic neurosurgeons was involved in the task of building this course curriculum. The process started with the identification of the problems to be addressed and the subsequent performance needed. After this, competencies were defined. In the final phase, educational activities were designed to achieve the intended learning outcomes. In the end, the entire process resulted in competency and outcomes-based education strategy, including a definition of all learning activities and learning outcomes (curriculum), that can be integrated with a faculty development process, including training. Further development was completed by 4 additional academic neurosurgeons supported by a curriculum developer specialist and a project manager. After the development of the course curriculum, template programs were developed with core and optional content defined for implementation and evaluation.

RESULTS

The content of the course curriculum is divided into essentials and advanced concepts and interventions in neurotrauma care. A mixed sample of 1583 neurosurgeons and neurosurgery residents attending 36 continuing medical education activities in 30 different cities around the world evaluated the course. The average satisfaction was 97%. The average usefulness score was 4.2, according to the Likert scale.

CONCLUSIONS

An international competency-based course curriculum is an option for creating a well-accepted neurotrauma educational process designed to address a broad spectrum of needs that a neurotrauma practitioner faces during the basic and advanced care of patients in different regions of the world. This process may also be applied to other areas of the neurosurgical knowledge spectrum. Moreover, this process allows worldwide standardization of knowledge requirements and competencies, such that training may be better benchmarked between countries regardless of their income level.

A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

In the first phase of development of lumbar endoscopic spine surgery, the focus was on removal of soft disc material through the working corridor of Kambin’s triangle using transforaminal endoscopic lumbar discectomy. With the introduction of the interlaminar approach and increased interest from both industry and surgeons, there has been an exponential development of endoscopic surgical equipment and a corresponding expansion of endoscopic techniques. Endoscopic treatment strategies are applied to conditions ranging from contained prolapsed intervertebral discs to noncontained migrated herniated discs, hard calcified discs, spinal stenosis in the central or lateral recess and the foraminal and extraforaminal region, and other combinations of degenerative conditions requiring decompression or fusion surgery. The further expansion of endoscopic surgical management involving complicated spinal cases and the final quartet of trauma, infections, tumors, and possibly deformities could be the future stage of endoscopic spine surgery development. This article covers the full range of current treatment strategies and presents possible future developments of endoscopic spine surgery for the management of lumbar spinal conditions.

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

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. These slides can be retrieved under Electronic Supplementary Material.

The Importance of Determining Trainee Perspectives on Procedural Competencies During Spine Surgery Clinical Fellowship

STUDY DESIGN

Longitudinal survey.

OBJECTIVE

It remains important to align competence-based objectives for training as deemed important by clinical fellows to those of their fellowship supervisors and program educators. The primary aim of this study was to determine trainee views on the relative importance of specific procedural training competencies. Secondarily, we aimed to evaluate self-perceived confidence in procedural performance at the commencement and completion of fellowship.

METHODS

Questionnaires were administered to 68 clinical fellows enrolled in the AOSNA fellowship program during the 2015-2016 academic year. A Likert-type scale was used to quantify trainee perspectives on the relative importance of specific procedural competencies to their training base on an established curriculum including 53 general and 22 focused/advanced procedural competencies. We measured trainee self-perceived confidence in performing procedures at the commencement and completion of their program. Statistical analysis was performed on fellow demographic data and procedural responses.

RESULTS

Our initial survey response rate was 82% (56/68) and 69% (47/68) for the follow-up survey. Although most procedural competencies were regarded of high importance, we did identify several procedures of high importance yet low confidence among fellows (ie, upper cervical, thoracic discectomy surgery), which highlights an educational opportunity. Overall procedural confidence increased from an average Likert score of 4.2 (SD = 1.3) on the initial survey to 5.4 (SD = 0.8) by follow-up survey (P < .0001).

CONCLUSIONS

Understanding trainee goals for clinical fellowship remains important. Identification of areas of low procedural confidence and high importance to training experience will better guide fellowship programs and supervisors in the strategic delivery of the educational experience.

A Competency-Based Curriculum for Critical Care Nurse Practitioners' Transition to Practice

BACKGROUND

Nearly one-third of new-graduate nurse practitioners report undergoing no formal orientation process, and postcertification orientation processes vary. A validated curriculum would address the need for structured training to enhance new graduates' practice transition.

METHODS

A competency-based practice transition curriculum for intensive care unit nurse practitioners was created using a literature review and expert panels. Competencies were established that were based on clinical categories essential to nurse practitioner practice in the intensive care unit and adapted from existing Accreditation Council for Graduate Medical Education training, aligned with the precertification nursing curriculum. Participants recruited from academic and clinical backgrounds were asked to rank curriculum items using a 4-point Likert scale. Competencies were refined on the basis of participants' survey feedback.

RESULTS

A total of 31 participants from academic medical centers and schools of nursing throughout the United States responded to the request for competency validation; 29% of participants provided qualitative data. All 9 competency topics received a mean rating greater than 3.5 and were deemed valid. Using the combined quantitative and qualitative data, a final set of competencies for nurse practitioners in the intensive care unit was developed.

CONCLUSIONS

The curriculum developed and validated in this study can become the basis for practice transition for novice nurse practitioners. The curriculum is adaptable and can be used for surgical and medical intensive care units. As refined, the competencies provide a validated foundation for training of new-graduate nurse practitioners in the intensive care unit.