Spinal Deformity recently published an article examining the current state of spine surgery residency and fellowship training in the United States.
The researchers sent a survey to residency and fellowship program directors for orthopedic and neurological programs. There were 147 completed surveys. Here are five things to know about the findings:
1. Orthopedic program directors said residents participated in 76 to 150 spine cases during their residencies, compared with neurological surgery directors who reported their residents participated in 450 spine cases. Around 94 percent of the orthopedic surgery residency programs were five years while 88.6 percent of neurological surgery programs were seven years. Among orthopedic surgery residents, a little over half of the program directors said residents spend two to four months dedicated to spine surgery service during their residency. By contrast, 40 percent of the neurological surgery programs have residents spending more than 12 months dedicated to the spine service.
When asked whether the current orthopedic surgery residency training in the United States is adequate in spine surgery, 73.1 percent of orthopedic surgery residency program directors said it was "just right," compared with 2.4 percent of neurological surgery program directors and 22.2 percent of fellowship program directors with the same response. The neurological surgery program directors and fellowship program directors were more likely to respond the orthopedic surgery residency training in spine is "too little."
2. None of the neurological surgery program directors recommended their trainees complete a fellowship if they wish to perform community spine surgery. By contrast, 88 percent of the orthopedic surgery program directors recommended a fellowship to perform community spine surgery. At the conclusion of the residency program, 100 percent of the neurological surgery residency program directors said their residents were highly confident in performing spinal instrumentation and decompression, compared with 42.6 percent of the orthopedic surgery residency program directors.
3. Both orthopedic and neurological surgery program directors recommended trainees complete a fellowship if they wanted to pursue spinal deformity surgery. Ninety-eight percent of the orthopedic directors and 86.4 percent of neurological surgery directors recommended this fellowship. Among orthopedic surgery residencies, 46.2 percent said residents log between 11 cases and 20 cases of pediatric spinal deformity. Eighty-one percent of neurological surgery programs say residents log 10 cases or less of pediatric spinal deformity. Thirteen percent of orthopedic surgery residency program directors said their residents were highly confident in performing adult spinal deformity at the completion of their residency, compared with 31.8 percent of the neurological residency programs.
4. Around three-quarters of program directors felt that surgical simulation and competency-based training could improve spine surgery training. Among fellowship program directors, 77 percent felt surgical simulation training was valuable. More than half of the residency and fellowship program directors felt trainees should spend more than 16 hours per week in the operating room during spine surgery education.
5. Sixty-six percent of spine fellowship program directors said their program accepts both orthopedic surgery and neurological surgery-trained applicants. Fifteen percent only accept orthopedic-trained applicants and 17.8 percent only accept neurosurgical-trained applicants. In 51 percent of the cases, the spine fellowship program is managed by the orthopedic surgery department only; it's managed by both orthopedic and neurological surgery departments in just 22.2 percent of the programs.
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