Spine Fellowships Should Include Boot Camps and Simulations in Training

Will simulation techniques replace cadaveric training?

Peer Reviewed

Boot camps and simulations are optimal ways to maximize education in spine surgery fellowships, according to a paper by Kumaria et al in the European Spine Journal. Researchers, including Michael G. Fehlings, MD, PhD, FRCSC, FACS, reviewed the literature and incorporated expert opinion into their assessment of spine surgery fellowships.

experienced spine surgeon discusses case with his spine fellowSpine fellowship programs afford increased accessibility of mentorship. Photo Source: iStock.com.

The researchers outlined a number of reasons why spine surgery fellowships are necessaryincluding the following:

  • Subspecialization and increased exposure to specialized management of specific disorders improves outcomes in spine surgery
  • Fellowship-trained spine surgeons are linked to cost savings at the department level
  • Highly specialized surgical techniques in spine surgery require a dedicated period of skill acquisition
  • Limitations in medical residents training hours may reduce time to train in spine techniques
  • Fellowship programs offer skill building in leadership, teamwork, communication, and interpersonal skills
  • Programs offer increased accessibility of research mentorship
  • The benefits of mentorship extend beyond fellowship

Intensive Boot Camp Training for Spine Surgery

Surgical specialty training boot camps were identified as one of the best strategies to maximize education and training opportunities in spine surgery fellowships. In fact, significant improvement in surgical performance was found in a small study of surgical interns randomized to a 3-day intensive boot camp style induction training or standard training, the authors noted.1

Dr. Fehlings, who coauthored the paper, indicated that among the benefits of spine surgery boot camps, are the following:

  • Comprehensive training in the technical skills and the scope of knowledge related to spine surgery
  • Provision of key knowledge base to facilitate success in achieving competence-based objectives
  • Accommodation of differences in the background preparation of fellowship trainees who come from different residency programs, such as neurosurgery vs orthopaedics
  • Development of professional connections with teachers and friendships among co-fellows

Will Simulation Techniques Replace Cadaveric Training?

Simulation training also was emphasized by the researchers as optimal for advancing fellowship training. Simulation in spine surgery historically has involved use of cadavers and animal dissections. However, cadavers are expensive, logistically challenging, and lack reusability. In addition, animal spines are limited in resemblance to human spines and pose ethical considerations, the researchers noted. Cadaveric and animal models also may lack specific spine pathology needed for training purposes.

Synthetic tissue, on the other hand, can be modelled accurately into specific pathologies including spinal deformities, degenerative spine conditions, and pediatric spine disorders such as neural tube defects. Simulation has demonstrated success in teaching minimally invasive lumbar surgery, posterior cervical laminectomy and foraminotomy, and anterior cervical discectomy and fusion.2,3

“Surgical simulation is in evolution,” Dr. Fehlings told SpineUniverse. “The technologies will reduce but not eliminate the need for cadaveric training. As anatomical models become more realistic and can accommodate haptic feedback, surgical simulation technologies will become more useful.”

Dr. Fehlings envisions that surgical education outside of the operating room will include the following:

  1. Didactic materials including articles, textbooks, and lectures
  2. Interactive case-based and problem-oriented seminar discussions
  3. Surgical simulation
  4. Cadaveric workshops

Competence-Based Objectives

Dr. Fehlings and colleagues also found evidence supporting the need for competence-based objectives for training in specific operative and technical procedures.

“Increasingly, spine fellowship education will need to incorporate competence-based objectives,” Dr. Fehlings told SpineUniverse. “Our group in the University of Toronto Spine Program, in collaboration with the Canadian Spine Society and AOSpine North America, have developed such competence-based objectives that define core spine fellowship training and subspecialty spine fellowship training in such areas as research, pediatrics, complex cervical, deformity, oncology, minimally invasive surgery, and other areas.4

“In addition, increasingly spine fellowship training will need to address key, non-technical areas including practice management and career planning, physician wellness, and avoidance of burnout,” Dr. Fehlings noted.

Dr. Fehlings has no disclosures of relevance.

Updated on: 01/21/20
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Michael G. Fehlings, MD, PhD, FRCSC, FACS
Professor of Neurosurgery
Vice Chair Research Department of Surgery University of Toronto

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