Confidence in spine training among senior neurosurgical and orthopedic residents

Study Design. A cross-sectional survey of senior neurosurgical and orthopedic residents. Objective. To evaluate the confidence of senior orthopedic and neurosurgery residents in performing spinal surgical procedures and their need for further training. The content and exposure to spine training as well as anticipated practice profile were characterized. Summary of Background Data. Spinal surgery is performed by specialists with backgrounds in orthopedic surgery and neurosurgery. As this subspecialty evolves, the need to modify training programs to keep up with technological and medical advances becomes increasingly clear. The primary objective of this study was to evaluate the self-assessed confidence and perceived need for further training of senior orthopedic and neurosurgical residents in performing a number of spinal surgical procedures. Methods. An evaluation of self-assessed surgical competence of senior orthopedic and neurosurgery residents in Canada was undertaken by mail-out questionnaire. A follow-up questionnaire was mailed to nonresponders 3 months later. Survey results were summarized using SPSS statistical software, and descriptive and comparative analyses were performed. Results. Significant differences in time and exposure to spine training differentiated the neurosurgical and orthopedic residencies (37% and 16% of total residency time devoted to spine, respectively). Neurosurgical residents reported significantly higher levels of confidence for all 25 surgical procedures. Of those residents anticipating incorporating spine into their practice, 29% of neurosurgery residents planned on entering a spine fellowship compared with 17% of their orthopedic colleagues. Conclusions. Training in spine surgery constitutes a considerably larger proportion of neurosurgery residency than orthopedic residency. Neurosurgery residents graduate with significantly higher levels of confidence to perform spine surgery, while orthopedic residents report significantly higher need for additional training in spine surgery. The majority of neurosurgery graduates report that they will include spine in their clinical practice, while most orthopedic graduates will exclude it.