Malik Azeem Tariq, Kim Jeffery, Ahmed Uzair, Yu Elizabeth, Khan Safdar N
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Surg Educ. 2021 Mar-Apr;78(2):686-693. doi: 10.1016/j.jsurg.2020.08.025. Epub 2020 Sep 10.
To understand trends and variability of procedures performed by orthopedic spine surgery fellows during training.
Cross-sectional survey.
Accreditation Council on Graduate Medical Education (ACGME) case logs.
Fellows enrolled in ACGME-accredited "Orthopaedic Surgery of the Spine" fellowships from 2010 to 2015.
The 2010 to 2015 ACGME fellowship case logs for "Orthopaedic Surgery of the Spine" were retrieved. Spine cases in case logs are grouped into the following categories: (1) Excision, (2) Osteotomy, (3) Fracture and/or Dislocation, (4) Decompression, (5) Anterior fusion/arthrodesis, (6) Posterior fusion, (7) Deformity surgery, (8) Exploration, (9) Instrumentation, and (10) other/uncategorized. The total number of spine cases logged by each fellow increased from 821 in 2010 to 1134 in 2015 (38.2% increase). The greatest increases were noted from fracture/dislocation cases (77.9%), followed by posterior fusions (62.2%), anterior fusions (43.6%), decompressions (36.3%), and instrumentation (29.5%). The average number of deformity cases decreased from 23 in 2010 to 19 in 2016 (18.6% decrease). The average number of adult-only cases increased from 770 in 2010 to 1100 in 2015 (42.8% increase), whereas the average number of pediatric-only cases declined from 51 in 2010 to 35 in 2015 (32.1% decrease). Based on case logs from 2015, the greatest variation in case volume between the 10th centile and 90th centile of fellows was noted for deformity cases, followed by decompressions and posterior fusions.
Even though there has been a 38% increase in the overall number of spine cases performed by fellows during training, a large amount of variation in type of case exposure exists between fellowships. The findings of our study call for the establishment of minimal case volumes and/or uniformity of training spectrums across the nation to ensure appropriate surgical care is made accessible to all patients.
了解骨科脊柱外科住院医师培训期间所实施手术的趋势和变异性。
横断面调查。
毕业后医学教育认证委员会（ACGME）病例日志。
2010年至2015年参加ACGME认证的“脊柱骨科手术”住院医师培训项目的住院医师。
检索了2010年至2015年ACGME“脊柱骨科手术”住院医师培训项目的病例日志。病例日志中的脊柱病例分为以下几类：（1）切除术，（2）截骨术，（3）骨折和/或脱位，（4）减压术，（5）前路融合/关节固定术，（6）后路融合术，（7）畸形矫正手术，（8）探查术，（9）器械植入术，以及（10）其他/未分类。每位住院医师记录的脊柱病例总数从2010年的821例增加到2015年的1134例（增加了38.2%）。增加最多的是骨折/脱位病例（77.9%），其次是后路融合术（62.2%）、前路融合术（43.6%）、减压术（36.3%）和器械植入术（29.5%）。畸形矫正病例的平均数量从2010年的23例下降到2016年的19例（下降了18.6%）。仅成人病例的平均数量从2010年的770例增加到2015年的1100例（增加了42.8%），而仅儿童病例的平均数量从2010年的51例下降到2015年的35例（下降了32.1%）。根据2015年的病例日志，住院医师第10百分位数和第90百分位数之间病例数量差异最大的是畸形矫正病例，其次是减压术和后路融合术。
尽管住院医师培训期间实施的脊柱病例总数增加了38%，但不同培训项目之间病例类型的接触存在很大差异。我们的研究结果呼吁在全国范围内确定最低病例数量和/或统一培训范围，以确保所有患者都能获得适当的手术治疗。
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