Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
World Neurosurg. 2023 Jul;175:e669-e677. doi: 10.1016/j.wneu.2023.04.005. Epub 2023 Apr 6.
BACKGROUND/OBJECTIVE: Education is at the core of neurosurgical residency, but little research in to the cost of neurosurgical education exists. This study aimed to quantify costs of resident education in an academic neurosurgery program using traditional teaching methods and the Surgical Autonomy Program (SAP), a structured training program.
SAP assesses autonomy by categorizing cases into zones of proximal development (opening, exposure, key section, and closing). All first-time, 1-level to 4-level anterior cervical discectomy and fusion (ACDF) cases between March 2014 and March 2022 from 1 attending surgeon were divided into 3 groups: independent cases, cases with traditional resident teaching, and cases with SAP teaching. Surgical times for all cases were collected and compared within levels of surgery between groups.
The study found 2140 ACDF cases, with 1758 independent, 223 with traditional teaching, and 159 with SAP. For 1-level to 4-level ACDFs, teaching took longer than it did with independent cases, with SAP teaching adding additional time. A 1-level ACDF performed with a resident (100.1 ± 24.3 minutes) took about as long as a 3-level ACDF performed independently (97.1 ± 8.9 minutes). The average time for 2-level cases was 72.0 ± 18.2 minutes independently, 121.7 ± 33.7 minutes traditional, and 143.4 ± 34.9 minutes SAP, with significant differences among all groups.
Teaching takes significant time compared with operating independently. There is also a financial cost to educating residents, because operating room time is expensive. Because attending neurosurgeons lose time to perform more surgeries when teaching residents, there is a need to acknowledge surgeons who devote time to training the next generation of neurosurgeons.
背景/目的：教育是神经外科住院医师培训的核心，但针对神经外科学术教育成本的研究甚少。本研究旨在使用传统教学方法和外科自主计划（SAP）量化一个学术神经外科项目中住院医师教育的成本，SAP 是一种结构化培训计划。
SAP 通过将病例分为最近发展区（开场、暴露、关键部位和结束）的区域来评估自主性。2014 年 3 月至 2022 年 3 月期间，1 位主治医生的所有首次单侧 1-4 级颈椎前路椎间盘切除融合术（ACDF）病例，分为 3 组：独立病例、传统教学组和 SAP 教学组。收集所有病例的手术时间，并在不同手术级别内比较组间差异。
研究共纳入 2140 例 ACDF 病例，其中 1758 例为独立病例，223 例为传统教学组，159 例为 SAP 教学组。对于 1-4 级 ACDF，教学时间比独立病例长，而 SAP 教学则增加了额外的时间。一位住院医师完成的 1 级 ACDF（100.1±24.3 分钟）与独立完成的 3 级 ACDF（97.1±8.9 分钟）时间相近。2 级病例独立完成的平均时间为 72.0±18.2 分钟，传统教学组为 121.7±33.7 分钟，SAP 组为 143.4±34.9 分钟，所有组间差异均有统计学意义。
与独立手术相比，教学需要花费大量时间。教育住院医师也需要花费昂贵的手术室时间。由于主治神经外科医生在教授住院医师时会失去执行更多手术的时间，因此需要认可那些投入时间培训下一代神经外科医生的外科医生。
