现代脊柱外科手术培训的纵向评估：对住院医师培训项目和脊柱专科 fellowship 项目主任的全国性调查的 10 年随访
Longitudinal Assessment of Modern Spine Surgery Training: 10-Year Follow-up of a Nationwide Survey of Residency and Spine Fellowship Program Directors.
作者信息
Daniels Alan H, Alsoof Daniel, McDonald Christopher L, Zhang Andrew S, Diebo Bassel G, Eberson Craig P, Kuris Eren O, Lavelle William, Ames Christopher P, Shaffrey Christopher I, Hart Robert A
机构信息
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Orthopedic Surgery, LSU Shreveport, Shreveport, Louisiana.
出版信息
JB JS Open Access. 2023 Aug 1;8(3). doi: 10.2106/JBJS.OA.23.00050. eCollection 2023 Jul-Sep.
UNLABELLED
Spine surgeons complete training through residency in orthopaedic surgery (ORTH) or neurosurgery (NSGY). A survey was conducted in 2013 to evaluate spine surgery training. Over the past decade, advances in surgical techniques and the changing dynamics in fellowship training may have affected training and program director (PD) perceptions may have shifted.
METHODS
This study is a cross-sectional survey distributed to all PDs of ORTH and NSGY residencies and spine fellowships in the United States. Participants were queried regarding characteristics of their program, ideal characteristics of residency training, and opinions regarding the current training environment. χ tests were used to compare answers over the years.
RESULTS
In total, 241 PDs completed the survey. From 2013 to 2023, NSGY increased the proportion of residents with >300 spine cases (86%-100%) while ORTH remained with >90% of residents with < 225 cases (p < 0.05). A greater number of NSGY PDs encouraged spine fellowship even for community spine surgery practice (0% in 2013 vs. 14% in 2023, p < 0.05), which continued to be significantly different from ORTH PDs (∼88% agreed, p > 0.05). 100% of NSGY PDs remained confident in their residents performing spine surgery, whereas ORTH confidence significantly decreased from 43% in 2013 to 25% in 2023 (p < 0.05). For spinal deformity, orthopaedic PDs (92%), NSGY PDs (96%), and fellowship directors (95%), all agreed that a spine fellowship should be pursued (p = 0.99). In both 2013 and 2023, approximately 44% were satisfied with the spine training model in the United States. In 2013, 24% of all PDs believed we should have a dedicated spine residency, which increased to 39% in 2023 (fellowship: 57%, ORTH: 38%, NSGY: 21%) (p < 0.05).
CONCLUSION
Spine surgery training continues to evolve, yet ORTH and neurological surgery training remains significantly different in case volumes and educational strengths. In both 2013 and 2023, less than 50% of PDs were satisfied with the current spine surgery training model, and a growing minority believe that spine surgery should have its own residency training pathway.
LEVEL OF EVIDENCE
IV.
未标注
脊柱外科医生通过骨科手术（ORTH）或神经外科手术（NSGY）住院医师培训完成训练。2013年进行了一项调查以评估脊柱外科手术培训。在过去十年中，手术技术的进步以及专科培训动态的变化可能影响了培训，项目主任（PD）的看法可能也发生了转变。
方法
本研究是一项横断面调查，分发给美国ORTH和NSGY住院医师培训项目以及脊柱专科培训项目的所有项目主任。就其项目的特点、住院医师培训的理想特点以及对当前培训环境的看法对参与者进行了询问。使用χ检验比较多年来的答案。
结果
共有241名项目主任完成了调查。从2013年到2023年，NSGY中脊柱手术病例超过300例的住院医师比例增加（从86%增至100%），而ORTH中脊柱手术病例少于225例的住院医师比例仍超过90%（p<0.05）。更多的NSGY项目主任鼓励即使是社区脊柱外科手术实践也进行脊柱专科培训（2013年为0%，2023年为14%，p<0.05），这与ORTH项目主任仍有显著差异（约88%表示同意，p>0.05）。100%的NSGY项目主任对其住院医师进行脊柱手术仍有信心，而ORTH的信心从2013年的43%显著降至2023年的25%（p<0.05）。对于脊柱畸形，骨科项目主任（92%）、NSGY项目主任（96%）和专科培训主任（95%）均一致认为应进行脊柱专科培训（p=0.99）。在2013年和2023年，约44%的人对美国的脊柱培训模式感到满意。2013年，所有项目主任中有24%认为我们应该设立专门的脊柱住院医师培训项目，这一比例在2023年增至39%（专科培训：57%，ORTH：38%，NSGY：21%）（p<0.05）。
结论
脊柱外科手术培训在持续发展，但ORTH和神经外科培训在病例数量和教育优势方面仍存在显著差异。在2013年和2023年，均不到50%的项目主任对当前的脊柱外科手术培训模式感到满意，并且越来越少的人认为脊柱外科手术应该有自己的住院医师培训途径。
证据级别
IV级。
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