Adequacy of spine surgery fellowship training in Turkey: Results of a survey

Objective: The aim of this study was to determine the adequacy of spine surgery fellowship training (SSFT) in Turkey and what is needed for further development by interviewing current fellows. Methods: Forty male orthopaedics and traumatology or neurosurgery specialists who had completed SSFT in three different spine centers in Turkey between 2010 and 2018 were asked to complete a survey with 29 questions about SSFT in Turkey. Thirty specialists responded, and the collected data were analyzed. Results: Twenty-seven (90%) participants were orthopaedic and traumatology specialists and three (10%) were neurosurgery specialists, with a mean age of 39 (range = 35-53) years. Most participants received their residency training in the provinces where their fellowship training took place (11 (37%) in İstanbul and 7 (23%) in Ankara). The mean duration between residency training and the start of SSFT was 4 (range = 0-14) years, and the mean SSFT duration was 8 (range = 1-18) months. Seventy percent of participants had participated in spine surgery cases during their residency. Twenty-three (77%) participants reported that spine surgery training in their hospital during their residency was inadequate. Seventeen (57%) participants felt that they could not independently perform spine surgery cases before SSFT. All three centers (100%) participating in the study that offered SSFT were non-public institutions such as private hospitals and private university hospitals of medicine managed by a dedicated mentor with personal commitment, without any accreditation for SSFT. While 25 (83%) participants indicated that they felt competent enough to perform a standard spinal deformity surgery case independently at the end of SSFT, 5 (17%) indicated the opposite. This proportion, which was 43% at the end of residency, increased to 83% after SSFT. Conclusion: The results of this study have demonstrated the importance of SSFT in spine surgery as a specialty with a potentially high risk of complications that require prolonged case observation, challenging work-up, and adequate equipment. In this regard, there is a need for regulations on accreditation in government health facilities that provide ideal conditions. We propose to offer SSFT to all surgeons interested in spine surgery in Turkey by conducting further studies supported by an optimal health sector that ensures the appropriate requirements, in accordance with the declaration of TOTEK (The Turkish Orthopaedics and Traumatology Education Council), training workshops, and an accredited master’s degree program in spine surgery or subspecialty

PDF

___

1. Allen WC. The relationship between residency programs and fellowships in the educational setting. Clin Orthop Relat Res. 1990;257:57-60 . 10.1097/00003086- 199008000-00012
2. Daniels AH, Grabel Z, DiGiovanni CW. ACGME accreditation of orthopaedic surgery subspecialty fellowship training programs. J Bone Jt Surg - Am Vol. 2014;96(11):e94. 10.2106/JBJS.M.01340
3. Dailey SW, Brinker MR, Elliott MN. Orthopedic residents’ perceptions of the content and adequacy of their residency training. Am J Orthop (Belle Mead NJ). 1998;27(8):563-570.
4. Kurulu TY. Türk Ortopedi Ve Travmatoloji Eğitim Konseyi (Totek) 2017 – 2019 Dokuzuncu Dönem Kitabi. Ankara:Karınca Creative Ajans; 2019. Available from: http://totek.totbid.org.tr/upload/1/TOTEK9.dönem.pdf.
5. Schwab F, Lafage V, Farcy JP, vd. Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis: Application of the new adult deformity classification. Spine. 2007;32(24):2723-2730. 10.1097/BRS. 0b013e31815a58f2
6. Zuckerman SL, Lim J, Lakomkin N, . Effect of resident and fellow involvement in adult spinal deformity surgery. World Neurosurg. 2019;122:e759-e764. . 10. 1016/j.wneu.2018.10.135
7. Hyun SJ, Jung J-M. Spinal deformity surgery: It becomes an essential part of neurosurgery. J Korean Neurosurg Soc. 2018;61(6):661-668. 10.3340/jkns.2018. 0150
8. Konczalik W, Elsayed S, Boszczyk B. Experience of a fellowship in spinal surgery: A quantitative analysis. Eur Spine J Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2014;23(Suppl 1):S40-54. 10.1007/s00586-014- 3209-y
9. Nousiainen MT, Latter DA, Backstein D, Webster F, Harris KA. Surgical fellowship training in Canada: What is its current status and is improvement required? Can J Surg. 2012;55(1):58-65. 10.1503/cjs.043809
10. Behmer Hansen RT, Silva NA, Cuevas R, vd. Fellowship, gender, and scholarly productivity: Trends among academic neurosurgeons in the US. J Neurosurg. 2020;1-9. 10.3171/2020.5.JNS20577
11. McCord JH, McDonald R, Leverson G, vd. Motivation to pursue surgical subspecialty training: Is there a gender difference? J Am Coll Surg. 2007;205(5):698- 703. 10.1016/j.jamcollsurg.2007.06.014
12. Schoenfeld AJ, Bhalla A, George J, Harris MB, Bono CM. Academic productivity and contributions to the literature among spine surgery fellowship faculty. Spine J. 2015;15(10):2126-2131. 10.1016/j.spinee.2015.03.026
13. Eisenkop SM, Spirtos NM. The relative importance of surgical training and laboratory research in a gynecologic oncology fellowship. Int J Gynecol Cancer off J Int Gynecol Cancer Soc. 2004;14(1):23-34. 10.1136/ijgc-00009577- 200401000-00003
14. Bernatz JT, Johnson KP, Stokman JJ, Cannada LK, Williams SK, Whiting PS. Factors Considered in ranking spine surgery fellowship applicants: A survey of program directors. Spine (Phila Pa 1976). 2021;. Publish Ahead of Print10. 1097/BRS.0000000000003938
15. Louie P, Harada G, Harrop J, vd. Perioperative anticoagulation management in spine surgery: Initial findings from the ao spine anticoagulation global survey. Glob Spine J. 2020;10(5):512-527. 10.1177/2192568219897598
16. Wera GD, Eisinger S, Oreluk H, Cannada LK. Trends in the orthopaedic surgery fellowship match 2013 to 2017. J Am Acad Orthop Surg Glob Res Rev. 2018;2 (12):e080. 10.5435/JAAOSGlobal-D-18-00080
17. Bateman AH, Larouche J, Goldstein CL, vd. The importance of determining trainee perspectives on procedural competencies during spine surgery clinical fellowship. Glob Spine J. 2019;9(1):18-24. 10.1177/ 2192568217747574
18. Acaroğlu E, Kahraman S, Senköylü A, Berk H, Caner H, Özkan S. Core curriculum (CC) of spinal surgery: A step forward in defining our profession. Acta Orthop Traumatol Turc. 2014;48(5):475-478. 10.3944/ AOTT.2014.14.0180
19. Guidelines A. Fellowship Validation.:9–11. https://www.eurospine.org/cm_ data/20200706_Fellowship_Guidelines_FINAL_2020.pdf.
20. Swedish Orthopedic Society (Spine Academy) Spine Fellowship Program Information. https://www.swedish.org/services/neuroscience-institute/fellow ships/complex-and-minimally-invasive-spine-fellowship/programinformation.