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Effect of Spine Fellow Training on Operative Outcomes, Affirming Graduated Responsibility

Lonner, Baron S. MD; Toombs, Courtney S. BA; Hammouri, Qusai MD; Terran, Jamie S. BS; Karia, Raj J. MPH; Errico, Thomas J. MD

doi: 10.1097/BRS.0b013e3182a3820c
Health Services Research

Study Design. Retrospective review of prospectively collected surgical data.

Objective. This study sought to determine the effect of fellow education during the course of the academic year (August–July) on surgical outcomes in adolescent idiopathic scoliosis. One surgeon and one type of surgery were chosen to minimize confounding factors.

Summary of Background Data. Educating and training the next generation of physicians and surgeons is necessary for the survival and continuation of medical care. There has been recent momentum to document scientifically that medical education is safe. Spine surgery is complex and demanding, with a steep learning curve, making it an ideal model to detect any potential negative impact of medical education.

Methods. Subjects: adolescent patients undergoing posterior spinal surgery, between August 2007 and July 2010, by a single senior surgeon at one institution with a fellow as the only surgical assistant. Demographic and perioperative data were collected and then segmented by surgical date into quarters according to the rotations of the academic year. One fellow was included in each quarter during the 4 years, resulting in 16 fellows across the 4 quarters. An analysis of variance model was used to assess differences in operative time, blood loss, length of stay, and complications between the quarters of the year.

Results. There were no significant differences between the groups regarding age, sex, or Lenke curve type. No statistically significant differences were found between the 4 quarters of the fellowship year for estimated blood loss, use of cell saver, length of stay, operative time, and complication rate.

Conclusion. This study is the first to show that fellow education during the course of the academic year did not impact the patient outcomes studied. It is clear that while there is significant academic benefit for the fellows as they complete their spine fellowship, there is no negative impact for patients.

Level of Evidence: 4

This study investigated the effect of the fellowship year on surgical outcomes in adolescent idiopathic scoliosis. No statistically significant differences were found for estimated blood loss, use of cell saver, length of stay, operative time, and complication rate. Fellow education did not impact the patient outcomes studied.

From the Department of Orthopaedic Surgery, New York University, Hospital for Joint Diseases, New York, NY.

Address correspondence and reprint requests to Baron Lonner, MD, 820 2nd Ave Ste 7A, New York, NY 10017; E-mail: blonner@nyc.rr.com

Acknowledgment date: May 8, 2012. First revision date: October 23, 2012. Second revision date: March 26, 2013. Third revision date: June 14, 2013. Acceptance date: June 21, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, payment for lectures, royalties, stocks.

© 2013 by Lippincott Williams & Wilkins