title: Early surgical education of residents is safe for microscopic lumbar disc surgery.
abstract: BACKGROUND
  It is a well-established dogma that many surgeons do not reach a quintessential level of their technical operative skills until successful completion of their training program. The aim of this study was to test the hypothesis that early introduction of supervised residents to non-complex spinal surgical procedures within a structured and supervised educational program does not harm the patient in terms of higher complication rates or worse pain- and health-related quality of life (HrQOL) outcomes.
  
  
  METHODS
  A prospective study on 102 patients undergoing surgery for lumbar disc herniation (LDH) was performed. The procedures were dichotomized into two groups according to the surgeon's level of experience: teaching cases (neurosurgical residents in the 1st to 4th year of training) and non-teaching cases (experienced board-certified faculty neurosurgeons). Pain levels (VAS) and the HrQOL using the 12-item short-form health survey (SF-12) were measured at baseline, at 4 weeks and as a survey at 1 year postoperatively. In addition, data concerning the operation and the postoperative course including common complications were assessed.
  
  
  RESULTS
  Intraoperative blood loss, length of surgery, as well as intra- and postoperative complications were similar between the study groups. Patients in both groups achieved equal results in terms of pain reduction after 4 weeks [mean VAS change -3.8 (teaching cases) vs. -3.1 (non-teaching cases), p = 0.25] and 1 year postoperatively [mean change in VAS -3.5 (teaching cases) vs. -3.37 (non-teaching cases), p = 0.84]. Teaching cases were 100 % (odds ratio of 1.00) as likely as non-teaching cases to achieve a favorable HrQOL response to surgery (p = 0.99).
  
  
  CONCLUSIONS
  Early introduction of resident surgeons to lumbar microdiscectomy can be conducted safely within a structured and supervised educational program as it neither harms the patient nor leads to worse 1-year results. Surgical resident education may thus be implemented safely in times of rigorous working laws. However, a structured education program in which the senior surgeon gives advice, guidance and communicates cautions during each resident surgery is of paramount importance to provide high-quality patient care.
authors.affiliation: Department of Neurosurgery, Kantonsspital St.Gallen, Rorschacher Str. 95, 9007, St.Gallen, Switzerland, mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D017586:Diskectomy / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000193:education*; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education*; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome