title: The Current State of United States Spine Surgery Training: A Survey of Residency and Spine Fellowship Program Directors.
abstract: METHODS
  Program director survey.
  
  
  OBJECTIVE
  To collect data on spine surgical experience during orthopedic and neurological surgery residency and assess the opinions of program directors (PDs) from orthopedic and neurological surgery residencies and spine surgery fellowships regarding current spine surgical training in the United States.
  
  
  BACKGROUND
  Current training for spine surgeons in the United States consists of a residency in either orthopedic or neurological surgery followed by an optional spine surgery fellowship. Program director survey data may assist in efforts to improve contemporary spine training.
  
  
  METHODS
  An anonymous questionnaire was distributed to all PDs of orthopedic and neurological surgery residencies and spine fellowships in the United States (N = 382). A 5-point Likert scale was used to assess attitudinal questions. A 2-tailed independent-samples t test was used to compare responses to each question independently.
  
  
  RESULTS
  A total of 147 PDs completed the survey. Orthopedic PDs most commonly indicated that their residents participate in 76 to 150 spine cases during residency, whereas neurological surgery PDs most often reported more than 450 spine cases during residency (p < .0001). Over 88% of orthopedic surgery program directors and 0% of neurological surgery PDs recommended that their trainees complete a fellowship if they wish to perform community spine surgery (p < .001). In contrast, 98.1% of orthopedic PDs and 86.4% of neurological surgery PDs recommended that their trainees complete a fellowship if they wish to perform spinal deformity surgery (p = .038). Most PDs agreed that surgical simulation and competency-based training could improve spine surgery training (76% and 72%, respectively).
  
  
  CONCLUSIONS
  This study examined the opinions of orthopedic and neurological surgery residency and spine fellowship PDs regarding current spine surgery training in the United States. A large majority of PDs thought that both orthopedic and neurological surgical trainees should complete a fellowship if they plan to perform spinal deformity surgery. These results provide a background for further efforts to optimize contemporary spine surgical training.
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA. Electronic address: alandanielsmd@gmail.com.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
authors.forename: J Mason
authors.initials: JM
authors.lastname: DePasse
authors.affiliation: Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave, RM M779, Box 0112, San Francisco CA 94143, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Magill
authors.affiliation: Office of Graduate Medical Education, Rhode Island Hospital, 593 Eddy Street, Aldrich 120, Providence RI 02903, USA.
authors.forename: Staci A
authors.initials: SA
authors.lastname: Fischer
authors.affiliation: Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Palumbo
authors.affiliation: Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave, RM M779, Box 0112, San Francisco CA 94143, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, OP31, Portland OR 97239, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
keywords: Competency-based training; Fellowship training; Program Director; Residency training; Simulation-based learning; Spine deformity surgery; Spine deformity training; Spine surgery training; Survey