Does Resident Involvement Impact Cervical Fusion Cases?
When residents are involved in posterior cervical fusion (PCF) is there an increase in morbidity or mortality?
A new study published in the March 1, 2018 edition of Spine examines that question. The study is entitled, “The Impact of Resident Involvement in Elective Posterior Cervical Fusion.”
Samuel K. Cho, M.D. with the Department of Orthopedics at the Icahn School of Medicine at Mount Sinai in New York and co-author on the study, told OTW, “Resident and fellow training and education is a critical part of academic medicine. This is how we continue to raise up the next generation of physicians who are going to go out into our communities and serve them.”
“At the same time, our patients have entrusted their health to us for utmost care. This is this ongoing tension between the practice of medicine and training of young physicians.”
“There have been several academic papers on this topic and we and other groups have published on. We want to explore resident involvement in the context of posterior cervical fusion (PCF) which is a complex and delicate procedure.”
“Further, I wanted to generate a larger discussion around how we are training physicians and whether there are areas for improvement and continued modifications. I think we can learn from other industries such as the airline industry, for example.”
The authors wrote, “The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was examined from 2005 to 2012…A total of 448 cases were assessed in NSQIP. Less than half of these cases involved residents…”
Dr. Cho commented to OTW, “The database that we used is a national one and as such allowed for a bird’s eye view of recent trends in surgical practices of multiple institutions. The use of these types of data mitigates certain biases that may be either surgeon or institution specific or arises from a small sample size. On the other hand, we lack granularity that we love as clinicians that is specific to our specialty, spine surgery in this case.”
“In some sense the results we obtained were as expected. When residents are involved in the surgical care of performing posterior cervical fusion, it takes slightly longer and there may be concomitant increase in blood loss and perhaps even length of stay. However, we also need to keep in mind that many of these participating institutions are tertiary academic medical centers where we take on the toughest and sickest patients. Therefore, surgical care may be a bit bumpier whether residents are involved or not.”
“Be mindful of the downstream effect of resident involvement during posterior cervical fusion on the patients and actively balance physician training and patient care on an ongoing basis. Resident education and training is the sine qua non of academic medicine. We should all be continuously engaged in this endeavor to produce the best and most well-trained physicians for our communities. At the same time, we should also think of ways to improve on the process.”
