McGill.CA / Division of Orthopaedic Surgery

Rotation Objectives: Spine

 Focused Goals and Objectives

McGill Orthopaedic Spine Rotation

 

Competency

The following competencies are required to be completed by each candidate during each rotation.  At the beginning of each rotation the CTU director or his representative will provide the candidates the following document. It is the candidate’s responsibility to complete these in a timely fashion.  At mid rotation, the CTU director will provide feedback as well as remind the candidate’s obligation as to the objectives of the rotation. At the end of the rotation, a formal evaluation will be completed by the CTU director and will be based on the completion of the following goals and objective.

 

1. History & physical examination:

Candidate (R1,R2)

Candidate will need to present the CTU director or one of the staff’s on the spine service a detailed work up investigations and management plan for two patients with one of the follow diagnosis:

  • Cervical spine fracture
  • Thoraco-lumbar fracture
  • Lumbar Discectomy
  • Spinal stenosis
  • Discitis      

If candidate does not encounter any patient during the rotation with the preceeding diagnosis, then the candidate will need to write up the classic signs and symptoms expected with two of these diagnoses

Candidate (R3,R4,R5)

Candidate will need to present the CTU director or one of the staff’s on the spine service a detailed history and physical for two patients with one of the follow diagnosis:

  • Occipital Cervical fracture dislocation fracture
  • Degenerative scoliosis
  • Cervical Myelopathy
  • Spinal Tumor
  • Thoracic Disc
  • Epidural abscess 

These H&E will be used to judges whether or not a trainee has acquired the skills needed to complete a medical history and performs an adequate physical examination to permit a valid formulation of the patient’s problem. The factor should also judge whether or not the information elicited and observed is recorded in an organized and sequential manner, which permits a clear definition of the problem and a rational approach to differential diagnosis and management.

2. Relevant Investigation & Management

Candidate (R1,R2)

Candidates will need to illustrate and document to the CTU director or one of the Staff’s on the spine service they have order the appropriate investigation and they have instigated the appropriate treatment of two patients with one of the follow diagnosis:

  •                   Cervical spine fracture
  •                   Thoraco-lumbar fracture
  •                   Lumbar Discectomy
  •                   Spinal stenosis
  •                   Discitis

In addition, the candidate will need to document which factors (clinical signs, classifications) have dictated there clinical  management. As previously stated if the candidates have not encountered any patient with the preceeding diagnosis, then the candidate will need to write up treatment algorithms for two of these diagnoses

Candidate (R3,R4,R5)

Candidates will need to illustrate and document to the CTU director or one of the staff’s on the spine service they have order the appropriate investigation and they have instigated the appropriate treatment of two patients with one of the follow diagnosis:

  •                   Occipital Cervical fracture dislocation fracture
  •                   Degenerative scoliosis
  •                   Cervical Myelopathy
  •                   Spinal Tumor
  •                   Thoracic Disc
  •                   Epidural Abscess

These objectives will judge whether or not the candidates are able to interpret correctly the information gathered and shows discrimination in identifying the important and less important information that will allow the identification of the problems affecting the health of the patient. The trainee’s concern for the cost of unnecessary investigation and sensitivity to patient inconvenience and discomfort will also be assessed.  In addition, these objectives will judge whether or not the candidates have initiated appropriate treatment for each diagnosis.

 

3. Technical Surgical skills

Candidate (R1,R2)

Candidates will need to perform for the CTU director or one of the staff’s on the spine service the following surgical procedures:

  •     Posterior Exposure of the Cervical, thoracic, lumbar spine
  •     Identification of the entry points for:
  •          Thoracic, Lumbar pedicle screws
  •          Cervical lateral mass screws   
  •     Orientation of pedicle screws and lateral mass screws

Candidate (R3,R4,R5)

Candidates will need to perform for the CTU director or one of the staff’s on the spine service the following surgical procedures:

  •   Posterior Exposure of the Cervical, thoracic, lumbar spine
  •   Insertion of Thoracic, Lumbar pedicle screws, Cervical lateral mass screws in patients with normal anatomy, and Laminectomy of the lumbar spine

 

4. Communication skills

 Stating the Obvious 

1.- Residents, fellows and staff are expected to round daily on all admitted patients.  If the staff did not manage to round on a patient then the residents and or fellows are expected to contact the staff on that day to inform them of the progress of their patients. 2- All consults must be reviewed in an expedient fashion with a spine staff’s.  N.B. Fellows on the spine service are considered like R6 hence the consults still need to be reviewed by a staff.  The timing of the review is dictated by the urgency and clinical management of the specific consults.  Any consults from the ICU must be completed with in one hour, and a clear treatment must be writing in the chart and transmitted to the attending in the ICU.  “Will review with staff is not an acceptable management”   3- Weekly clinical spine activities (OR, Clinics) are reviewed on Wednesday during preop rounds.  Residents and fellows will be assigned to specific activities. The distribution of the activities must be fair and equilibrated across the residents and fellows.  The senior resident must present the weekly distribution to the CTU director for approval.  4- Monthly schedules of all spine staff’s will also be provided to residents on the service.  Hence at any given time in the week, the resident on call will know were the spine staff on call can be reached.  If the resident on call has paged the staff on call and the staff has not respond with in 10 min, then the resident can check the master schedule or check with the staff secretary in order to know were the staff on call can be found to review the pending consult.  If the staff is in the OR and then the resident on call can review the case with a spine staff not on call, to expedite the management of the urgent consult.  . The resident, having the master schedule of all spine staff will be able to contact an attending in the clinic. Bellow are the contact information for each of the spine attending to facilitate communication with the spine staff. Dr Weber, who is based full time at the MGH, is the “second On call” during regular hours, and Dr Golan is the “second On call” at the JGH 5- Resident and fellows are expected to actively participate in teaching rounds (Wednesday preop spine rounds – prepare cases, Thursday Journal club - must read the papers, Peds fellow is to attend the preop peds rounds on Thursday and then go to the Journal club)

 

Clinical Duties for the Spine Team at the MGH

McGill Orthopaedic Spine Surgery Rotation

 

(These guidelines apply to Neuro & Ortho residents)

 

General Objectives

Trainees will be able to master the fundamentals of Basic sciences, clinical and therapeutic knowledge to treat patients with simple and urgent spinal disorders.  

Trainees will participate in the conservative and surgical management of patients on the Spine service. The specific duties will vary depending on the number of residents on the service.  Seeing the rotations are specialty based, are hope is not to divide residents tasks solely on level of training.  The resident team must equally distribute tasks and responsibility through out the team. juniors (R1-R2) and seniors (R3-R6) including fellows must work together and ensure that all are exposed to the many levels of patient care:   post op patient issues on the floor (orders/writing detailed progress notes); out patient clinics; OR exposure, emergency consult. This document pertains specifically to the clinical duties of the residents, for the learning objectives of the rotation, please refer to “Goals and Objectives for the Residents, McGill Orthopaedic Spine Surgery”.

 

Specific responsibilities of spine fellows

  1. The fellow is to be considered as a “hands on” junior staff.  By this we expect the fellows to round in the morning with the spine residents, checking on post operative patients as well as all new admissions waiting for surgeries.  If the spine service is short of residents then we expect them to write progress notes and dealing with clinical issue on the floor.  They are to be on-call and responsible for all emergency cases presenting to the hospitals. We expect the fellows to elaborate and present to the treating team, the management and surgical plan for all elective and emergency patients.  As the fellows skills progress, we expect them to be the primary surgeon on all emergency cases, and the majority of the elective cases, pending the complexity of cases.  We expect that the residents will be the first assistants to the fellows with direct supervision of the attending spine surgeons.   Fellows will be assigned to a specific hospital for a 4 months rotation resulting in 3 rotations.  (Three rotations are: JGH/MGH /MCH/Shriners)  

 Specific responsibilities of spine residents

  1. First call:  Every day the team must designate a First call resident:  This must be communicated to locating every morning to ensure that they have the correct resident for 1st call.
    1. As a guideline, if there are more than on junior residents (R1-R2) on the service for a bloc rotation, they will share the first call duties for the Spine service that block. If there is only one junior resident on the service for the month than it is expected that the senior resident will on occasion take the First call designation.
    2. If there are no junior residents on the service, then the senior residents (R3-R6) will equally share the first call duties for the block.
      1. Example: an R6 in Neurosurgery and an R3 in Orthopaedics are both considered senior residents and must share call duties equally if there is no junior resident on the service.
  1. Consults:
    1. Any consult for the Spine service must be seen in a timely manner by the resident who is responsible for covering the first call.
    2. Conceptually, the chain of decision making would be the junior who would discuss the case with the senior and then the fellow, and then the staff.  However this must almost happen simultaneously to ensure that the process is efficient and patients are treated in a timely fashion. If the junior feels that urgent management is required they can contact the staff directly at any point.  If at any point any resident feels that management of patients are less than ideal, they are to contact the staff directly.
    3. All consults must be discussed with fellows and staff. It is important that all consults and cases are placed on the spine list and discussed with all residents and fellows on the service to ensure that no patient is “forgotten” or certain members of the team are not aware of a case. 
  1. Operating Room: For elective cases.
    1. The priority in the operating room to be first assistant during surgeries will be given to the senior residents.
    2. If there are more than one senior (R3-R6) on the service, then the cases must be divided equally amongst them.
    3. If there are no senior residents on the service, then the junior residents (R1-R2) will share the first assistant role amongst themselves.
  1. Operating Room: For emergency cases
    1. The priority will be given to the resident that works up the patient in the emergency room irrespectively of the level of training.
  1. Morning rounds:
    1. All residents and fellows on the Spine service must round as a group on patients admitted under the Spine service.
  1. Sign out rounds
    1. At the end of the day, it is the responsibility of the senior resident to review any issues in the “Spine Book”. If points have been raised and he/she is unable to answers, then they are to contact the fellow or the staff to ensure that all issues are resolved before the end of the day.
  1. Morning teaching:
    1. There are Spine sign-out rounds in the Orthopaedic residents room (MGH) every Monday morning at 7am. All residents on the Spine service are expected to be present at those rounds to ensure good patient care.
    2. Spine rounds take place every Friday from 6:30am – 7:30am. All residents on the Spine service must be present for the rounds. We understand that the Neurosurgery residents have grand rounds every Friday morning, however, they must still be present for the first half of the Spine rounds. Each resident is expected to give at least one presentation a month during the Spine rounds. Please discuss the topics with Dr. Ouellet or Dr. Jarzem.
  1. Clinics:
    1. Spine clinic is usually every Wednesday starting at around 8am and all residents are expected to be present for the clinic. The actual timings for the clinic may vary from week to week. It the responsibility of the residents to check the start time of the clinic every week. Residents are expected to cover the three Spine staff (Dr. Jarzem, Dr. Ouellet, Dr. Reindl).

Goals and Objectives

Residents on the Complex Spine Rotation

 

 Complex Spinal Rotation

 General Objectives

 Independent of trainee’s background (orthopedics or neurosurgery residency) we anticipate the trainees will be integrated fully into the orthopedic service to acquire the skill sets to manage all spinal pathologies as per the CanMeds objectives.  Basic mechanical orthopedic principles are required to better understand the biomechanical constraints of spinal ailments.

 Complex Spine rotations are to be undertaken with the concept that junior and senior residents as well as the spine fellows work in close collaboration.  Objectives are divided per years of training not to dictate the task the trainees are limited to undertake but rather to delineation the expectation of the acquisition of knowledge.

 A. Medical Expert

Complex Spinal Rotation R1, R2

 Trainees should master in an incremental fashion the patho-physiology underlying congenital, acquired, degenerative spinal ailment. The trainees need to concentrate on the non-surgical management of spinal ailments.  They need to familiarize themselves with the peri-operative complications of spinal disease. Focus on history and physical is expected in the R1 / R2 years 

History & physical examination:

1.   Display clinical competence in evaluating spinal disorders:

Relevant history taking to all spinal disorders

Relevant physical exam assessing for spinal deformity, spinal instability

Relevant neurological exam

 Basic scientific knowledge to be acquired:

1. Detailed knowledge of anatomy, embryology and physiology of the spinal cord

2. Congenital, developmental and acquired non-traumatic conditions of the spinal column

3. Musculo-skeletal anatomy of cervical, thoracic, lumbar spine; osseous ligamentous and neural elements including Inter vertebral disc morphology

4. Biomechanical and functional anatomy of the spine

This factor judges whether or not a trainee takes a complete medical history and performs an adequate physical examination to permit a valid formulation of the patient’s problem. The factor should also judge whether or not the information elicited and observed is recorded in an organized and sequential manner which permits a clear definition of the problem and a rational approach to differential diagnosis and management.

Complex Spinal Rotation R3, R4, R5

Trainees should master in an incremental fashion from R3 through R5, the fundamental sciences, clinical and therapeutic knowledge to treat patients with simple and urgent spinal disorders.

By spinal disorders we specifically expect the trainees to initiate (conservative) management of the following pathologies:

  1. Cervical, thoracic, lumbar fracture and dislocation
  2. Scoliosis, Kyphosis, spondylolysis-lesthesis
  3. Degenerative disc disease: cervical, thoracic, lumbar disc herniations; cervical or lumbar spinal stenosis
  4. Spinal infections
  5. Spinal tumors 

For the following pathologies we expect the trainees to acquire the surgical skills to safely manage these pathologies.

  1. Cervical and lumbar discectomies
  2. Stabilization of sub axial cervical fractures, thoracic and lumbar fractures.
  3. Cervical, thoracic, lumbar laminectomies.

 

Basic scientific knowledge to be acquired:

1    Natural degeneration of the spine

2.   Systemic inflammatory illness affecting the spine

 

Basic clinical knowledge:

1.   Appreciation of Classification (discal, degenerative disorders, mechanical instabilities, spinal deformities).

2.   Display knowledge of appropriate investigative techniques

3.   Interpretation of advanced investigative techniques:

            Computerized axial tomography.

            CT Myelography.

            Magnetic resonance imaging.

4.   Display a detailed knowledge of operative approaches to the spinal column.

These factors are judged using standardized rating system described below. 

A low rating indicates the trainee shows serious gaps in his/her knowledge of clinical sciences or that he/she does not apply this knowledge correctly. A satisfactory rating indicates that the trainee has a good knowledge of clinical sciences that he/she applies well in problem- solving and other aspects of patient care. This factor should also consider the trainee’s knowledge of current scientific literature and his/her application of this knowledge to case presentation and daily patient management.

 

Interpretation and utilization of information:

1.   Role of physiotherapy and occupational therapy in the management of spinal disorders - acute and chronic

2.   Display competence in the non operative management of spinal disorders

3.   Understand indications, contraindications and complications related to surgical intervention

This factor judges whether or not the trainee is able to interpret correctly the information gathered and shows discrimination in identifying the important and less important information that will allow the identification of the problems affecting the health of the patient. The trainee’s concern for the cost of unnecessary investigation and sensitivity to patient inconvenience and discomfort should also be considered.

 

Clinical judgment & decision making:

  1.  Display competence in the non-operative management of spinal disorders.
  2. Display adequate knowledge in advanced non operative management of spinal disorders - bracing techniques, physiotherapy
  3. Appreciate indications for surgery for spinal disorders
  4. Understand principle of fusion levels in spinal deformity with their implication regarding complications, and natural history
  5. Recognize and manage postoperative complications.
  6. Recognize and evaluate vertebral sepsis: Osteomyelitis, Discitis.

This factor judges the trainee’s ability to effectively and efficiently establish a program of investigation and management adapted to the patient’s condition, recognizing the limits of his/her ability, the hazards of drugs and other therapy and the need to modify therapy when indicated. The trainee should also demonstrate his/her appreciation for the total needs of the patient, recognizing factors that may limit compliance with prescribed therapy and the non-medical (socio-economic and other) factors that may affect the patient’s health.

 

Technical skills required in the specialty: 

  1. Display surgical competence in the following areas: Lumbar decompression: i.e. Laminectomy, discectomy, Lumbar fusion with or with out instrumentation Cervical discectomy       
  2. Display surgical competence in spinal instrumentation: Transpedicular vertebral fixation (pedicle screws – lumbar fusions), Anterior cervical plating, Cervical Lateral mass screws
  3.  Display a detailed knowledge of the principles of internal fixation with regards to: Fracture management cervical thoracic lumbar.  Specific are Gardners-Well Tongs application, Halo & Vest application, usage of pedicle fixation and rod constructs to stabilize

This factor judges if the trainee can carry out professional techniques correctly and efficiently.

B. Communicator

Interprofessional relationships with physicians:

This factor judges if the trainee can work effectively with other physicians in the healthcare team, shows consideration and tact for junior members of the team and is respectful of team members.  Ability to communicate the urgency of spinal cord compression or neurological deficits due to spinal pathology to other members of the     medical profession

Communications with other allied health professionals:

This factor judges the trainee’s ability to communicate and work effectively with the other members of the healthcare team.

Communications with patients:

This factor judges if the trainee is able to communicate easily with patients, showing respect for his/her patients and gaining their cooperation and confidence.  Post spinal injury paralysis or motor deficit requires a certain skills which will be conveyed to the trainee.

Communications with families:

This factor judges if the trainee is able to communicate easily with patients’ families, showing respect for his/her patients and gaining their cooperation and confidence.

Written communication and documentation:

History, physical, diagnostic formulation, progress notes, plans; discharge summaries and consultation reports are complete and accurate with satisfactory organization and assessment.

Clear, focus documentation is critical in the management of spinal patients as transfer of information is key in optimization of clinical outcome

 

C. Collaborator

Interacts and consults effectively with all health professionals by recognizing and acknowledging their roles and expertise

Delegates effectively:

This factor judges that the trainee delegates effectively to other members of the healthcare team.

Manager

Understands & uses information technology:

This factor judges if the trainee is able to use current information technology in the course of their professional life. The ability to evaluate spinal condition heavily relies on ever growing multimodality imaging

Uses health care resources cost-effectively:

This factor judges that the trainee has concern for the cost of unnecessary investigation and sensitivity to patient inconvenience and discomfort in the course of their professional duties.

Make usage of MRI or other imaging will be assessed as a marker of cost effectiveness.

Organization of work & time management:

This factor judges whether or not the trainee effectively organizes his/her work in such a way that priorities are established and that coordination occurs with the other members of the team ensuring total, acute, and continuing care of his/her patients. Prioritization of consult is critical when managing patient with spinal ailments as delayed of diagnosis and treatment leads to poor outcomes.

 

D. Health advocate

Advocates for the patient:

This factor judges the trainee’s ability to advocate for the patient.

Health habits, weight loss, smoking cessation, osteoporosis treatment, all have a direct impact on management of spinal pathology

Advocates for the community:

This factor judges the trainee’s ability to advocate for society and the community.

Scholar

Motivation to read and learn:

This factor judges the trainee’s knowledge of current scientific literature and his//her application of this knowledge to case presentation and daily patient management.         Weekly rounds with focus topics are reviewed as resident are expected to have read up on recurrent topics.

Critically appraises medical literature:

This factor judges the trainee’s ability to critically-appraise research methodology and medical literature.  Spine Journal Club participation and preparation

Teaching skills:

This factor judges whether the trainee takes the initiative and develops the ability to teach other health care professionals and/or patients about specific relevant health care issues.

Per rotation trainees organize a Friday morning spine rounds.

Completion of research/project:

This factor judges that the trainee is able to organize and complete successfully research, or a project.

Professional

Integrity & honesty:

This factor judges whether the trainee is dependable, reliable, honest and forthright in all information and facts.

Sensitivity & respect for diversity:

This factor judges that the trainee is able to understand and be sensitive to issues related to age, gender, culture and ethnicity.

Responsible and self-disciplined:

This factor judges whether the trainee adequately accepts professional responsibilities, placing the needs of the patients before the trainee’s own, ensuring that the trainee or his/her replacement are at all times available to the patients, recognizing the limits of competence, and seeking and giving assistance when necessary. The trainee is punctual, and respects local regulations relating to the performance of his/her duties.

Communicates with patients with compassion and empathy

Recognition of own limitations, seeking advice when needed:

This factor judges that the trainee is able to understand his/her limits of competence, and is able to seek and give assistance when necessary.

Understands principles of ethics; applies to clinical situations:

This factor judges the trainee’s ability to understand the principles and practice of biomedical ethics as it relates to the specific specialty or subspecialty, and to practice medicine in an ethically responsible manner.

Global evaluation of competence and progress

This factor judges the total professional competence and progress of the trainee in consideration of his/her stage of training in his/her specialty. This judgment synthesizes the assessments given in the above criteria, keeping in mind their relative importance and indicating the degree to which the trainee has shown progress and diligence during his/her rotation.

 

Explanation of Ratings:

Please assess the trainee’s overall clinical competence using the following ratings:

Superior: Far exceeds reasonable expectations.

Satisfactory: Meets reasonable expectations.

Borderline: Often falls short of reasonable expectations.

Unsatisfactory: Falls far short of reasonable expectations.

“Reasonable expectations” should be appropriate to the level of training of the candidate.

“Could not judge” in the global evaluation of competence and progress: This means that the trainee did not complete the rotation.

 McGill’s Combined Spine Fellowship Goals & Objectives 

 

General Objectives

Trainees should master in an incremental fashion over a 12 month period:  the fundamentals sciences, clinical and therapeutic knowledge required to treat, patients with any spinal disorders.

By spinal disorders we specifically expect the trainees to be able to initiate conservative management, assess if treatment is successful and if not proceed to surgical management for all the following pathologies:

  1. Occipital Cervical, Cervical, thoracic, lumbar, and sacral fracture with or with out dislocation
  2. Spinal Deformities: Acquired or congenital of the Scoliotic or Kyphotic type. Spondy / lolysis / lesthesis / loptosis
  3. Degenerative disc disease: cervical, thoracic, lumbar disc herniations; cervical or lumbar spinal stenosis
  4. Spinal infections
  5. Spinal tumors

The second role of the trainees is to supplement educational and research endeavors at McGill.  This includes teaching resident’s basic science and clinical knowledge as well as surgical skill via daily clinical activities, daily OR, bi weekly spine rounds, and formal quarterly didactic talks.  We expect the trainees to complete a research project either clinical or of basic science in our spine lab which will lead to a publication.

Basic scientific knowledge to be acquired:

  1. Detailed knowledge of anatomy, embryology and physiology of the spine
  2. Congenital, developmental and acquired non-traumatic conditions of the spinal column and its impact on management of these
  3. Musculo-skeletal anatomy of Cervical, thoracic, lumbar spine; osseous ligamentous and neural elements including Inter vertebral disc morphology
  4. Biomechanical and functional anatomy of the spine
  5. Natural degeneration of the spine
  6. Systemic inflammatory illness affecting the spine

Basic clinical knowledge:

  1. Appreciation of Classification (discal, degenerative disorders, mechanical instabilities, spinal deformities).
  2. Display knowledge of appropriate investigative techniques
  3. Interpretation of advanced investigative techniques: Computerized axial tomography, CT Myelography, Magnetic resonance imaging
  4. Display a detailed knowledge of operative approaches to the spinal column.

These factors are judged using standardized rating system described below.

A low rating indicates the trainee shows serious gaps in his/her knowledge of clinical sciences or that he/she does not apply this knowledge correctly. A satisfactory rating indicates that the trainee has a good knowledge of clinical sciences that he/she applies well in problem- solving and other aspects of patient care. This factor should also consider the trainee’s knowledge of current scientific literature and his/her application of this knowledge to case presentation and daily patient management.

History & physical examination:

  1. Display clinical competence in evaluation spinal disorders: Relevant history taking to all spinal disorders, Relevant physical exam assessing for spinal deformity, spinal instability,Relevant neurological exam

This factor judges whether or not a trainee takes a complete medical history and performs an adequate physical examination to permit a valid formulation of the patient’s problem. The factor should also judge whether or not the information elicited and observed is recorded in an organized and sequential manner which permits a clear definition of the problem and a rational approach to differential diagnosis and management.

Interpretation and utilization of information:

The trainee must master:

  1. Role of physiotherapy and occupational therapy in the management of spinal disorders - acute and chronic
  2. Display competence in operative and non operative management of spinal disorders in respect to indications, contraindications and complications related to surgical intervention

This factor judges whether or not the trainee is able to interpret correctly the information gathered and shows discrimination in identifying the important and less important information that will allow the identification of the problems affecting the health of the patient. The trainee’s concern for the cost of unnecessary investigation and sensitivity to patient inconvenience and discomfort should also be considered.

Clinical judgment & decision making: 

  1. Display competence in the non operative management of spinal disorders.
  2. Display adequate knowledge in advanced non operative management of spinal disorders - bracing techniques, physiotherapy
  3. Appreciate indications for surgery for spinal disorders
  4. Understand principle of fusion levels in spinal deformity with their implication regarding complications, and natural history
  5. Recognize and manage postoperative complications.
  6. Recognize and evaluate vertebral sepsis: Osteomyelitis, Discitis.

Fellows are expected to apply their knowledge to make surgical decisions pending the clinical presentations for all the conditions mentioned above.

This factor judges the trainee’s ability to effectively and efficiently establish a program of investigation and management adapted to the patient’s condition, recognizing the limits of his/her ability, the hazards of drugs and other therapy and the need to modify therapy when indicated. The trainee should also demonstrate his/her appreciation for the total needs of the patient, recognizing factors that may limit compliance with prescribed therapy and the non-medical (socio-economic and other) factors that may affect the patient’s health.

Technical skills required in the specialty: 

  1. Display surgical competence in the following areas: Laminectomy, Lumbar fusion techniques anterior vs posterior, discectomy cervical, thoracic and lumbar, foraminotomy, spinal tumor debulking
  2. Display surgical competence in complex spinal instrumentation: Transpedicular vertebral fixation, application of spinal hooks; Anterior and Posterior vertebral instrumentation for the cervical, thoracic                        and lumbar spine; either with plates, screws, or rods; Different pelvic fixation,  Interbody spacers as well as vertebral body replacements
  3. Display a detailed knowledge of the principles of internal fixation with regards to: indications, complication, contraindications, and limitations.

This factor judges if the trainee can carry out professional techniques correctly and efficiently.

Communicator

Interprofessional relationships with physicians:

This factor judges if the trainee can work effectively with other physicians in the healthcare team, shows consideration and tact for junior members of the team and is respectful of team members.

Communications with other allied health professionals:

This factor judges the trainee’s ability to communicate and work effectively with the other members of the healthcare team.

Communications with patients:

This factor judges if the trainee is able to communicate easily with patients, showing respect for his/her patients and gaining their cooperation and confidence.

Communications with families:

This factor judges if the trainee is able to communicate easily with patients’ families, showing respect for his/her patients and gaining their cooperation and confidence.

Written communication and documentation:

History, physical, diagnostic formulation, progress notes, plans, discharge summaries and consultation reports are complete and accurate with satisfactory organization and assessment.

 

Collaborator

Interacts and consults effectively with all health professionals by recognizing and acknowledging their roles and expertise.

Delegates effectively: This factor judges that the trainee delegates effectively to other members of the healthcare team. Manager

Understands & uses information technology:

This factor judges if the trainee is able to use current information technology in the course of their professional life.

Uses health care resources cost-effectively:

This factor judges that the trainee has concern for the cost of unnecessary investigation and sensitivity to patient inconvenience and discomfort in the course of their professional duties.

Organization of work & time management:

This factor judges whether or not the trainee effectively organizes his/her work in such a way that priorities are established and that coordination occurs with the other members of the team ensuring total, acute, and continuing care of his/her patients.

Health advocate

Advocates for the patient:

This factor judges the trainee’s ability to advocate for the patient.

Advocates for the community:

This factor judges the trainee’s ability to advocate for society and the community.

Scholar

Motivation to read and learn:

This factor judges the trainee’s knowledge of current scientific literature and his//her application of this knowledge to case presentation and daily patient management.

Critically appraises medical literature:

This factor judges the trainee’s ability to critically-appraise research methodology and medical literature.

Teaching skills:

This factor judges whether the trainee takes the initiative and develops the ability to teach other health care professionals and/or patients about specific relevant health care issues.

Completion of research/project:

This factor judges that the trainee is able to organize and complete successfully a research, or a project.

Professional

Integrity & honesty:

This factor judges whether the trainee is dependable, reliable, honest and forthright in all information and facts.

Sensitivity & respect for diversity:

This factor judges that the trainee is able to understand and be sensitive to issues related to age, gender, culture and ethnicity.

Responsible and self-disciplined:

This factor judges whether the trainee adequately accepts professional responsibilities, placing the needs of the patients before the trainee’s own, ensuring that the trainee or his/her replacement are at all times available to the patients, recognizing the limits of competence, and seeking and giving assistance when necessary. The trainee is punctual, and respects local regulations relating to the performance of his/her duties.

Communicates with patients with compassion and empathy

Recognition of own limitations, seeking advice when needed:

This factor judges that the trainee is able to acknowledge his/her limits of competence, and is able to seek and give assistance when necessary.

Understands principles of ethics; applies to clinical situations:

This factor judges the trainee’s ability to understand the principles and practice of biomedical ethics as it relates to the specific specialty or subspecialty, and to practice medicine in an ethically responsible manner.

Global evaluation of competence and progress 

The trainee will be evaluated quarterly in a informal fashion.  At mid rotation and at the termination of his fellowship a formal written evaluation will be completed judging his performance and on completion of his objectives.  This factor judges the total professional competence and progress of the trainee in consideration of his/her stage of training in his/her specialty. This judgment synthesizes the assessments given in the above criteria, keeping in mind their relative importance and indicating the degree to which the trainee has shown progress and diligence during his/her rotation.

Explanation of Ratings:

Please assess the trainee’s overall clinical competence using the following ratings:

Superior: Far exceeds reasonable expectations.

Satisfactory: Meets reasonable expectations.

Borderline: Often falls short of reasonable expectations.

Unsatisfactory: Falls far short of reasonable expectations.

“Reasonable expectations” should be appropriate to the level of training of the candidate.

“Could not judge” in the global evaluation of competence and progress: This means that the trainee did not complete the rotation. 

Proposed changes to the Spine Rotation subsequent to the

Visit of Royal College

The spine group has met and is putting forward the following changes to address the shortcoming of the spine service subsequent to the Royal college accreditation. The specific criticism from the royal college regarding the spine service was inadequate supervision of the trainings during the spine rotation. 

Specifically, residents have expressed the following concerns: 1) they are unable to reach the attending on call leaving them unsupervised, 2) they still lack clear objectives regarding their tasks, 3) they feel that their intraoperative experience is less than ideal as the fellows are doing most of the cases. 

In addition, we the spine group, feel that some global criticisms of the program need to be address in our measures to ensure, that the spine service remains a strong academic rotation.

We intend to address these criticisms via the implementation of the following measure:

1. Start of rotation Orientation:

A Hand out will be given to each resident explaining the internal working of the rotation.  It will spell out exactly what is expected from each resident based on year of training Junior R1&R2, Senior R3 & R4 & R5. What is expected of them in clinic, in OR, for Wednesday: pre-op rounds, Friday research rounds, Thursday bimonthly journal club.  New Friday attending business rounds will be instigated to review resident’s evaluations, and any pending issues. Learning Objectives.

2.Weekly Global roster will be established identifying OR cases and clinics with specific resident and fellows assigned to each cases and each clinic.

3. All resident and fellows will receive the monthly agenda’s of all the spine surgeons.   This measure will ensure that at all time, residents will know where the spine surgeon on call can be found.  Hence, if a surgeon is scrub in the OR and has not responded to a page, the resident will be able to call directly into the operating room informing the surgeon that a consultation is pending.  In addition, this master agenda will provide the resident were the other spine surgeons can be reached and will ensure permanent attending coverage.    We have assigned Dr Weber, as the back up consulting spine surgeon for urgent consult at the MGH during regular hours.  Dr Golan has been assigned as the back up consulting spine surgeon for urgent consults at the JGH during regular hours.  If the spine surgeon on call has not answered a call with in 10 to 15 mins and the resident has not managed to track him down then Dr Weber or Dr Golan will be on site to review pending consults as a “second” on call spine surgeon.

4. The number of spine fellow has been limited to TWO.  If after these new measures have been implemented and the surgical experience of the fellows or the resident remains poor, we will limit the spine fellowship position to ONE.

5. Formal sit down mid rotation and end of rotation evaluation will be scheduled via CTU secretary Mary Pampena.  These will be done during or new Friday morning business spine rounds.  Dr Weber and Dr Jarzem have been designated to do so.

My office remains open for at all time to discuss any matters related to the behaviors of staff, fellows and residents. Similar objectives will be elaborated about fellows

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