Postgraduate Endoscopic Spine Surgery Training and Surgeons’ Confidence, Procedural Adoption, and Autonomy: A Cross-sectional Survey
A cross-sectional survey of 54 surgeons indicates that completing a structured 1-year hybrid endoscopic spine surgery program was associated with significantly increased self-reported confidence, broader procedural adoption, reduced reliance on proctoring, and greater autonomy, although the retrospective design limits causal inference.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Spine surgery has long been a field where the goal is to relieve pressure on nerves while causing as little damage as possible to the surrounding muscles and tissues. In recent years, a technique called endoscopic spine surgery has emerged as a way to achieve this. Instead of making large incisions, surgeons use a tiny camera and specialized tools inserted through a small opening to remove damaged tissue. This approach promises less pain and a faster recovery for patients. However, learning to perform these operations is not simple. The surgeon must look at a video screen rather than directly at the patient's body, coordinate their hands with what they see on that screen, and work within a very narrow space while keeping the area clear of blood. Because the skills required are so specific and the margin for error is small, doctors need structured training to learn how to do these procedures safely and effectively. Without a clear path for education, the spread of this technology can be uneven, leaving some patients without access to these modern benefits.
A team of researchers at Hospital Israelita Albert Einstein in Brazil set out to understand how a specific training program affected the surgeons who completed it. They focused on a one-year hybrid course that combined online lectures with hands-on practice. The study did not follow surgeons from the beginning to the end of their training in real time. Instead, the researchers asked fifty-four surgeons who had already finished the program to look back and compare their skills and confidence before the course with how they felt and acted after completing it. The goal was to see if the structured education helped them feel more capable, perform more types of surgeries, and rely less on outside help.
The results painted a clear picture of change. Before the training, a significant number of the surgeons reported having performed very few, or even no, endoscopic spine procedures. After finishing the program, their self-reported confidence in performing seven different types of spinal operations increased dramatically across the board. For the most common lower back surgeries, their average confidence score jumped from a low level to near the top of the scale. The improvement was even more striking for more difficult procedures, such as operations on the upper back or the neck, where many surgeons initially felt they had little to no experience. Following the training, the proportion of surgeons who said they actually performed these difficult operations rose sharply. For instance, the number of surgeons doing endoscopic surgery for upper back disc problems grew from a tiny fraction to the vast majority of the group.
Beyond just feeling more confident, the surgeons reported tangible changes in how they worked. Before the program, nearly two-thirds of the participants said they needed a proctor—an experienced surgeon watching over them—to assist during their operations. After the training, that number dropped significantly, with most surgeons saying they could work independently. Similarly, the ability to finish a surgery that was indicated for an endoscopic approach, rather than having to switch to a different method, improved from less than half of the cases to almost all of them. The training seemed to have a ripple effect as well; nearly half of the surgeons who completed the course said they had begun helping their own colleagues or acting as proctors for others, suggesting they felt ready to teach what they had learned.
The researchers were careful to note that these findings are based on the surgeons' own memories and self-assessments, which means the study shows a strong association between the training and the reported improvements, but it does not prove that the training caused the changes in a strictly scientific sense. The study did not measure patient outcomes or use independent observers to verify the surgeons' technical skills. However, the consistency of the reports across confidence, the variety of procedures performed, and the reduced need for supervision suggests that this type of structured, hybrid education is a powerful tool. It appears to help surgeons move from a place of hesitation and reliance on others to a state of greater independence and broader capability in the operating room.
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