278 Accreditation Council for Graduate Medical Education (ACGME) training programs were assessed to identify 923 full-time faculty members with spinal surgery designation defined by spine fellowship training or surgeon case volume >75% spine surgeries. Faculty were assessed with respect to parent discipline, years of fellowship training, academic rank, gender, and academic productivity (h index).
The spine-teaching workforce contains 55% orthopedic surgeons and 45% neurosurgeons with wide gender asymmetry overall and at all faculty ranks. Of the female spine surgeons, those with neurosurgical training (64.44%) nearly doubled the number with orthopedic training (35.56%). Academic productivity increased with academic rank similarly for both genders and subspecialties. Orthopedic spine surgeons had a higher mean fellowship number than neurological spine surgeons. Fellowship time of completion (intra-residency/infolded vs. post-residency) did not significantly affect h-indices. Addition of fellowship(s) conferred academic productivity benefit for orthopedic surgeons only.
Neurological and orthopedic spine surgery show similar patterns for spread of faculty across academic ranks and trends in academic productivity. There is marked gender disparity seen in both neurosurgical and orthopedic surgery with fewer female spine surgeons seen at every academic rank. Orthopedic spine surgeons have a greater mean fellowship number than their neurosurgical counterparts and lack of fellowship correlated with a lower academic productivity in orthopedic but not neurological spine surgery 1).
Resident work hour regulations are a major concern in residency training programs. Previous studies have noted the risks inherent in daytime sleepiness during the post-call period, including potential adverse patient outcomes.
Residents' self-perceptions of their degree of physiologic sleepiness were poor and that levels approached those of clinical sleep disorders.
Additional studies have shown the negative impact of sleep deprivation and the effects on decision making and memory.
Due to these concerns, the American College of Graduate Medical Education (ACGME) has mandated limits for resident work hours.
A night float system has been implemented in many institutions to address these concerns and to help in achieving this goal.
The daytime physicians are relieved by a night team that admits patients and takes care of patient-related tasks. The day team then returns the following day to continue the care of the patients. Thus, the extended hours of the post-call day are avoided.
Although NF is a potential solution, it has generated a number of concerns. Residents feel that NF does not provide adequate teaching and view the rotation as more of a “service” rotation rather than as a learning opportunity.
Another concern is the discontinuity of care, which may result in poor patient satisfaction and adverse outcomes.
Many studies examining the perceptions of residents towards the NF system have been limited by small sample sizes ranging from 10 to 24 residents, brief surveys consisting of 10 to 30 questions, experiences of a group of residents in a single hospital or a single post-graduate year, and a lack of comparison between a NF and a non-NF system.