I am a long time reader but registered today after reading this thread. I am an orthopedic surgeon trained outside the US. Where I come from , spine is not yet as advanced surgically as it is in the states. While this might not be true for top echelons of private practice, it is true of the training scene. While I did have a few months of spine exposure during residency [ 4-5] , it was not structured and I think left something to be desired from the surgical skills point of view. I was a year and half out of residency and wanted to move to spine. I decided to pursue a fellowship.
After my rather singular experience, I want a perspective from American ortho residents here. I have two questions:
1. How comfortable are you guys/girls surgically at the start of a spine fellowship?
2. What are the research requirements in a clinical fellowship?
I had an awful experience. I interviewed for an empty spot in a non-accredited spine fellowship. Workload at the place was mainly adult deformities/revisions etc so I cleared during the interview that my surgical experience was limited in spine. I was re-assured. This was an inaugural fellowship with the only fellow before me being an in-folded neuro resident from a top program. Research requirements were six abstracts- at least three peer reviewed publications- for graduation. My comfort level with spine was more or less a picture of that of a usual trainee from my country . Posterior exposure - usually with one bovie, cobb and sequential packings- we rarely have two bovies. But I picked up soon with the one hand suction-one hand bovie way. Occasional lumbar pedicle screws, a couple of lamis and some microdisks assisted. ACDFs are something we assist as a rule , do a few if you are lucky. Posterior cervicals are usually decomp cases with lateral mass screws- mainly assisted. C1-2 is usually domain of neurosurgeons at most of our institutes. Also, operative microscope is not always available and things are usually done with loupes or in case of open cases,just without them. Adult deformity is rare. I assisted a couple of cases of AIS at most. Drills were not commonly used at my place. So my goals were to learn proper decompression, microdisks , pedicle screws -esp. in thoracic spine- and TLIF. I was also excited to learn things I had never seen such as XLIFs and ALIFs.
Things started going south as it took me some time to get used to the suction-bovie approach. A T10-pelvis with muliple previous lamis etc. [ a usual case in the practice] were expected to be exposed in 20-25 mins , pedicles found and cannulated by the time attending arrived. I increased the speed but this was something which just would take more time for me to arrive at. I was told on my first evaluation at one and a half month that my skills were at level of a first year ortho resident in uncle sam. I was shell-shocked as I received complements from the same attending/director initially. This went on and I was subsequently informed that teaching proper decompression/microdisks, proper drill/scope usage etc was not something they had time to teach in a fellowship. ACDFs were expected to be exposed-retractors in place. I was usually very good at clinical examination and communication so even they couldn't find much to complain about. All these was deemed in the first 3 months of fellowship. This was more or less the usual tone of my feedback regularly. I did chart extraction for an existing project and added around 150 cases to a dataset with more than 100 variables. Did stats and wrote introduction etc. but the need was to come up with at least 3-5 project proposals independently. I wanted someone to look at my work, help me correct and edit things but their expectation was an independent research effort through the manuscript stage. Research department consisted of a PhD who would be busy with work for multiple attendings, so the research had to be done more-or-less independently. I was constantly reminded of my inferior research effort compared to the previous guy. He was a great guy and unusually research oriented and published multiple articles. I tried but the pressure got the better of me. I just couldn't balance my need to learn surgery with the research and requirements. I wanted to get out but I had no option as I left all my options in my homeland to pursue this. Plus I was on a visa so I just couldn't go out and get something. Ultimately, one day I was told we were parting ways. I had the honour primarily for being inadequate at research and also as they had no time to improve my rather primitive skills. My 'passion' for spine surgery was put in doubt. The ordeal was over in 4 months. The way it went, I was relieved to be free of the constant comparisons and dressing downs but it left me shattered.
I have blamed and loathed myself for what happened. Maybe I was wrong in presuming that my learning requirements echoed the usual? Why was this the case with me while other guys were having a great time at their fellowships? May be I deserved it. What happened is the past but my experience has ignited in me a need to know where I stand. Maybe I could get some salvation from the answers I get here.
