How 9 spine surgeons keep their skill sets sharp: Drs. Robert Bray Jr., Neel Shah & more


From pursuing learning opportunities to discussions with colleagues and continuing to practice your craft, nine spine surgeons share how they maintain their skill sets.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: How do you see spine care delivery changing in the next five years?

Please send responses to Alan Condon at by 5 p.m. CDT Wednesday, March 24.

Note: The following responses were lightly edited for style and clarity.

Question: What can spine surgeons do to ensure their skill set remains sharp?

Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): My answer to staying sharp is to keep working. If you don't belong to an ASC model, seek out a commitment to one. While I firmly believe this is the progressive future of spine, it has been very well-suited to responding to and remaining functional during the pandemic. More needs to be done to integrate into hospital systems for the long term. Many academic and educational opportunities exist online and are a vital part of education, but nothing replaces staying busy for surgeons.

Now, and for the near future, the ASC model will be an important and growing part of the healthcare delivery system. Proven quality, cost efficiency and ability to react and adapt will continue to expand this model. For the surgeon, it is a safety net to function. For the system as a whole, it needs to integrate to ensure maintenance of care for needed services. 

Michael Musacchio, MD. NorthShore Neurological Institute and NorthShore Spine Center (Evanston and Skokie, Ill.): First, you must stay current with literature and peer-reviewed articles. The field continues to evolve, particularly with minimally invasive approaches, motion-preservation alternatives to fusion, computer navigation and robotics. But more than reading is necessary with these evolutions in techniques and technologies, which require new skills and workflow developments.

Industry-sponsored training programs, such as cadaver labs, saw bone events and related webinars – many which are free – are invaluable for learning and practicing new techniques. It is important to keep in step with new technologies to avoid making major leaps to catch up with modern spine techniques and theory.

Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): Surgical skill sets are quite different from diagnostic skill sets, and are often best maintained by operating on patients several times a week. One method is to maintain good physical conditioning, strength and exercise, as long surgeries can be quite gruelling and taxing. To remain healthy and sharp, it's important to remain in good physical and mental condition.

Diagnostic skill sets often come with time and learning, listening and aggressively being involved in conferences and discussions with other surgeons as well as collectively coming up with more diagnostic options to provide better skills when seeing patients individually. Having extensive training in physical examination is critical. I'm very concerned when I have a patient tell me that the physician they saw before me only looked at their MRIs, and they did not have a thorough physical examination. 

Taking a careful history and listening to the patient, and combining that with a careful physical exam and diagnostic studies, keeps the surgeon sharp in order to make the correct diagnosis and plan the correct surgery. Listening to the patient is probably the most key skill set that a surgeon needs to develop.

Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Assess and reassess, and never stop trying to get better. You must constantly evaluate yourself and your outcomes. Always look for less invasive approaches to problems and ways to expedite your patients' return to the things they love. Attend conferences, listen to webinars, learn new tips and tricks from colleagues and critically read the literature.

Neel Shah, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Medicine is described as a practice for a reason. We, as physicians, are constantly learning. What we do is a lifelong practice. Physicians should always be striving to learn as we travel through our careers. The routine way to stay on top of our professions is to read the latest literature, attend meetings and participate in conferences. But, along with this learning, my philosophy on staying sharp entails evolving and not being complacent.

Medicine is changing at an incredibly rapid pace. I believe that the best way for me to stay sharp is to constantly evaluate how I am going about treating the disorders and pathologies in spinal surgery, as well as how I am going about performing surgery. That being said, I am always cautious when evaluating new technologies, but am also willing to implement them into my practice as long as they are safe and efficacious. 

Alok Sharan, MD. NJ Spine and Wellness (East Brunswick, N.J.): Constant learning is critical for surgeons to keep their skills sharp. Unfortunately, time is very limited for many of us, so it becomes very challenging for surgeons to constantly update their skills. We created Doc.Social as an online learning platform so surgeons can have access to a multitude of resources to help update their skills. On our site, we have traditional online lectures and courses. Realizing that education comes in many forms, Doc.Social also has groups whereby people can have discussions on specific topics such as robotics in surgery and podcasts to hear what [key opinion leaders] have to say about certain topics.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Just like in any other field, you have to practice. More importantly, you have to analyze each case — the actual surgery and outcomes — and understand what went well and what can be improved. I also recommend collaborating with fellow surgeons on a regular basis: discuss cases, attend conferences, stay up to date on the latest publications. The spine field is constantly evolving. Even if your skills are sharp, there are always new skills and technologies to learn to improve our patients' outcomes.  

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Skills remain sharp with practice. If cases are canceled or delayed due to the pandemic, taking industry-offered courses can be helpful. Other skills can be practiced cognitively, by watching interesting surgical videos from resources like VuMedi, the Neurosurgical Operative Atlas and YouTube. Thinking through a case when you look at patient films, even if you are not doing the case for some time, will also keep those synapses firing.

Richard Chua, MD, Northwest NeuroSpecialists (Tucson, Ariz.): Keep reading the literature, attending conferences, attending cadaver and other demonstrations. Take advantage of educational resources provided by our societies and industry partners. Set goals for improvement, practice, re-evaluate and revise. I know that I can make every operation better, each and every time. 

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